Management of Talar Component Subsidence

Li, Shuyuan; Myerson, Mark S.

doi:10.1016/j.fcl.2017.01.006

Cited by 27 publications

(18 citation statements)

References 74 publications

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“…Talar component subsidence is always associated with uneven distribution of load, which causes a shift of the load-bearing axis, further bone erosion, and eventual prosthesis failure. 59 Symptomatic talar component subsidence in the setting of a failed TAA can be treated with complete revision or isolated talar component revision if the tibial component is stable. Revision in these scenarios is complicated further by additional bone loss with removal of the talar component, debridement of necrotic bone, and resection of the talus to a flat platform sufficient to achieve stability with the revision component.…”

Section: Management and Outcomesmentioning

confidence: 99%

Pathogenesis, Evaluation, and Management of Osteolysis Following Total Ankle Arthroplasty

et al. 2020

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Periprosthetic osteolysis is a common occurrence after total ankle arthroplasty (TAA) and poses many challenges for the foot and ankle surgeon. Osteolysis may be asymptomatic and remain benign, or it may lead to component instability and require revision or arthrodesis. In this article, we present a current and comprehensive review of osteolysis in TAA with illustrative cases. We examine the basic science principles behind the etiology of osteolysis, discuss the workup of a patient with suspected osteolysis, and present a review of the evidence of various management strategies, including grafting of cysts, revision TAA, and arthrodesis. Level of Evidence: Level V, expert opinion.

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Section: Management and Outcomesmentioning

confidence: 99%

Pathogenesis, Evaluation, and Management of Osteolysis Following Total Ankle Arthroplasty

et al. 2020

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“…15,18,21 Differentiating between normal component settling, migration, subsidence, and component collapse can be challenging. 4,7,15,32 Although available studies frequently report on rates of subsidence, very few have defined how subsidence is measured. 1,2,6,11,20,29 In addition, although other studies have described the measurements used to define component migration, they have relied on implant-specific landmarks that may not be transferable to all cases or implants.…”

Section: Discussionmentioning

confidence: 99%

“…Although pathologic subsidence is associated with component loosening, instability, and failure, “stable subsidence,” where vertical migration of the component occurs more than would be expected with simple physiological settling but not to the point of destabilizing the component, may also occur. 1,32,34 By choosing a conservative, yet reproducible, definition of subsidence, we may have combined patients with stable and unstable subsidence, and this could potentially explain the disparity between our rate of subsidence and the failure rate. Lending support to this is the review by Glazebrook et al, who in their classification of TAA complications, classified subsidence as a medium-grade complication leading to failure less than 50% of the time.…”

Section: Discussionmentioning

confidence: 99%

Hindfoot Arthrodesis Screw Position and Trajectory Effect on Talus Subsidence When Performed With Total Ankle Arthroplasty

et al. 2018

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Background: Total ankle arthroplasty (TAA) is increasingly being recognized as an effective surgical option for end-stage ankle arthritis. Associated hindfoot arthrodesis procedures are at times needed to correct malalignment or to address adjacent joint arthritis. Results following TAA and associated hindfoot arthrodesis have at times been underwhelming and the devascularization of the talar blood supply has been postulated as a potential cause. This study explored the association between hindfoot arthrodesis fixation and talar component subsidence. Methods: The study included 81 consecutive patients who underwent a TAA with either an isolated subtalar arthrodesis or combined subtalar and talonavicular arthrodesis with a minimum of 2 years of follow-up. Radiographic and clinical evaluations including patient-reported outcomes were performed at each postoperative visit. The primary outcome measure was the presence of talar component subsidence while patient-reported outcomes were the secondary outcome measure. Results: 30.9% of patients had evidence of talar component subsidence. Subsidence was seen in 55.5% of patients with dorsal to plantar subtalar fixation compared to 11.1% of patients with plantar to dorsal screws ( P < .001) and in 44.4% of patients with screws violating the sinus tarsi compared to 3.7% of patients without screws in the sinus tarsi ( P < .001). Screws that were placed from dorsal to plantar were more likely to violate the sinus tarsi ( P < .001). Patients with evidence of talar subsidence reported higher pain scores and lower functional scores. There were 8 TAA failures, and the presence of dorsal to plantar screws was associated with failure ( P < .01). Conclusion: Screws that are placed across the subtalar joint from a dorsal to plantar approach are more likely to violate the sinus tarsi, contributing to a significantly higher rate of talar component subsidence when associated with TAA. Level of Evidence: Level II, prospective comparative series.

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“…The painful TAR with loosening or subsidence can be treated with isolated tibial or talar component revision if the other component remains stable or complete revision if there is loss of fixation around both components (Figure 6). 67 It is critical to assess the amount of residual bone stock around each component of the implant, as structural support is vital to obtaining a stable revision construct. Tibial component revision requires a healthy cancellous bone base that comprises at least 50% of the tibial articular surface, as well as medial and lateral structural support, and maintenance of both malleoli.…”

Section: Is There Subsidence/loosening?mentioning

confidence: 99%

Evaluating and Managing the Painful Total Ankle Replacement

et al. 2021

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The number of total ankle replacements (TARs) performed in the United States has dramatically increased in the past 2 decades due to improvements in implant design and surgical technique. Yet as the prevalence of TAR increases, so does the likelihood of encountering complications and the need for further surgery. Patients with new-onset or persistent pain after TAR should be approached systematically to identify the cause: infection, fracture, loosening/subsidence, cysts/osteolysis, impingement, and nerve injury. The alignment of the foot and ankle must also be reassessed, as malalignment or adjacent joint pathology can contribute to pain and failure of the implant. Novel advanced imaging techniques, including single-photon emission computed tomography and metal-subtraction magnetic resonance imaging, are useful and accurate in identifying pathology. After the foot and ankle have been evaluated, surgeons can also consider contributing factors such as pathology outside the foot/ankle (eg, in the knee or the spine). Treatment of the painful TAR is dependent on etiology and may include debridement, bone grafting, open reduction and internal fixation, realignment of the foot, revision of the implants, arthrodesis, nerve repair/reconstruction/transplantation surgery, or, in rare cases, below-knee amputation. Level of Evidence: Level V, expert opinion or review.

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Management of Talar Component Subsidence

Cited by 27 publications

References 74 publications

Pathogenesis, Evaluation, and Management of Osteolysis Following Total Ankle Arthroplasty

Pathogenesis, Evaluation, and Management of Osteolysis Following Total Ankle Arthroplasty

Hindfoot Arthrodesis Screw Position and Trajectory Effect on Talus Subsidence When Performed With Total Ankle Arthroplasty

Evaluating and Managing the Painful Total Ankle Replacement

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