Custom-made total ankle arthroplasty for the salvage of major talar bone loss.
OBJECTIVE
A failed total ankle arthroplasty (TAA) is often associated with much bone loss. As an alternative to arthrodesis, the surgeon may consider a custom-made talar component to compensate for the bone loss. Our aim in this study was to assess the functional and radiological outcome after the use of such a component at mid- to long-term follow-up.


METHODS
A total of 12 patients (five women and seven men, mean age 53 years; 36 to77) with a failed TAA and a large talar defect underwent a revision procedure using a custom-made talar component. The design of the custom-made components was based on CT scans and standard radiographs, when compared with the contralateral ankle. After the anterior talocalcaneal joint was fused, the talar component was introduced and fixed to the body of the calcaneum.


RESULTS
At a mean follow-up of 6.9 years (1 to 13), 11 ankles were stable with no radiological evidence of loosening. Only one was lost to follow-up. The mean arc of movement was 21°(10°to 35°). A total of nine patients (75%) were satisfied or very satisfied with the outcome, two (17%) were satisfied but with reservations and one (8%) was not satisfied. All but one patient had an improvement in the American Orthopaedic Foot and Ankle Society hindfoot score (p = 0.01). Just one patient developed deep infection, leading to arthrodesis.


CONCLUSIONS
A custom-made talar component yielded satisfactory results with regard to function, stability and satisfaction. This should encourage the use of such components as an alternative to arthrodesis of the ankle in patients with a failed TAA. Cite this article: Bone Joint J 2017;99-B:231-6.
Clinic of Orthopaedic Surgery, Kantonsspital Baselland, CH-4410 Liestal, Switzerland.
J
J
Wagener
Medical University of South Carolina, Department of Orthopaedic Surgery, Charleston, South Carolina, USA.
C E
CE
Gross
Clinic of Orthopaedic Surgery, Kantonsspital Baselland, CH-4410 Liestal, Switzerland.
C
C
Schweizer
Clinic of Orthopaedic Surgery, Kantonsspital Baselland, CH-4410 Liestal, Switzerland.
T Horn
TH
Lang
Clinic of Orthopaedic Surgery, Kantonsspital Baselland, CH-4410 Liestal, Switzerland.
B
B
Hintermann
D000328:Adult; D000368:Aged; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D058737:Arthroplasty, Replacement, Ankle / Q000379:methods*; D001862:Bone Resorption / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D020127:Recovery of Function; D012086:Reoperation; D016879:Salvage Therapy; D013628:Talus / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
Custom-made talar component; Failed total ankle arthroplasty; Revision arthroplasty; Talar bone defect