SLR - December 2019 - James Michael Steriovski
Reference: Tracey J, Arora D, Gross CE, Parekh SG. Custom 3D-Printed Total Talar Prostheses Restore Normal Joint Anatomy Throughout the Hindfoot. Foot Ankle Spec. 2019 Feb;12(1):39-48.
Scientific Literature Review
Reviewed By: James Michael Steriovski, DPM
Residency Program: Grant Medical Center – Columbus, Ohio
Podiatric Relevance: End-stage talar avascular necrosis (AVN) is a challenging post-traumatic sequelae with few predictable treatment options available. While controversial, the joint-sparing surgical technique of synthetic talar prosthesis may be a reliable alternative. Recently, the third generation talar implants have shown promising results internationally. The authors hypothesized that custom 3D-printed total talar prostheses is a viable option to restore normal joint anatomy of the ankle after sustaining end-stage AVN of the talus.
Methods: This article presents a retrospective review of 14 patients who underwent a custom total talar replacement (TTR). The preoperative and postoperative radiographs were compared with respect to talar height, talar arc length, and talar width, in addition to tibiotalar alignment, talar tilt angle, talar declination angle, Boehler’s angle and Meary’s angle. The averages of these measurements were calculated and t-tests were applied to identify statistical significance (P ≤ .05).
Results: The average follow-up was 20.5 weeks with zero complications at the conclusion of the study. There were no statistically significant changes from preoperative to postoperative measurements with respect to talar arc length, talar width, tibiotalar alignment, talar tilt angle, Boehler’s angle, and Meary’s angle. There was however a statistically significant change between preoperative and postoperative talar height measurements.
Conclusions: Maintaining normal joint articulation is obtainable utilizing total talar implants. Significance noted in height restoration allows for natural anatomical distribution of load through the hindfoot. In addition, congruence of the artificial joint surfaces prolongs survival of the implant. Third generation, custom 3D-Printed TTR may be a viable alternative for revisional ankle replacements, in addition to the primary indication of end-stage AVN of the talus. The results from this study reassure that life-altering surgical intervention for traumatic ankle injuries are available and will continue to improve in quality with the advancement of total talar prostheses technology.