Custom ankle arthroplasty for talar bone loss

One of the arguments against total ankle replacement is that when it fails there can be large bone defects left which essentially compromise the outcomes from total ankle replacement. There are few potential effective salvage options in the case of major talar bone loss as fusion can be difficult to effect, often requiring inclusion of the subtalar joint. These authors from Liestal (Switzerland) report an innovative option to address the potential problems of talar bone loss.⁸ Their series of just 12 ankles with major bone defects reports on the option of revising them to a custom-made talar prosthesis; certainly many times more expensive and complex than a simple fusion. The authors report the outcomes of their small series of 12 patients to a mean follow-up of seven years. They were able to report that revision with a custom talar component was not only technically possible, but that at final follow-up 11 ankles were stable with no evidence of radiological loosening. Functional outcomes were a mixed bag, with 17% reporting poor levels of satisfaction, however, given the complexity of the presentations this should be seen as a good result. It certainly appears that while still a long way from being a mature technology, the option to manufacture custom talar components to address bone stock issues is certainly an avenue worth pursuing in those patients where other options would not be suitable.