An Alumina Ceramic Total Talar Prosthesis for Osteonecrosis of the Talus

Background: Treatment of osteonecrosis of the talus is challenging. Total talar replacement has the potential to restore the function of the ankle joint without an associated leg-length discrepancy. The purpose of the present study was to investigate postoperative function and pain after total talar replacement in patients with osteonecrosis of the talus. Methods: Fifty-five ankles in fifty-one consecutive patients with osteonecrosis of the talus who were treated with a total talar replacement from 2005 to 2012 were included in the investigation. Scores according to the Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale and the Ankle Osteoarthritis Scale (AOS) were assessed before surgery and at the final follow-up evaluation. Results: According to the JSSF ankle-hindfoot scale, the score for pain improved from a mean (and standard deviation) of 15 +/- 9.4 points (range, 0 to 20 points) to 34 +/- 5.6 points (range, 20 to 40 points); the score for function, from 21.2 +/- 9.7 points (range, 4 to 38 points) to 45.1 +/- 4.0 points (range, 37 to 50 points); the score for alignment, from 6.0 +/- 2.8 points (range, 5 to 10 points) to 9.8 +/- 0.9 points (range, 5 to 10 points); and the total score, from 43.1 +/- 17.0 points (range, 11 to 68 points) to 89.4 +/- 8.4 points (range, 76 to 100 points). According to the AOS scale, the score for pain at its worst improved from a mean of 6.1 +/- 3.3 points (range, 0 to 9.9 points) to 2.0 +/- 1.7 points (range, 0 to 6.3 points). Conclusions: Prosthetic talar replacement is a useful procedure for patients with osteonecrosis of the talus as it maintains ankle function.