Acute Talar Arthroplasty as an Initial Treatment for Non-Salvageable Talar Trauma

Research Type: Level 4 – Case series Introduction/Purpose: Custom 3D total talus replacements (TTR) offer a unique solution to acute and chronic talar pathology. They re-establish the normal alignment of the foot, preserve motion, and normalize gait patterns. The aim of this study was to assess the short-term outcomes of TTR performed in the acute setting for non-salvageable talar trauma. Our hypothesis is that custom 3D printed talar body replacements lead to good outcomes and patient satisfaction scores. Methods: A retrospective chart review on 6 patients who underwent acute TTR at our institution who were enrolled in a single-center prospective observational study. Only TTRs for acute talar trauma with 1 year follow-up were included (n=6). All TTRs had an associated subtalar ingrowth stem. Patient reported outcome measures included the AAOS Foot and Ankle Questionnaire and visual analog scale pain scores. Results: Four patients were in motor vehicle collisions, two fell from heights. Five (5/6; 83%) had open injuries. All injuries were considered non-salvageable and initially treated with external fixation. Average time in external fixator prior to TTR was 72 days (range: 42 – 118). Two patients (2/6; 33%) required rotational peroneus brevis flaps for soft tissue coverage. There were no infections, and all patients were satisfied with their surgical results at one year. Only one (1/6; 17%) had an unplanned return to the operating room, unrelated to the talar implant. Mean VAS score was 3.6 (range: 0 - 6) 1 year post-operatively. Average Foot and Ankle Core Standardized Mean was 70.2 (range: 33.8 - 94.4). Mean Shoe Comfort Standardized Mean was 81 (range: 30 – 100). Conclusion: TTR can be safely and effectively performed in the setting of acute trauma to the talus when deemed non-salvageable. TTR for trauma offers good outcomes and should be considered for patients presenting with significant trauma to the talus, even with soft tissue compromise. Patient selection, optimization, and education is important. This study represents the largest, and one of the first, studies for acute TTR as initial treatment for trauma.