Background: Structural bone grafts are often used in foot and ankle surgery to fill gaps, maintain height, length or correction. Bone graft, whether autograft or allograft, has limitations and disadvantages. With porosity and mechanical properties similar to native bone, porous tantalum has been used successfully in hip and knee applications. This study investigates the potential advantages of porous tantalum as a substitute for conventional bone graft in foot and ankle surgery. Methods: A retrospective review of 27 arthrodesis procedures was performed of foot and ankle procedures using Trabecular Metal™ porous tantalum over a period of 5 years. Twenty-five patients were involved. Mean age at the time of surgery was 63 (range, 41 to 80) years. All the patients had pathologies in the foot and ankle that required arthrodesis with structural graft. Average followup was 27 (range, 12 to 72) months. Results: At final followup the mean American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot / Midfoot score improved from 40.6 (range, 16 to 64) preoperatively to 86.3 (range, 57 to 100) postoperatively ( p < 0.001). When the pain component of the AOFAS was examined, the score improved from a mean of 8.2 (range, 0 to 20) to 35.2 (range, 20 to 40), ( p < 0.001). At the time of last followup, 56% of patients reported no pain, 40% reported mild occasional pain, and 4% reported moderate pain. Conclusion: Porous tantalum therefore, was found to be a viable alternative to conventional bone graft when structural support was required. Level of Evidence: IV; Retrospective Case Series

The technique described has several advantages when compared to other methods of salvage ankle arthrodesis. The subtalar joint is not included in the fusion unless it is degenerative and symptomatic. Height of the ankle is maintained throughout the fusion process. Furthermore, Trabecular Metal is abundantly available; it avoids donor site morbidity and eliminates the risk of transmissible diseases.

Total ankle arthroplasty using the Agility Total Ankle Arthroplasty prosthesis has clinically encouraging outcomes; however the high complication rate should prompt surgeons to carefully select patients for this procedure.

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