Management Options in Avascular Necrosis of Talus

Dhillon, Mandeep Singh; Rana, Balvinder; Panda, Inayat; Patel, Sandeep; Kumar, Prasoon

doi:10.4103/ortho.ijortho_608_17

Cited by 52 publications

(26 citation statements)

References 44 publications

(63 reference statements)

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“…Talar necrosis and collapse (TNC) is caused by avascular necrosis of the talus [1]. Irregular positioning or dislocation of talus, incomplete correction of pathological bone condition, and instability of four adjacent articular facet are related factors of talus functional reconstruction.…”

Section: Introductionmentioning

confidence: 99%

Three dimension printing talar prostheses for total replacement in talar necrosis and collapse

Yang

Chen

et al. 2021

International Orthopaedics (SICOT)

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Background Reconstructing bone structures and stabilizing adjacent joints are clinical challenges in treating talar necrosis and collapse (TNC). 3D printing technology has been demonstrated to improve the accuracy of talar replacement. This study aimed to evaluate anatomical talar replacement and the clinical results. Methods Nine patients with TNC were enrolled between 2016 and 2020. The prosthetic shape and size were designed by CT post-processing and mirror symmetry technology. The clinical outcomes included radiographic parameters of the forefoot, hindfoot, and ankle alignment, ankle activity, recurrent pain, and peri-operative complications. Results After a mean follow-up of 23.17 ± 6.65 months, degenerative arthritis and prosthetic dislocation and other complications were not observed on plain radiographs. Each 3D-printed talar prosthesis was placed in the original anatomical position. The parameters which have significant changes pre-operative and post-operative are as follows: talar height, 27.59 ± 5.99 mm and 34.56 ± 3.54 mm (95% CI − 13.05 to − 0.87, t = 2.94, P = 0.032) and Meary’s angle, 11.73 ± 4.79° and 4.45 ± 1.82° (95% CI 1.29~22.44, t = 2.89, P = 0.034). The AOFAS hindfoot score improved from 26.33 ± 6.62 to 79.67 ± 3.14 at the final follow-up (95% CI 43.36~63.30, t = 13.75, P = 0.000). The VAS score decreased from 6.33 ± 1.03 to 0.83 ± 0.75 (95% CI 4.40~6.60, t = 12.84, P = 0.000). The post-operative satisfaction scores regarding pain relief, activities of daily living, and return to recreational activities were good to excellent, and the change of activity range was statistically significant. Conclusions The 3D printing patient-specific total talar prostheses allowed anatomical reconstruction in TNC. This novel treatment with 3D-printed prostheses could serve as a reliable patient-specific alternative in TNC.

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Section: Introductionmentioning

confidence: 99%

Three dimension printing talar prostheses for total replacement in talar necrosis and collapse

Yang

Chen

et al. 2021

International Orthopaedics (SICOT)

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“…According to the literature, various treatment strategies for talar AVN can be grouped into 2 categories, joint-sacrificing procedures, such as talectomy and arthrodesis, and joint-sparing procedures, such as conservative treatment, core decompression, and total ankle replacement. [14,16] Although aforementioned strategies have been reported in the literature, there is currently no consensus with regard to the ideal options to talar AVN. Conservative treatment and core decompression have been suggested as alternatives for treatment of AVN of the talus prior to collapse.…”

Section: Discussionmentioning

confidence: 99%

Conservative tibiotalocalcaneal fusion for partial talar avascular necrosis in conjunction with ankle and subtalar joint osteoarthritis in Kashin–Beck disease

Li¹,

Wang²,

Zhu³

et al. 2019

Medicine

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Rationale: Kashin–Beck disease (KBD) is known for some typical characters like finger joint enlargement, shortened fingers, and dwarfism. However, Avascular necrosis (AVN) of the talus in KBD has rarely been reported in the literature. Here, we reported on a KBD patient presented with partial AVN of the talus in conjunction with ankle and subtalar arthritis. Patient concerns: A 50-year-old woman presented with severe pain and limited range of motion in her left ankle and subtalar joint while walking for 2 years. She had been walking with the aid of crutches for many years. Conservative treatment with rigid orthosis and activity restriction could not help reduce the pain in the left foot. Diagnoses: Radiographs demonstrated that partial AVN was developed in the body of the talus and arthritis was viewed in the left ankle and subtalar joint. Hence, we established the diagnosis of partial talar AVN in conjunction with ankle and subtalar arthritis. Interventions: A conservative tibiotalocalcaneal fusion attempting to preserve as much viable talar body as possible was performed using a humeral locking plate and 2 cannulated compression screws. Outcomes: Bone union proved by CT scan and a good alignment of the left limb were achieved at 4-month follow-up postoperatively. Lessons: Partial AVN of the talus along with ankle and subtalar arthritis in KBD patients has rarely been reported as it is not a common characteristic of KBD in clinical practice. Conservative tibiotalocalcaneal fusion could help preserving much more viable talar body, maintaining most structural integrity of the ankle joint, and achieving a stable and plantigrade foot postoperatively.

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“…Various joint sparing treatment options exist for avascular necrosis. 22 One of the most widely investigated options is core decompression, which was reviewed in treatment of avascular necrosis of the talus and found to result in 82 90% successful outcomes in Ficat stages 1 3 without dome collapse. 23 Core decompression augmented with stem cell injection resulted in overall improved prognosis in comparison to core decompression alone.…”

Section: Discussionmentioning

confidence: 99%

Novel technique of intraosseous arteriogram to evaluate talar viability after high-energy trauma

Bala

Foote

Piraino

2021

Foot & Ankle Surgery: Techniques, Reports & Cases

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This study describes an innovative, minimally-invasive technique to evaluate perfusion to the talar dome and body as a predictor of avascular necrosis and structural collapse after an open, talar neck fracture/dislocation. The patient was a 31-year-old female status-post polytraumatic motor vehicle accident, with an open talar neck fracture/dislocation. The patient was managed surgically and the 6-week AP radiograph showed positive "Hawkins sign" to central and medial dome, with questionable sclerosis laterally. Due to concerns of developing avascular necrosis, a novel technique utilizing an intraosseous arteriogram (IOA) of the right talus was performed. IOA revealed brisk perfusion to the central and medial dome, with anterolateral ischemia. The anterolateral talus was decompressed and backfilled with calcaneal autograft. This technique allowed for evaluation of talar dome perfusion along with decompression of the talus via bone biopsy. Radiographic findings, pathology and Magnetic Resonance Imaging were combined to confirm diagnosis. The patient returned to ambulation with significant improvement in function in 8-weeks. Serial radiographic surveillance revealed union across the fracture site without collapse of the talar dome, which was confirmed on the 18-month postoperative CT scan. This case demonstrates evaluation and treatment of talar neck AVN utilizing various imaging modalities, including intra-osseous arteriogram with a unique surgical technique. This innovative practice offers advancement of current treatment methods which could lead to improved time to diagnosis and treatment.

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Management Options in Avascular Necrosis of Talus

Cited by 52 publications

References 44 publications

Three dimension printing talar prostheses for total replacement in talar necrosis and collapse

Three dimension printing talar prostheses for total replacement in talar necrosis and collapse

Conservative tibiotalocalcaneal fusion for partial talar avascular necrosis in conjunction with ankle and subtalar joint osteoarthritis in Kashin–Beck disease

Novel technique of intraosseous arteriogram to evaluate talar viability after high-energy trauma

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