A Realistic Look at Total Talus Replacement (TTR) Outcomes

by Vince Vacketta, DPM

TTR offers a motion and limb-sparing solution for patients with severe talar pathology. However, there is limited research on the potential complications associated with this procedure.

Comprehensive review

A review of current literature and case series was conducted to identify the failure mechanisms, surgical considerations, and long-term outcomes of TTR.

Failure points:

• Implant loosening

• Subsidence

• Joint degeneration

• Instability

• Material wear and fracture

Surgical pearls:

• Fuse the subtalar joint (STJ): This procedure offers stability and reduces the risk of osteoarthritis pain in the STJ following TTR. It may also help prevent subsidence.

• Protect the tibia: Combining TTR with TAA can help prevent tibial plafond erosion. Consider using stemmed implants in this setting for increased stability.

• Stabilize and customize: Customized TTR provides options for ligament repair or reconstruction, and typically offers more accurate implant sizing options.

Long-term concerns:

• Limited high-quality outcome data

• Unknown survivorship past 10+ years

• Salvage options are complex and limited

TTR shows promise but is still evolving. Better implant designs, careful patient selection, and comprehensive long-term data are key for improving outcomes.