Use of 3-D printed total talus implant in a challenging case of post-traumatic arthritis and avascular necrosis of the talus

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Journal of the International Foot & Ankle Foundation


Post-traumatic osteoarthritis and avascular necrosis (AVN) of the talus are both challenging problems to treat independently but in conjuncture pose a very complex pathology. In this study, we utilized a novel technique of using a prosthetic talar implant in conjecture to a total ankle tibial implant for the treatment of arthritis with talar AVN. A 60-year-old female with a past medical history of diabetes and hypertension presented with an ankle dislocation secondary to fall. Radiographs and Computed Tomography (CT) scans revealed a trimalleolar ankle fracture with comminution of the talus. Patient underwent primary open reduction with internal fixation (ORIF) of the left ankle. Two years post-ORIF, the patient's arthritic pain continued to worsen and rated her pain as a 9/10 on the Visual Analog Scale (VAS). Physical examination revealed limited ankle and subtalar joint range of motion with pain to the left ankle. Conservative treatment was employed but was unsuccessful. CT of the left ankle was ordered which indicated severe osteoarthritic of the tibiotalar joint with AVN of the talar body. Due to the level of the AVN and cystic changes, it was decided that the talus was non-viable and a total talar prosthesis with a tibial ankle implant was appropriate. After the procedure, the patient was able to ambulate with complete resolution of pain. She rated her pain as a 0/10 at one year follow-up with no failure or subsidence of the implant. This procedure indicates the effectiveness of a prosthetic talar implant to improve a patient’s symptoms.





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