What is Total Talus Replacement?
Total talus replacement is a surgical procedure in which the damaged or injured talus bone of the ankle joint is removed and replaced with a prosthetic implant.
Anatomy of the Talus
The foot and ankle are complex structures that are involved in movement and provide stability and balance to the body. They consist of 26 bones, 33 joints, and several tendons, muscles, and ligaments.
The foot is usually differentiated into 3 parts; the forefoot (5 toes) that forms the front of the foot, the midfoot (5 bones) that forms the arch of the foot, and the hindfoot that is comprised of the heel and ankle. The ankle is made up of 3 bones: the tibia, fibula, and talus. Ligaments and tendons provide flexibility to the foot enabling a wide range of movements.
The talus is a small, hard bone in the ankle joint. It articulates with the tibia and fibula, bones of the lower leg above, the calcaneus or heel bone below, and the navicular and the cuboid bones of the hindfoot in front. The talus is surrounded by cartilage that helps in the easy movement of the foot. The talus has a poor blood supply through the posterior tibial arteries.
Indications for Total Talus Replacement
Indications for total talus replacement include:
- Avascular necrosis of the talus due to its poor blood supply
- Hindfoot and ankle arthritis
- Tumour of the talus
Preparation for Total Talus Replacement
Prior to the surgery, your doctor will analyze the damage and obtain detailed X-ray and CT scan images of the ankle. This information is sent to the lab where a talus implant is designed and adjusted as per your surgeon’s instructions. Once the design is finalized, a custom-made 3D print or talus implant is constructed, usually of cobalt chrome. A few other trial implants with slight variation in sizes are also constructed so that the appropriate-sized implant may be used to replace the talus in your ankle joint.
Procedure for Total Talus Replacement
- The procedure is performed under regional or nerve block anaesthesia.
- A small incision will be made in the front of the ankle in order to easily access the talus.
- The talus is freed of its soft tissue attachments.
- A bone saw will be used to cut the talus into pieces which are then removed until the talus is completely excised.
- The trial implants are then placed and your doctor will assess fitness, range of motion, and stability to select the correct implant.
- The final implant will then be fixed appropriately.
- The incision is closed and your ankle is placed in a padded splint.
Post-operative Instructions for Total Talus Replacement
Post-operative instructions for total talus replacement include:
- You will be in the hospital for 2-3 days after the surgery.
- Your doctor will prescribe medications for pain control.
- Applying ice packs and elevating your ankle will help with swelling and discomfort.
- Sutures or staples will be removed at your postoperative visit in 2 weeks.
- You will be advised to avoid bearing weight on the ankle for around 4 weeks.
- After 4 weeks you will begin weight-bearing in a special boot.
- Physical therapy will be recommended to improve movement.
- Your next follow-up visits will usually be at 3 and 6 months.
Risks and Complications of Total Talus Replacement
Risks and complication of total talus replacement include:
- Nerve damage
- Poor bone healing
- Blood clotting