There are many causes of large bone defects in the tibiotalar joint that need to be definitively treated with a tibiotalocalcaneal (TTC) arthrodesis. Some of the challenges of a large defect are its effect on leg length and the complications associated with trying to fill the defect with structural bone graft. We present an operative strategy involving the use of a trabecular metal implant, a TTC nail that utilized 2 forms of compression, and Reamer/Irrigator/Aspirator (RIA) autograft, to address limitations of previous operative approaches and reliably treat this operative challenge.
BobynJDStackpoolGJHackingSATanzerMKrygierJJ.Characteristics of bone ingrowth and interface mechanics of a new porous tantalum biomaterial. J Bone Joint Surg Br. 1999;81(5):907-914.
2.
BouchardMBarkerLGClaridgeRJ.Technique tip: tantalum: a structural bone graft option for foot and ankle surgery. Foot Ankle Int. 2004;25(1):39-42.
3.
CoetzeeJC.Treatment of hindfoot and midfoot arthritis. In: CoughlinMJSaltzmanCLAndersonRB, eds. Mann’s Surgery of the Foot and Ankle. Vol 1. 9th ed.Philadelphia, PA: Elsevier Saunders; 2014:1008-1036.
4.
ConwayJD.Autograft and nonunions: morbidity with intramedullary bone graft versus iliac crest bone graft. Orthop Clin North Am. 2010;41(1):75-84.
5.
CristBDStokerAMStannardJPCookJL.Analysis of relevant proteins from bone graft harvested using the reamer irrigator and aspirator system (RIA) versus iliac crest (IC) bone graft and RIA waste water. Injury. 2016;47(8):1661-1668.
6.
DeVriesJGBerletGCHyerCF.A retrospective comparative analysis of Charcot ankle stabilization using an intramedullary rod with or without application of circular external fixator—utilization of the Retrograde Arthrodesis Intramedullary Nail database. J Foot Ankle Surg. 2012;51(4):420-425.
7.
DiGiovanniCWLinSSDanielsTR. The importance of sufficient graft material in achieving foot or ankle fusion. J Bone Joint Surg Am. 2016;98(15):1260-1267.
8.
FriggADougallHBoydSNiggB.Can porous tantalum be used to achieve ankle and subtalar arthrodesis?: a pilot study. Clin Orthop Relat Res. 2010;468(1):209-216.
HenricsonARydholmU.Use of a trabecular metal implant in ankle arthrodesis after failed total ankle replacement. Acta Orthop. 2010;81(6):745-747.
11.
HorisbergerMPaulJWiewiorskiM. Commercially available trabecular metal ankle interpositional spacer for tibiotalocalcaneal arthrodesis secondary to severe bone loss of the ankle. J Foot Ankle Surg. 2014;53(3):383-387.
12.
JengCLCampbellJTTangEYCerratoRAMyersonMS.Tibiotalocalcaneal arthrodesis with bulk femoral head allograft for salvage of large defects in the ankle. Foot Ankle Int. 2013;34(9):1256-1266.
13.
LiuJLudwigTEbraheimNA.Effect of the blood HbA1c level on surgical treatment outcomes of diabetics with ankle fractures. Orthop Surg. 2013;5(3):203-208.
14.
NunagPVunSHAtiyaSPillaiAKurdyN.Surgical tip: titanium foam blocks can simplify fusion of failed total ankle replacements. Foot (Edinb). 2014;24(3):111-115.
15.
SagherianBHClaridgeRJ.Porous tantalum as a structural graft in foot and ankle surgery. Foot Ankle Int. 2012;33(3):179-189.
16.
SagherianBHClaridgeRJ.Salvage of failed total ankle replacement using tantalum trabecular metal: case series. Foot Ankle Int. 2015;36(3):318-324.
17.
van DijkCNReilinghMLZengerinkMvan BergenCJ.Osteochondral defects in the ankle: why painful?Knee Surg Sports Traumatol Arthrosc. 2010;18(5):570-580.
18.
WiewiorskiMSchlemmerTHorisbergerM. Ankle fusion with a trabecular metal spacer and an anterior fusion plate. J Foot Ankle Surg. 2015;54(3):490-493.
