Reconstruction of talus using femoral head allograft and Tibio-Talo-Calcaneal fusion in advanced arthritis of hindfoot: A rare case series

Abstract

Introduction: Ankle and hindfoot arthritis are debilitating conditions, that require arthrodesis for pain-free ankle joints. In case of limited bone stock due to distorted talus bulk of allograft or femoral head allograft can be used along with talar remnant to maintain height during arthrodesis by Tibio-Talo-Calcaneal nail. Objective: In our study, we aim to present the cases of subtalar and ankle joints which involve reconstructing the talus with femoral head allograft in limited bone stock and fixing with a Tibio-Talo-Calcaneal nail. Methods: Three consecutive patients of subtalar and ankle joints have undergone TTC nail with talus reconstruction by femoral head allograft. Patient-followed and evaluated on outcome criteria by; Visual analog score, AOFAS score, allograft uptake, time to fusion, and complications. Result: The average age was 45.67 years. Pain and swelling were the most common symptoms. The deformity was seen in patients with Charcot's Neuropathy (cases 1 and 2). Type II DM was an associated risk factor in 2/3 of patients. The mean preoperative AOFAS and VAS scores were 39.3 and 5.67, respectively, and at the final follow-up, the mean AOFAS and VAS scores were 83 and 1.67. The uptake of femoral head allograft as a substitute for talar head was seen in all cases, and the meantime for arthrodesis was 7.67 months. Conclusion: Reconstruction of the talar body with allograft and arthrodesis with TTC nail in case of advanced arthritis of the hindfoot is found to have good surgical, clinical, and functional outcomes and an increase in overall patient satisfaction.

Keywords

• Tibio-Talo-Calcaneal nail
• Charcot's neuropathy
• Charcot's osteoarthropathy
• Femoral head allograft
• Talar reconstruction