Preliminary Outcomes of Primary Stemmed Talus Ankle Replacement

1
Preliminary Outcomes of Primary Stemmed Talus
Ankle Replacement

• Ferras Zeni, M.D.
• Sigvard Hansen, M.D.

We have no potential conflicts with this
presentation
2
Rationale for Primary Stemmed Talus Ankle
Replacement

• General consensus regarding increased rates of
  failure of the talar component compared to the
  tibial component.
• Kopp et al.
• 45 subsidence, 2/3 of which involved the talar
  component
• Spirt et al.
• Inability to salvage an ankle replacement
  secondary to talar subsidence
• Knecht et al.
• Expressed concern regarding the longevity of the
  talar component

3
Our Study

• Retrospective Review
• 37 patients
• 27 female 10 male
• 21 right 16 left
• Minimum two year follow up
• Etiology
• Post-traumatic 60
• Rheumatoid arthritis 14
• CMT 11
• Other (polio, PTTI, primary OA) 15

4
Indications

• Associated subtalar joint arthritis
• Axial malalignment
• Prior history of subtalar fusion
• Poor talar bone stock/AVN

5
Operative Technique Template

• Talar body size (sizes 1-6)
• Talar body can be augmented based on extent of
  bone loss
• Stem length

6
Operative Technique

• Initial tibial and talar cuts identical to
  nonstemmed arthroplasty
• Custom jig allows for accurate placement of the
  guide wire in both the sagital and axial planes
• Guide wire is then overdrilled using cannulated
  ACL reamer

7
Stem Insertion
8
Complications

• 9/37 patients underwent reoperation (24)
• Two patients awaiting reoperation
• No infections (one delayed wound healing)
• One tibial component revision associated with
  intraoperative medial malleolar fracture
• No talar component revisions

9
Most Common Reasons for Reoperation

• Malalignment
• 6/37 (16)
• 5/6 patients had preoperative malalignment
• Relative risk 3.6 (p.25)
• Syndesmotic nonunion
• 3/37 (8)
• Comparable to previously reported rates

10
Other Reasons for Reoperation
11
Factors Associated with Reoperation
12
Conclusion

• Eliminates complications relative to talar
  subsidence
• 24 reoperation rate
• Malalignment is the most common reason for
  revision
• Likely related to loss of the accommodative
  function of the subtalar joint
• There is a trend towards reoperation in patients
  less than 55, post traumatic etiology and
  patients with preoperative malalignment, but this
  did not reach statistical significance.