A Systematic Review of Third-Generation Total Talus Replacements

Abstract

Category: Hindfoot; Ankle Introduction/Purpose: Total talus replacement (TTR) has emerged as a novel treatment for talar avascular necrosis and severe trauma to the talus. Despite TTR first being described over 35 years ago, many questions still remain regarding the procedure. The objective of this study was to summarize the evidence on third-generation TTR's, focusing on surgical indications, surgical technique, prosthesis design, clinical outcomes, and postoperative complications. Methods: MEDLINE and EMBASE were queried and data abstraction was performed by 2 independent reviewers. Inclusion criteria for the articles were (1) peer-reviewed clinical studies with levels of evidence from I to IV, (2) with at least 5 patients, (3) reporting clinical outcomes of third-generation TTR's that were not done in conjunction with a total ankle arthroplasty, and (4) with a minimum clinical follow-up of at least 6 months. Results: Five studies met inclusion criteria for analysis including 101 ankles in 97 patients. The mean reported patient age was 52.8 years. The most common indication for TTR was avascular necrosis (86%), followed by trauma (10%), and tumor (4%). The mean follow up was 40 months. 98% of TTR's were performed through an anterior approach. There was significant variation in implant material, with 60% alumina ceramic, 27% cobalt chromium, 9% titanium, and 4% stainless steel. Only 3 studies obtained preoperative outcome measures, but these all demonstrated improvement at final follow up. Average dorsiflexion after TTR was 6.1 degrees and average plantarflexion was 35.1. Only 5% of ankles had complications requiring return to the operating room and only 2% of the total taluses were revised. Conclusion: While evidence is limited, short-term and mid-term results are promising for TTR as it demonstrates improvement in ankle function and has a low rate of revision. As the consequences of failure of a TTR are significant, including pantalar fusion or below knee amputation, higher quality studies and long-term results are needed to further evaluate this procedure.