Total Talar Replacement Following Collapse of the Talar Body as a Complication of Total Ankle Arthroplasty

Abstract

Collapse of the talar body is a serious complication of total ankle arthroplasty. As the degree of osteoporosis increases, collapse is more likely, especially in patients with rheumatoid arthritis1. A paucity of revision implants, poor soft-tissue coverage and vascularity, and decreased bone stock make revision of a failed total ankle arthroplasty more challenging than revision of a failed hip or knee arthroplasty2. Kotnis et al.2 reported that revision is inadvisable in the presence of large osseous defects because they increase the chances of malalignment and instability, with resultant early failure. Johl et al.3 recommended a tibiotalocalcaneal arthrodesis with a short retrograde femoral nail as the treatment for aseptic loosening after a total ankle replacement with extensive bone loss because of the stability that is created and the low risk of pseudarthrosis. However, the major disadvantages of a tibiotalocalcaneal arthrodesis are a certain degree of shortening and a stiff foot4. In the case reported here, to restore the range of motion and to prevent degenerative changes in the distal joints such as the tarsometatarsal and metatarsophalangeal joints, we replaced a collapsed talar body and previous implants with a total talar prosthesis. The patient was informed that data concerning the case would be submitted for publication, and she consented. A fifty-six-year-old woman who had been managed for rheumatoid arthritis for twenty years presented to our institution because she had had increasing pain and loss of function in the left ankle for the previous year. Extensive changes in the ankle and subtalar joints that were typical of rheumatoid arthritis were verified with radiography, and a total ankle …