Avascular osteonecrosis (AVN) of the talus (AVNT) is a painful and challenging clinical diagnosis. AVNT has multiple known risk factors and etiologies and presents at different stages in severity. Given these unique factors, the optimal treatment solution has yet to be determined. Both joint-preserving and joint-sacrificing procedures are available, including core decompression and arthrodeses. Recently, new salvage and replacement techniques have been described including vascularized pedicle bone grafts and total talus replacement using patient-specific prosthesis; however, evidence remains limited. This review examines the current trends AVNT treatment and the emerging data behind these novel techniques.
Abd-EllaMMGalhoumAAbdelrahmanAFWaltherM.Management of nonunited talar fractures with avascular necrosis by resection of necrotic bone, bone grafting, and fusion with an intramedullary nail. Foot Ankle Int. 2017;38(8):879-884.
2.
AdelaarRSMadrianJR.Avascular necrosis of the talus. Orthop Clin North Am. 2004;35(3):383-395, xi.
3.
ArriazaRLeyesM.Tibiocalcaneal arthrodesis: a new arthroscopic procedure. Knee Surg Sports Traumatol Arthrosc. 2011;19(1):128-130.
4.
BibboCPatelDVHaskellMD.Recombinant bone morphogenetic protein-2 (rhBMP-2) in high-risk ankle and hindfoot fusions. Foot Ankle Int. 2009;30(7):597-603.
5.
BlairHC.Comminuted fractures and fracture dislocations of the body of the astragalus: Operative treatment. Am J Surg. 1943;59(1):37-43.
6.
CanaleSTKellyFBJr.Fractures of the neck of the talus. Long-term evaluation of seventy-one cases. J Bone Joint Surg Am. 1978;60(2):143-156.
7.
ChangCCGreenspanAGershwinME.Osteonecrosis: current perspectives on pathogenesis and treatment. Semin Arthritis Rheum. 1993;23(1):47-69.
8.
ClementsJR.Use of allograft cellular bone matrix in multistage talectomy with tibiocalcaneal arthrodesis: a case report. J Foot Ankle Surg. 2012;51(1):83-86.
9.
CodyEANunleyJA.Vascularized pedicle graft for talar osteonecrosis. Foot Ankle Clin. 2019;24(1):121-129.
10.
CohenMMKazakM.Tibiocalcaneal arthrodesis with a porous tantalum spacer and locked intramedullary nail for post-traumatic global avascular necrosis of the talus. J Foot Ankle Surg. 2015;54(6):1172-1177.
11.
DekkerTJPellegriniMJSchiffAP, et al. Isolated subtalar arthrodesis for avascular necrosis of the talus. J Surg Orthop Adv. 2019;28(2):132-136.
12.
DelanoisREMontMAYoonTRMizellMHungerfordDS.Atraumatic osteonecrosis of the talus. J Bone Joint Surg Am. 1998;80(4):529-536.
13.
DennisonMGPoolRDSimonisRBSinghBS.Tibiocalcaneal fusion for avascular necrosis of the talus. J Bone Joint Surg Br. 2001;83(2):199-203.
14.
DevaliaKLRamaskandhanJMuthumayandiKSiddiqueM.Early results of a novel technique: Hindfoot fusion in talus osteonecrosis prior to ankle arthroplasty: A case series. Foot (Edinb). 2015;25(4):200-205.
15.
DevriesJGPhilbinTMHyerCF.Retrograde intramedullary nail arthrodesis for avascular necrosis of the talus. Foot Ankle Int. 2010;31(11):965-972.
16.
FelsonDTLawrenceRCDieppePA, et al. Osteoarthritis: new insights. Part 1: the disease and its risk factors. Ann Intern Med. 2000;133(8):635-646.
17.
GriceJCannonL.Percutaneous core decompression: a successful method of treatment of Stage I avascular necrosis of the talus. Foot Ankle Surg. 2011;17(4):317-318.
18.
GrossCEHaughomBChahalJHolmesGB.Treatments for avascular necrosis of the talus: a systematic review. Foot Ankle Spec. 2014;7(5):387-397.
19.
HaddockNTWapnerKLevinLS.Vascular bone transfer options in the foot and ankle: a retrospective review and update on strategies. Plast Reconstr Surg. 2013;132(3):685-693.
20.
HaliburtonRASullivanCRKellyPJPetersonLF.The extra-osseous and intra-osseous blood supply of the talus. J Bone Joint Surg Am. 1958;40 (5):1115-1120.
21.
HanselmanAECodyEAEasleyMEAdamsSBParekhSG. Avascular necrosis of the talus after subchondroplasty. Foot Ankle Int. 2021:10711007211005435.
22.
HarnroongrojTVanadurongwanV.The talar body prosthesis. J Bone Joint Surg Am. 1997;79(9):1313-1322.
23.
HaskellA.Natural history of avascular necrosis in the talus: when to operate. Foot Ankle Clin. 2019;24(1):35-45.
24.
HawkinsLG.Fractures of the neck of the talus. J Bone Joint Surg Am. 1970;52(5):991-1002.
25.
HernigouPDuboryAFlouzat LachanietteCHKhaledIChevallierNRouardH.Stem cell therapy in early post-traumatic talus osteonecrosis. Int Orthop. 2018;42(12):2949-2956.
26.
HorstFGilbertBJNunleyJA.Avascular necrosis of the talus: current treatment options. Foot Ankle Clin. 2004;9(4): 757-773.
27.
HoudekMTWylesCCCollinsMS, et al. Stem cells combined with platelet-rich plasma effectively treat corticosteroid-induced osteonecrosis of the hip: a prospective study. Clin Orthop Relat Res. 2018;476(2):388-397.
28.
