Global avascular necrosis of the talus is a devastating complication that usually occurs as a result of a post-traumatic or metabolic etiology. When conservative options fail, tibiocalcaneal arthrodesis is generally indicated in conjunction with massive bone grafting to maintain the functional length of the extremity. Several bone grafting options are available, including the use of a freeze-dried or fresh-frozen femoral head allograft or autograft obtained from the iliac crest or fibula, all of which pose their own inherent risks. The noted complications with massive bone grafting techniques have included graft collapse, infection, immune response, donor site morbidity, and nonunion. In an effort to avoid many of these complications, we present a case report involving post-traumatic talar avascular necrosis in a 59-year-old male who was successfully treated with the use of a porous tantalum spacer, an autogenic morselized fibular bone graft, and 30 mL of bone marrow aspirate in conjunction with a retrograde tibiocalcaneal nail. Porous tantalum is an attractive substitute for bone grafting because of its structural integrity, biocompatibility, avoidance of donor site complications, and lack of an immune response. The successful use of porous tantalum has been well-documented in hip and knee surgery. We present a practical surgical approach to tibiotalocalcaneal arthrodesis with a large segmental deficit. To our knowledge, this is the first published report describing an alternative surgical technique to address global avascular necrosis of the talus that could have additional applications in salvaging the ankle with a large bone deficiency.
Level of Clinical Evidence
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- Porous tantalum as a structural graft in foot and ankle surgery.Foot Ankle Int. 2012; 33: 179-189
- Autogenous bone grafts in foot and ankle surgery.Orthop J Harvard Med Sch. 2007; 9: 113-116
- Comparison of anterior and posterior iliac crest bone grafts in terms of harvest site morbidity and functional outcomes.J Bone Joint Surg Am. 2002; 84: 716-720
- Complications of iliac crest bone harvesting.Clin Orthop Relat Res. 1996; 329: 300-309
- Management of failed ankle arthroplasty.Techn Foot Ankle Surg. 2010; 9: 134-141
- Ankle arthrodesis: a literature review.Clin Podiatr Med Surg. 2012; 29: 509-527
- A review of ankle arthrodesis: predisposing factors to nonunion.Foot Ankle Int. 1994; 15: 581-584
- Ankle fusion in a high risk population: an assessment of nonunion risk factors.Foot Ankle Int. 1999; 20: 491-496
- The use of circular wire external fixation in the treatment of salvage ankle arthrodesis.J Foot Ankle Surg. 2005; 44: 22-31
- Cigarette smoking and nonunion after ankle arthrodesis.Foot Ankle Int. 1994; 15: 64-67
- Traditional ankle arthrodesis for the treatment of ankle arthritis.Clin Podiatr Med Surg. 2009; 26: 259-271
- Tibiotalocalcaneal arthrodesis with bulk femoral head allograft for salvage of large defects in the ankle.Foot Ankle Int. 2013; 34: 1256-1266
- Fresh-frozen structural allografts in the foot and ankle.J Bone Joint Surg Am. 2005; 87: 113-120
- Can porous tantulum be used to achieve ankle and subtalar arthrodesis?.Clin Orthop Relat Res. 2010; 468: 209-216
- Technique tip: tantalum: a structural bone graft option for foot and ankle surgery.Foot Ankle Int. 2004; 25: 39-42
Published online: May 20, 2015
Financial Disclosure: None reported.
Conflict of Interest: None reported.
© 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.