Johnson Lindsey G, Anastasio Albert T, Fletcher Amanda N, Hendren Stephanie, Adams Samuel B
Department of Orthopaedic Surgery, Duke University, Durham, NC, USA; Campbell University School of Osteopathic Medicine, Lillington, NC, USA.
Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.
Foot Ankle Surg. 2022 Dec;28(8):1194-1201. doi: 10.1016/j.fas.2022.08.010. Epub 2022 Aug 20.
The treatment of pathologic changes to the talus and surrounding joints presents a unique challenge to the foot and ankle surgeon. The purpose of this systematic review is to summarize the literature for unconstrained (no surrounding fusion or replacement) total talus replacement (TTR) and evaluate whether it leads to improved clinical and radiographic outcomes and appropriate safety metrics.
Concepts of talus and arthroplasty were searched in MEDLINE, Embase, CINAHL Complete, and Scopus from 2005 to 2021. Inclusion Criteria were 1) previous trauma to the talus, 2) post-traumatic or degenerative arthritis to the tibiotalar joint, 3) avascular necrosis of talus, 4) multiple failed prior interventions, and 5) inflammatory arthropathy to tibiotalar joint. Manuscripts in non-English languages or those with concomitant total ankle arthroplasty or revision arthroplasty were excluded.
Twenty-two studies of 191 patients (196 ankles) were included. Nineteen studies utilized third generation implants, two studies used first generation (n = 9) and one study used second generation implants (n = 14) made largely of ceramic (n = 84), cobalt chrome (n = 49), or titanium (n = 24). Patient-reported outcome measures were favorable in all described categories (Table 4) with ten studies reporting an average postoperative change of + 2.92° of dorsiflexion and - 2.05° plantarflexion at final follow-up. The most common adverse outcome was adjacent joint arthritis with five studies reporting some degree of postoperative, degenerative changes in the surrounding joints (n = 52).
TTR is an alternative to joint sacrificing procedures to maintain range of motion through the tibiotalar joint and allow for maintenance of normal foot and ankle biomechanics. Despite promising early- and mid-term outcomes, future, prospective, randomized research should be conducted to better assess survivorship and complication rates with direct comparison of TTR to existing forms of salvage options for advanced talar pathology.
III, Systematic Review of Level IV Studies.
距骨及周围关节的病理改变治疗给足踝外科医生带来了独特的挑战。本系统评价的目的是总结无限制（无周围融合或置换）全距骨置换（TTR）的文献，并评估其是否能带来更好的临床和影像学结果以及合适的安全指标。
2005年至2021年期间在MEDLINE、Embase、CINAHL Complete和Scopus数据库中检索距骨和关节成形术的相关概念。纳入标准为：1）既往距骨创伤；2）胫距关节创伤后或退行性关节炎；3）距骨缺血性坏死；4）既往多次干预失败；5）胫距关节炎性关节病。排除非英语语言的手稿或同时进行全踝关节置换或翻修关节成形术的手稿。
纳入了22项针对191例患者（196个踝关节）的研究。19项研究使用第三代植入物，2项研究使用第一代植入物（n = 9），1项研究使用第二代植入物（n = 14），这些植入物主要由陶瓷（n = 84）、钴铬合金（n = 49）或钛（n = 24）制成。所有描述类别的患者报告结局指标均良好（表4），10项研究报告最终随访时平均术后背屈增加2.92°，跖屈减少2.05°。最常见的不良结局是相邻关节关节炎，5项研究报告周围关节出现一定程度的术后退行性改变（n = 52）。
全距骨置换是一种替代牺牲关节手术的方法，可维持胫距关节的活动范围，并保持足踝正常生物力学。尽管早期和中期结果令人鼓舞，但未来应进行前瞻性、随机研究，以更好地评估生存率和并发症发生率，并将全距骨置换与晚期距骨病变的现有挽救选择进行直接比较。
III，IV级研究的系统评价。