HungerfordDS.Response: the role of core decompression in the treatment of ischemic necrosis of the femoral head. Arthritis Rheum. 1989;32(6):801-806.
29.
IssaKNaziriQKapadiaBHLammBMJonesLCMontMA.Clinical characteristics of early-stage osteonecrosis of the ankle and treatment outcomes. J Bone Joint Surg Am. 2014;96(9):e73.
30.
JengCLCampbellJTTangEYCerratoRAMyersonMS.Tibiotalocalcaneal arthrodesis with bulk femoral head allograft for salvage of large defects in the ankle. Foot Ankle Int. 2013;34(9):1256-1266.
31.
JeyaseelanLSi-Hyeong ParkSAl-RumaihH, et al. Outcomes following total ankle arthroplasty: a review of the registry data and current literature. Orthop Clin North Am. 2019;50(4):539-548.
32.
JordanRKBafnaKRLiuJEbraheimNA.Complications of talar neck fractures by Hawkins classification: a systematic review. J Foot Ankle Surg. 2017;56(4):817-821.
33.
KadakiaRJAkohCCChenJSharmaAParekhSG.3D printed total talus replacement for avascular necrosis of the talus. Foot Ankle Int. 2020;41(12):1529-1536.
34.
KanzakiNChinzeiNYamamotoTYamashitaTIbarakiKKurodaR.Clinical outcomes of total ankle arthroplasty with total talar prosthesis. Foot Ankle Int. 2019;40(8):948-954.
35.
KendalARCookePSharpR.Arthroscopic ankle fusion for avascular necrosis of the talus. Foot Ankle Int. 2015;36(5):591-597.
36.
KodamaNTakemuraYShiojiSImaiS.Arthrodesis of the ankle using an anterior sliding tibial graft for osteoarthritis secondary to osteonecrosis of the talus: a comparison of vascularised non-vascularised grafts. Bone Joint J. 2016;98-B(3):359-364.
37.
KodamaNTakemuraYUebaHImaiSMatsusueY.A new form of surgical treatment for patients with avascular necrosis of the talus and secondary osteoarthritis of the ankle. Bone Joint J. 2015;97-b(6):802-808.
38.
LachmanJRAdamsSB.Tibiotalocalcaneal arthrodesis for severe talar avascular necrosis. Foot Ankle Clin. 2019;24(1): 143-161.
39.
LampertC.Ankle joint prosthesis for bone defects. Article in German. Orthopade. 2011;40(11):978-983.
40.
LéducSClareMPLaflammeGYWallingAK.Posttraumatic avascular necrosis of the talus. Foot Ankle Clin. 2008;13(4):753-765.
MagnanBFacciEBartolozziP.Traumatic loss of the talus treated with a talar body prosthesis and total ankle arthroplasty. A case report. J Bone Joint Surg Am. 2004;86(8):1778-1782.
43.
MarulandaGAMcGrathMSUlrichSDSeylerTMDelanoisREMontMA.Percutaneous drilling for the treatment of atraumatic osteonecrosis of the ankle. J Foot Ankle Surg. 2010;49(1):20-24.
44.
MontMASchonLCHungerfordMWHungerfordDS.Avascular necrosis of the talus treated by core decompression. J Bone Joint Surg Br. 1996;78(5):827-830.
45.
NunleyJAHamidKS.Vascularized pedicle bone-grafting from the cuboid for talar osteonecrosis: results of a novel salvage procedure. J Bone Joint Surg Am. 2017;99(10):848-854.
46.
PiccoloPPBen-AmotzOAshleyBWapnerKLLevinLS.Ankle arthrodesis with free vascularized fibula autograft using saphenous vein grafts: a case series. Plast Reconstr Surg. 2018;142(3):806-809.
47.
ScottDJSteeleJFletcherAParekhSG.Early outcomes of 3D printed total talus arthroplasty. Foot Ankle Spec. 2020;13(5):372-377.
48.
ShnolHLaPortaGA.3D printed total talar replacement: a promising treatment option for advanced arthritis, avascular osteonecrosis, and osteomyelitis of the ankle. Clin Podiatr Med Surg. 2018;35(4):403-422.
49.
StruckmannVFHarhausLSimonR, et al. Surgical revascularization-an innovative approach to the treatment of talar osteonecrosis dissecans stages II and III. J Foot Ankle Surg. 2017;56(1):176-181.
50.
SultanAAMontMA.Core decompression and bone grafting for osteonecrosis of the talus: a critical analysis of the current evidence. Foot Ankle Clin. 2019;24(1):107-112.
51.
TaniguchiATakakuraYSugimotoK, et al. The use of a ceramic talar body prosthesis in patients with aseptic necrosis of the talus. J Bone Joint Surg Br. 2012;94(11):1529-1533.
52.
TaniguchiATakakuraYTanakaY, et al. An alumina ceramic total talar prosthesis for osteonecrosis of the talus. J Bone Joint Surg Am. 2015;97(16):1348-1353.
53.
TaniguchiATanakaY.An alumina ceramic total talar prosthesis for avascular necrosis of the talus. Foot Ankle Clin. 2019;24(1):163-171.
54.
TenenbaumSStocktonKGBariteauJTBrodskyJW.Salvage of avascular necrosis of the talus by combined ankle and hindfoot arthrodesis without structural bone graft. Foot Ankle Int. 2015;36(3):282-287.
55.
TraceyJAroraDGrossCEParekhSG.Custom 3D-printed total talar prostheses restore normal joint anatomy throughout the hindfoot. Foot Ankle Spec. 2019;12(1):39-48.
56.
Van BergeykAStotlerWBealsTManoliA2nd. Functional outcome after modified Blair tibiotalar arthrodesis for talar osteonecrosis. Foot Ankle Int. 2003;24(10):765-770.
