Talar Avascular Necrosis: Replace, Don't Fuse

by Vince Vacketta, DPM

Management of global avascular necrosis (AVN) of the talus is a challenging problem with limited surgical options, including fusion or replacement.

Evidence supporting total talus implants has been positive to date, though reports are limited to small case series leaving many surgeons wary regarding the long-term outcomes of these custom devices.

10 years of talar replacements

A recent study conducted by Harnroongroj et al. and published in Foot and Ankle Internagtional, compared the outcomes of using a talar prosthesis versus tibiotalocalcaneal (TTC) arthrodesis for treating collapsed talar avascular necrosis (AVN). The study found that patients who received a talar prosthesis had better results in activities of daily living, Foot and Ankle Ability Measure (FAAM) scores, and a higher 10-year survivorship rate compared to those who underwent TTC arthrodesis. Specifically, the TTC group had a non-union rate of 29%, while there were no prosthesis-related complications in the talar implant group.