Foot and Ankle Surgery, Duke University Medical Center, Durham, North Carolina.
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
Foot Ankle Spec. 2023 Jun;16(3):273-282. doi: 10.1177/19386400221120567. Epub 2022 Aug 29.
Late-stage talar avascular necrosis (AVN) results in devascularization of the talus with osteonecrosis and subchondral collapse. A combined total ankle and total talus replacement (TATTR) with hindfoot arthrodesis may be utilized for end-stage talar AVN with tibiotalar and hindfoot joint arthritis. The purpose of this study is to evaluate the short-term outcomes of combined TATTR with hindfoot arthrodesis. Patients who underwent a combined TATTR or TTR with a hindfoot arthrodesis (subtalar with or without talonavicular arthrodesis) from 2016 to 2020 were retrospectively reviewed. Patient demographics, comorbidities, and surgical data were collected. Outcomes included the Visual Analog Scale (VAS) scores, range of motion, radiographic parameters, union rates, and complications. A total of 18 patients were reviewed. Nine patients were included with an average of 19.4 months follow-up. Significant postoperative improvements were observed in VAS scores (P < .001), ankle plantarflexion (P = .04), talocalcaneal height (P = .03), and tibiotalar alignment (P = .02). All patients achieved a successful union of their subtalar and talonavicular joints arthrodesis. There was one reoperation for a persistent varus ankle deformity. This is the first study to evaluate the clinical outcomes, radiographic outcomes, and union rate in combined TATTR with hindfoot arthrodesis. The early results demonstrated significant clinical improvement with 100% hindfoot union rate and no prosthetic failure. IV.
晚期距骨缺血性坏死(AVN)导致距骨血管化,发生骨坏死和软骨下塌陷。对于终末期距骨 AVN 伴距下关节和后足关节炎,可采用踝关节和距骨全关节置换术(TATTR)联合后足融合术。本研究旨在评估 TATTR 联合后足融合术的短期疗效。回顾性分析了 2016 年至 2020 年间接受 TATTR 或 TTR 联合后足融合术(距下关节融合,伴或不伴跟距关节融合)的患者。收集了患者的人口统计学、合并症和手术数据。结果包括视觉模拟评分(VAS)、关节活动度、影像学参数、愈合率和并发症。共 18 例患者接受了回顾性分析,其中 9 例患者平均随访 19.4 个月。术后 VAS 评分(P <.001)、踝关节跖屈(P =.04)、距跟骨高度(P =.03)和距下关节对线(P =.02)均有显著改善。所有患者的距下关节和跟距关节融合均获得成功。有 1 例患者因持续性内翻踝畸形行再次手术。这是第一项评估 TATTR 联合后足融合术的临床结果、影像学结果和愈合率的研究。早期结果表明,该手术具有显著的临床改善,100%的后足融合率,且无假体失败。IV 级。