Functional Outcomes and Complications Following Total Talus Replacement

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Total talus replacement (TTR) is an emerging alternative for patients with talar avascular necrosis, nonunion, and trauma, preserving ankle motion compared to tibiotalar and subtalar fusion. However, data on failure rates, functional outcomes, and predictors of poor results remain limited. The purpose of this study is to evaluate functional outcomes, reoperation rates, and risk factors for complications following TTR. Methods: A retrospective review identified patients who underwent isolated elective total talus replacement between 2017 and 2023. Patients with total ankle arthroplasty or tibiotalar fusion were excluded. Demographic variables, including age, sex, BMI, and comorbidities, were recorded. Functional outcomes were assessed using Foot and Ankle Outcome Scores (FAOS), evaluating pain, symptoms, activities of daily living (ADL), sports/recreation, and quality of life (QOL). Complications, revision rates, and additional surgeries were analyzed. Results: Thirty-one patients underwent TTR, with a mean age of 41.6 ± 15.4 years and a mean follow-up of 1.7 ± 0.9 years. The majority were female (71.2%), and the mean BMI was 29.7 ± 7.0. Diabetes was present in 12.9% of patients. Functional outcomes significantly improved across all FAOS domains ( < 0.001). The FAOS Pain score increased from 42 ± 17.3 preoperatively to 75.3 ± 18.6 at their final follow-up. Similar improvements were seen in FAOS Symptoms (42 ± 19.1 to 66.4 ± 22.9), ADL (54.5 ± 23.5 to 84.3 ± 18.6), Sports/Recreation (26.8 ± 31.4 to 36.5 ± 28.4), and QOL (10.4 ± 14.5 to 42.8 ± 21.2). Revision surgery was required in 2 patients (6.4%), and 4 patients (12.9%) underwent additional procedures. Conclusion: Patients undergoing TTR demonstrated significant improvements in pain, symptoms, and functional outcomes, with high early implant survivorship. Total talar replacement can restore function and mobility in appropriately selected patients, offering a promising solution for those seeking to avoid fusion procedures.