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Categories: Abstracts, 2025-Nov, Podium

Outcomes and Classification of Total Talus Replacements

Ciaran Nolan, Mark Davies, Howard Davies, Ian Sharpe, Andrew Goldberg, Adrian Kendal, Rick Brown

Sheffield Teaching Hospitals, Sheffield

Introduction: Total talus replacement (TTR) is an innovative technology with increasing availability. The outcomes, expected function, surgical challenges and complications need to be described. Standardising the terminology describing the implants and their degree of constraint is necessary to compare outcomes in future research on the topic.

Methods: Prospectively collected PROMS including MOXFQ, VAS, EQ-5D and the Tegner activity score have been analysed from 29 TTRs from four centres in the UK. The effects of physical and psychological comorbidities, underlying disease and the component design were studied.

Results: There were 29 total talus replacement implants, of which 8 were combined with a total ankle replacement (TATTR). Of the 21 TTR, 15 were fully articulating and 6 were constrained by intended bone-metal incorporation at one or more joint surfaces. After mean follow up of 21 months (minimum 6 months), the overall MOXFQ improved from 80.8% (CI 14 75.1-86.4) to 41% (C.I 30.4-51.6, p<0.0001). The mean VAS increased from 44.7 (CI 15 33.2-56.1) to 76.2 (C.I 69.7-82.7, p<0001). The Tegner activity level score increased by 2.5, while the mean EQ5D was shown to have significantly improved (p<0001). Three patients with a fully articulating TTR (11%) have undergone a re-operation, and an additional patient has a revision procedure planned.

Conclusion: In challenging cases with destruction of the talus, a total talus replacement provides an option to relive pain, while improving both function and activity. When clinically required, constraining a joint surface with a bone-metal incorporation, produces clinical outcomes as good as those after a fully articulating total talus replacement. Standardising the terminology used to describe these novel implants will help surveillance in a national registry as well as future research to compare outcomes and the recognised complications.

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Tags: Ankle Clinical Test

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