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Outcomes following total talus replacement: A systematic review
Foot and Ankle Surgery ( IF 2.5 ) Pub Date : 2022-08-20 , DOI: 10.1016/j.fas.2022.08.010
Lindsey G Johnson 1 , Albert T Anastasio 2 , Amanda N Fletcher 2 , Stephanie Hendren 2 , Samuel B Adams 2
Affiliation  

Introduction

The treatment of pathologic changes to the talus and surrounding joints presents a unique challenge to the foot and ankle surgeon. The purpose of this systematic review is to summarize the literature for unconstrained (no surrounding fusion or replacement) total talus replacement (TTR) and evaluate whether it leads to improved clinical and radiographic outcomes and appropriate safety metrics.

Methods

Concepts of talus and arthroplasty were searched in MEDLINE, Embase, CINAHL Complete, and Scopus from 2005 to 2021. Inclusion Criteria were 1) previous trauma to the talus, 2) post-traumatic or degenerative arthritis to the tibiotalar joint, 3) avascular necrosis of talus, 4) multiple failed prior interventions, and 5) inflammatory arthropathy to tibiotalar joint. Manuscripts in non-English languages or those with concomitant total ankle arthroplasty or revision arthroplasty were excluded.

Results

Twenty-two studies of 191 patients (196 ankles) were included. Nineteen studies utilized third generation implants, two studies used first generation (n = 9) and one study used second generation implants (n = 14) made largely of ceramic (n = 84), cobalt chrome (n = 49), or titanium (n = 24). Patient-reported outcome measures were favorable in all described categories (Table 4) with ten studies reporting an average postoperative change of + 2.92° of dorsiflexion and − 2.05° plantarflexion at final follow-up. The most common adverse outcome was adjacent joint arthritis with five studies reporting some degree of postoperative, degenerative changes in the surrounding joints (n = 52).

Conclusion

TTR is an alternative to joint sacrificing procedures to maintain range of motion through the tibiotalar joint and allow for maintenance of normal foot and ankle biomechanics. Despite promising early- and mid-term outcomes, future, prospective, randomized research should be conducted to better assess survivorship and complication rates with direct comparison of TTR to existing forms of salvage options for advanced talar pathology.

Level of Evidence

III, Systematic Review of Level IV Studies



中文翻译:

全距骨置换术后的结果:系统评价

介绍

治疗距骨和周围关节的病理变化对足踝外科医生提出了独特的挑战。本系统评价的目的是总结无约束(无周围融合或置换)全距骨置换术 (TTR) 的文献,并评估它是否会改善临床和影像学结果以及适当的安全指标。

方法

从 2005 年到 2021 年,在 MEDLINE、Embase、CINAHL Complete 和 Scopus 中搜索了距骨和关节成形术的概念。纳入标准为 1) 距骨既往外伤,2) 胫距关节外伤后或退行性关节炎,3)缺血性坏死距骨,4) 多次失败的先前干预,以及 5)胫距关节的炎症性关节病。非英语手稿或同时进行全踝关节置换术或翻修术的手稿被排除在外。

结果

纳入了 191 名患者(196 个脚踝)的 22 项研究。19 项研究使用了第三代植入物,两项研究使用了第一代植入物 (n = 9),一项研究使用了主要由陶瓷 (n = 84)、钴铬合金 (n = 49) 或钛制成的第二代植入物 (n = 14)。 n = 24)。患者报告的结果测量在所有描述的类别中都是有利的(表 4),十项研究报告在最终随访时平均术后变化为 + 2.92° 背屈和 - 2.05° 跖屈。最常见的不良后果是邻近关节关节炎,有五项研究报告了周围关节一定程度的术后退行性变化 (n = 52)。

结论

TTR 是关节牺牲手术的替代方案,可通过胫距关节保持运动范围,并允许维持正常的足部和踝部生物力学。尽管有希望的早期和中期结果,但应进行未来的前瞻性随机研究,以通过直接比较 TTR 与晚期距骨病理的现有形式的补救选择来更好地评估生存率和并发症发生率。

证据等级

三、四级研究的系统评价

更新日期:2022-08-20
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