Traumatic Loss of the Talus Treated with a Talar Body Prosthesis and Total Ankle Arthroplasty

Abstract

Total talar dislocation is a rare injury1-6 that usually occurs as a result of a high-energy continuation of extreme supination forces causing lateral subtalar dislocation or extreme pronation forces causing medial subtalar dislocation7. Most of these injuries are open and are associated with a high rate of postreduction complications, such as persistent infection (reported in up to 89% of patients2), shearing osteochondral fractures (45%3), osteonecrosis (33% to 50%1,8,9), and severe degenerative arthritis5,6. Prompt closed or open reduction of the talus, when possible, is the recommended treatment, in combination with soft-tissue debridement of open injuries3,10. However, the high rate of complications has led many authors to suggest that primary excision of the talus or tibiocalcaneal arthrodesis1,2,4,5,11 should be performed instead. Tibiotalar or pantalar arthrodesis has been recommended for any cases of osteonecrosis or arthritis that develop later. Primary open dislocation with loss of the talus (“missing talus”)2, however, necessitates the performance of either a tibiocalcaneal arthrodesis or a resection arthroplasty, which is difficult to create and maintain. Both procedures often produce unwanted effects on the foot, particularly in young patients, because of loss of function of the peritalar joints3,12-14. To avoid the necessity of performing these procedures and to preserve ankle function, the implantation of a talar body prosthesis has been proposed15. Because the long-term survival of such an implant, especially in active individuals, is not known, a total ankle arthroplasty coupled with a talar prosthesis fixed to the calcaneus and the navicular may be an alternative solution. We describe the case of a forty-five-year-old man in whom total ankle arthroplasty and …