title: Risks to the blood supply of the talus with four methods of total ankle arthroplasty: a cadaveric injection study.
abstract: BACKGROUND
  Despite the use of contemporary total ankle arthroplasty implant designs, clinical outcomes of total ankle arthroplasty continue to lag behind those of other joint replacement procedures. Disruption of the extraosseous talar blood supply at the time of ankle replacement may be a factor contributing to talar component subsidence-a common mechanism of early failure following ankle replacement. We evaluated the risk of injury to specific extraosseous arteries supplying the talus associated with specific total ankle arthroplasty implants.
  
  
  METHODS
  Sixteen fresh-frozen through-knee cadaveric specimens were injected with latex and barium sulfate distal to the popliteal trifurcation to visualize the arteries. Four specimens each were prepared for implantation of four contemporary total ankle arthroplasty systems: Scandinavian Total Ankle Replacement (STAR), INBONE II, Salto Talaris, and Trabecular Metal Total Ankle (TMTA). Postoperative computed tomography scans and 6% sodium hypochlorite chemical debridement were used to examine, measure, and document the proximity of the total ankle arthroplasty instrumentation to the extraosseous talar blood supply.
  
  
  RESULTS
  All four implant types subjected the extraosseous talar blood supply to the risk of injury. The INBONE subtalar drill hole directly transected the artery of the tarsal canal in three of four specimens. The lateral approach for the TMTA transected the first perforator of the peroneal artery in two of four specimens. The STAR caused medial injury to the deltoid branches in all four specimens, whereas the other three systems did not directly affect this supply (p < 0.005). The Salto Talaris and STAR implants caused injury to the artery of the tarsal canal in one of four specimens.
  
  
  CONCLUSIONS
  All four total ankle arthroplasty systems tested posed a risk of injury to the extraosseous talar blood supply, but the risks of injury to specific arteries were higher for specific implants.
authors.affiliation: Department of Orthopaedics, UNC School of Medicine, CB 7055, Chapel Hill, NC 27599-7055. E-mail address: josh_tennant@med.unc.edu.
authors.forename: Joshua N
authors.initials: JN
authors.lastname: Tennant
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 0102x JPP, Iowa City, IA 52242-1088.
authors.forename: Chamnanni
authors.initials: C
authors.lastname: Rungprai
authors.affiliation: Department of Anatomy and Cell Biology, University of Iowa, 100 Bowen Science Building, 51 Newton Road, Iowa City, IA 52242.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Pizzimenti
authors.affiliation: Orthopaedic Biomechanics Research Laboratory, University of Iowa, 2180 Westlawn, Iowa City, IA 52242.
authors.forename: Jessica
authors.initials: J
authors.lastname: Goetz
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 0102x JPP, Iowa City, IA 52242-1088.
authors.forename: Phinit
authors.initials: P
authors.lastname: Phisitkul
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 0102x JPP, Iowa City, IA 52242-1088.
authors.forename: John
authors.initials: J
authors.lastname: Femino
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 0102x JPP, Iowa City, IA 52242-1088.
authors.forename: Annunziato
authors.initials: A
authors.lastname: Amendola
mesh_terms: D000368:Aged; D058737:Arthroplasty, Replacement, Ankle / Q000009:adverse effects*; D002102:Cadaver; D006801:Humans; D007267:Injections; D007431:Intraoperative Complications / Q000209:etiology*; D008875:Middle Aged; D012306:Risk; D013628:Talus / Q000098:blood supply* / Q000293:injuries*