Juels Christopher A, So Eric, Seidenstricker Chad, Holmes Jeffrey, Scott Ryan T
Fellow, The CORE Institute Foot and Ankle Advanced Reconstruction Fellowship, Phoenix, AZ.
Fellow, The CORE Institute Foot and Ankle Advanced Reconstruction Fellowship, Phoenix, AZ.
J Foot Ankle Surg. 2020 Jan-Feb;59(1):149-155. doi: 10.1053/j.jfas.2019.06.006. Epub 2019 Nov 19.
Reoperation rates and complication rates can be high for patients receiving an osteochondral talar allograft transplant. Complications can include graft failure, delamination of the graft, arthrofibrosis, advancing osteoarthritis, nonunion of malleolar osteotomies, and partial or complete osteonecrosis of the talus. Graft failure refers to failure of graft incorporation with subsequent necrosis and subsidence. Treatment options for talar graft failure are limited, and outcomes for these treatments have rarely been reported. We present a review of the published data on the complications and treatments for failed talar allograft transplantation. A case report is presented on a young woman who experienced graft failure and osteonecrosis of her talar allograft transplant. Because of the size of the present osteonecrosis, an ankle arthrodesis was performed as the initial revision procedure. Talar necrosis was removed and revascularized from the ankle fusion with solid fusion was confirmed with computed tomography. Symptomatic adjacent joint pain quickly developed in the hindfoot after the ankle fusion, and 12 months later an ankle fusion conversion to total ankle arthroplasty was performed. The patient has returned to normal activity with significant reduction in pain at most recent follow-up visit. This patient was followed for 7 years from initial osteochondral talar allograft transplantation and for 2 years from conversion of ankle fusion to total ankle arthroplasty. It is important to understand the techniques, indications, and outcomes for the various revision options for talar allograft failure. This case report illustrates how multiple revision options can be used to provide the best outcome for the patient.
接受距骨异体骨软骨移植的患者再次手术率和并发症发生率可能较高。并发症可能包括移植物失败、移植物分层、关节纤维性变、进行性骨关节炎、踝关节截骨不愈合以及距骨部分或完全坏死。移植物失败是指移植物融合失败并随后发生坏死和下沉。距骨移植物失败的治疗选择有限，且这些治疗的结果鲜有报道。我们对已发表的关于距骨异体移植失败的并发症和治疗的数据进行了综述。本文报告了一名年轻女性距骨异体移植失败并发生坏死的病例。由于目前存在的坏死范围，最初的翻修手术为踝关节融合术。切除距骨坏死部分，并通过踝关节融合使其重新血管化，计算机断层扫描证实融合牢固。踝关节融合术后后足很快出现了有症状的相邻关节疼痛，12个月后进行了踝关节融合转换为全踝关节置换术。在最近的随访中，患者已恢复正常活动，疼痛明显减轻。该患者从最初的距骨异体骨软骨移植开始随访7年，从踝关节融合转换为全踝关节置换术开始随访2年。了解距骨异体移植失败的各种翻修选择的技术、适应症和结果非常重要。本病例报告说明了如何使用多种翻修选择为患者提供最佳结果。
