J Korean Foot Ankle Soc.  2024 Dec;28(4):165-168. 10.14193/jkfas.2024.28.4.165.

Tibiotalocalcaneal Arthrodesis Using Talar Allograft: A Case Report

• Kim AY
• Kang C
• Lee GS
• Song JH

• KMID: 2562454
• DOI: http://doi.org/10.14193/jkfas.2024.28.4.165

Abstract

Tibiotalocalcaneal (TTC) arthrodesis is a limb salvage procedure for severe hindfoot disease and ankle deformity. Previous studies have reported several procedures, but controversy remains regarding its standard procedure. Talar body osteonecrosis can be a devastating condition that is difficult to manage surgically. Advanced-stage disease with extensive talus involvement may require a TTC arthrodesis, and the procedure frequently requires a structural bulk bone graft. A femoral head allograft and intramedullary nailing have been used to solve these problems, but a high rate of non-union was reported. The use of a talus allograft for TTC arthrodesis has been reported to achieve a higher union rate and lower complication rate. In the present case report, a patient with severe talar osteonecrosis was treated successfully with TTC arthrodesis using a talar allograft. To the best of the authors’ knowledge, this is the first report in South Korea regarding the treatment of talar osteonecrosis using TTC arthrodesis with a talar allograft.

Keyword

Tibiotalocalcaneal arthrodesis; Talar osteonecrosis; Femoral head allograft; Talus allograft

Figure

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  Figure 1 Preoperative simple ankle radiographs (A, B) and magnetic resonance imaging images (C, D) showing collapse of subtalar joint with bone destruction of talus and calcaneus.

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  Figure 2 Intraoperative images showing resection of distal fibula (A), destruction of talas and calcaneus (B), and resected necrotic bone (C).

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  Figure 3 Intraoperative images showing joint preservation of calcaneus (A, B) and talus (C, D).

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  Figure 4 Postoperative simple ankle radiographs with anteroposterior (A) and lateral (B) images.

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  Figure 5 2-year follow up simple ankle radiographs with anteroposterior (A) and lateral (B) images.

Reference

Acosta R., Ushiba J., Cracchiolo A 3rd. 2000. The results of a primary and staged pantalar arthrodesis and tibiotalocalcaneal arthrodesis in adult patients. Foot Ankle Int. 21:182–94. doi: 10.1177/107110070002100302. DOI: 10.1177/107110070002100302. PMID: 10739148.

Song MH., Kim BH., Ahn SJ., Kang SW., Kim YJ., Kim DH, et al. 2014. Tibiotalocalcaneal arthrodesis using retrograde compressive intramedullary nail. J Korean Foot Ankle Soc. 18:202–7. DOI: 10.14193/jkfas.2014.18.4.202.

DeFontes KW 3rd., Vaughn J., Smith J., Bluman EM. 2018. Tibiotalocalcaneal arthrodesis with bulk talar allograft for treatment of talar osteonecrosis. Foot Ankle Int. 39:506–14. doi: 10.1177/1071100718761036. DOI: 10.1177/1071100718761036. PMID: 29542351.

Jeng CL., Campbell JT., Tang EY., Cerrato RA., Myerson MS. 2013. Tibiotalocalcaneal arthrodesis with bulk femoral head allograft for salvage of large defects in the ankle. Foot Ankle Int. 34:1256–66. doi: 10.1177/1071100713488765. DOI: 10.1177/1071100713488765. PMID: 23650649.

Bussewitz B., DeVries JG., Dujela M., McAlister JE., Hyer CF., Berlet GC. 2014. Retrograde intramedullary nail with femoral head allograft for large deficit tibiotalocalcaneal arthrodesis. Foot Ankle Int. 35:706–11. doi: 10.1177/1071100714531231. DOI: 10.1177/1071100714531231. PMID: 24719399.

Coetzee JC., Den Hartog BD., Stone McGaver R., Seiffert KJ., Giveans MR. 2021. Femoral head allografts for talar body defects. Foot Ankle Int. 42:815–23. doi: 10.1177/1071100720983811. DOI: 10.1177/1071100720983811. PMID: 33541133.

Cuttica DJ., Hyer CF. 2011. Femoral head allograft for tibiotalocalcaneal fusion using a cup and cone reamer technique. J Foot Ankle Surg. 50:126–9. doi: 10.1053/j.jfas.2010.08.004. DOI: 10.1053/j.jfas.2010.08.004. PMID: 20851001.

Vaughn J., DeFontes KW 3rd., Keyser C., Bluman EM., Smith JT. 2019. Case series: allograft tibiotalocalcaneal arthrodesis utilizing fresh talus. Foot Ankle Orthop. 4:2473011419834541. doi: 10.1177/2473011419834541. DOI: 10.1177/2473011419834541. PMID: 35097319. PMCID: PMC8696819.

Ramhamadany E., Chadwick C., Davies MB. 2021. Treatment of severe avascular necrosis of the talus using a novel keystone-shaped 3D-printed titanium truss implant. Foot Ankle Orthop. 6:24730114211043516. doi: 10.1177/24730114211043516. DOI: 10.1177/24730114211043516. PMID: 35097475. PMCID: PMC8554568.