Revision total talus replacement with constrained implant

Abstract

Avascular necrosis of the talus can oftentimes result in severe painful deformity due to the eventual collapse of the body. This condition historically has had limited options for joint sparing procedures. Total talus replacements are a relatively new implant type with limited data available in the literature concerning the most recent, third generation model. The non-constrained version of these implants contains the largest breadth of published literature and have performed well in mid-term length studies. This current case report presents a revision total talus replacement with a constrained implant. The patient of interest initially developed talus AVN four years after talus open reduction internal fixation resulting from a bicycle versus motor vehicle accident. Throughout the patient's course and numerous surgeries, progressive cavovarus deformity was a common theme that may have originated from the one week delay between the date of injury to the index procedure. Eventually the decision was made to prevent any further progression of this deformity through a constrained total talus replacement with fixation into the subtalar and talonavicular joints. This procedure occurred 3 years after the initial total talus replacement and was only performed after all conservative cares had been entirely exhausted. The surgical course of this case is followed in detail and describes a successful revision total talus replacement with a constrained implant. It is the authors’ conclusion that this option is appropriate to preserve ankle range of motion and delay tibiotalocalcaneal fusion.

Keywords

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