PMC9893085_01
Preoperative (A) computed tomographic scan and (B) magnetic resonance imaging scan demonstrating talar AVN with fragmentation but reasonably preserved articular surfaces. (C) TTR modeled on the contralateral normal talus. (D) TTR trial manufactured from medical-grade plastic. (E) Intraoperative photograph demonstrating anterior approach to the talus and insertion of the TTR. (F) Lateral postoperative radiograph at 3 years. (G) Anteroposterior postoperative radiograph at 3 years. AVN, avascular necrosis; TTR, total talar replacement.
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Figure 3 illustrates a case of a 55-year-old woman with idiopathic AVN of the entire talus in which, following appropriate informed consent, a TTR was performed.
PMC9893085_02
(A) A TTR (Ti6Al4V with TiN coating and mirrored polish finish (Additive Orthopaedics-Paragon 28; Little Silver, NJ) with matched articulation on the upper surface to an INBONE poly insert. (B) Intraoperative photograph, showing nylon TTC trials to match to the INBONE tibial trial. (C) A postoperative anteroposterior radiograph of the patient that has undergone revisions of 2 failed TARs, on the right to a TTC (3 years prior), and on the left to a TTR matched to the INBONE TAR (2 years prior). (D) A lateral radiograph of the TTR implanted in panel C. TAR, total ankle replacement; TTC, tibiotalocalcaneal; TTR, total talar replacement.
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At short-term follow-up (2 years), he was walking pain free and very happy on the left side but remained disappointed with the pain and a limp on his right-sided TTC (Figure 4).