Total talus replacement is a surgical procedure performed for avascular necrosis of the talus. Avascular necrosis of the talus means that the talus bone (the bone in the center of the ankle) has lost its blood supply and is no longer alive. This may happen after a bad injury to the talus or for other reasons, including steroid use and alcohol abuse. Avascular necrosis of the talus is often painful and can lead to other problems, including arthritis and stiffness of the joints around the talus.
Total talus replacement is only performed for severe avascular necrosis that involves most of the talus bone. It involves replacing the talus bone with a metal bone custom-designed for you.
Avascular necrosis of the talus is usually diagnosed using X-rays, MRI, and/or CT scans. If most or all of the talus bone is involved, then your foot and ankle orthopaedic surgeon may discuss total talus replacement with you. If only part of the talus is involved, other procedures that save the talus bone are usually recommended first.
Some patients may also have arthritis (cartilage loss with joint damage) in one or more of the joints around the talus, including the ankle joint, the subtalar joint, and/or the talonavicular joint. If you have arthritis in one or more of these joints, your surgery may be more complicated than a simple total talus replacement.
In a total talus replacement, your foot and ankle orthopaedic surgeon begins by making an incision over the front of your ankle. Your surgeon removes the talus bone and inserts a metal talus to replace it. Usually the metal of the new talus will glide over the joint surfaces of the surrounding joints. In some cases, your surgeon may have the talus designed so that it can be fused or joined to one or more of the bones around it. For patients with ankle arthritis, the talus can be designed so that it can be replaced at the same time as an ankle replacement.
Most patients stay overnight one night in the hospital after surgery. Usually the first 2 weeks after surgery are spent in a splint or cast, followed by 4-6 weeks in a walking boot. You may be allowed to put weight on your foot after 2 weeks, but it may be longer depending on any additional procedures you might have needed.
Because total talus replacement is a new procedure, it is not known yet how patients do over the long-term. Most patients have better function and less pain after the surgery, but we do not know how long the implants last.
If the total talus replacement fails, you may need to have a fusion procedure, in which multiple bones in your foot and ankle are joined together, or potentially an amputation (loss of your leg)
Short-term risks of the surgery include nerve injury, which usually leads to some numbness and tingling over the top of the foot. In most cases, this improves over time. Infection is a serious risk; if it is a deep infection, the whole talus replacement may need to be removed to treat the infection. You can also develop arthritis at the other joints around the talus, which can lead to continued pain after surgery and possibly the need for more surgery in the future.
Most patients with avascular necrosis of the talus do not need a total talus replacement. There are various other treatments for avascular necrosis, including medication. Some patients benefit from procedures designed to bring the talus bone back to life, such as core decompression (drilling into the bone to improve blood supply) and vascularized bone grafting (attaching bone with a good blood supply to the talus bone). It is important to discuss your options with your foot and ankle orthopaedic surgeon.
Foot and ankle orthopaedic surgeons have the training and expertise to perform total talus replacements. They can evaluate you to see if you are a good candidate for the procedure or if other procedures might be better for you.
Original article by Elizabeth Cody, MD
Contributors/Reviewers: Sudheer Reddy, MD
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