Total Talus Replacement: A Systematic Review of the Literature

CATEGORY: Ankle Arthritis INTRODUCTION/PURPOSE: Total talus replacements have been proposed as a method to treat talar AVN replacing the entire talus. The potential for total talar replacements has increased with the advent of patient specific implants utilising 3D printing based on CT scanning of the ipsilateral or contralateral talus. The primary aim of this systematic review is to analyse the current literature on total talus replacements. It specifically aims to look at the indications, complications, survival and functional outcomes. METHODS: A systematic review was undertaken including all levels of evidence and following PRISMA guidelines. Basic percentages and a weighted pooled proportion for failures using the Freeman Tukey double arscine transformation were performed. RESULTS: 9 papers with 151 patients were included. The mean age ranged from 27.6 to 72, with 5 papers having a mean age of less than 50. Mean follow-up ranged from 12.8 to 58 months. The most common indication was avascular necrosis in 103 patients.4 studies used 3D printing and 5 customised implants. 3 studies undertook a talus replacement with an ankle replacement. 4 studies used ceramic prostheses, 3 cobalt chromium 1 stainless steel and 1 titanium with ceramic surface. Post-operative complications ranged from 0 to 33%. 69.6% of 23 functional outcomes scores demonstrated significant improvement in functional scores with the others demonstrating a non-significant improvement.3 of 151 implants failed requiring further surgery with 2 revisions and 1 amputation. 6 of the 8 studies did not report any operations for failure. The cumulative incidence of failure was 0.1 % (95% CI 0.0- 4.9%). CONCLUSION: Total talus replacements are a potential alternative to tibiotalocalcaneal fusion for patients with avascular necrosis of the talus. Further studies are required to ensure good outcomes prior to an increase in use of this prosthesis.