Abstract
Research Type:
Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies
Introduction/Purpose:
Avascular necrosis of the talus (AVNT) is a serious complication of talar fractures, often leading to talar collapse, instability, pain, and deformity. Managing AVNT presents a significant challenge for orthopedic surgeons, with treatment options including nonoperative management or a variety of surgical interventions. If surgery is chosen, surgeons must, in certain cases, decide between total talus replacement (TTR) and total ankle-total talus replacement (TATTR). Despite the increasing use of these procedures, limited research compares patient-perceived outcomes between them, making it difficult to guide treatment decisions. This study retrospectively evaluates patient-reported outcome measures (PROMs) in individuals undergoing TTR or TATTR to better understand functional outcomes and patient satisfaction.
Methods:
Following IRB approval, a retrospective analysis was conducted, identifying all patients who underwent total talus replacement and/or combined total ankle-total talus replacement at a single institution with a single surgeon from January 1, 2018 to December 31, 2023. Patient-reported outcome measures from the Patient-Reported Outcomes Measurement Information System (PROMIS) and Foot and Ankle Disability Index (FADI) evaluations were recorded.
The difference between preoperative and postoperative PROMIS scores (ΔPROMIS) was calculated for each domain and mean ΔPROMIS was then compared between the TTR and TATTR groups using two-sample t-tests. Statistical analysis was performed using International Business Machines Corporation’s Statistical Package for the Social Sciences, with significance set at p < 0.05.
Results:
A total of 23 patients were analyzed, with 11 undergoing TTR and 12 undergoing TATTR. One patient initially underwent TTR but converted to TATTR due to progressive arthritis. All procedures were performed for AVNT secondary to trauma. 10 patients had both preoperative and 1-year postoperative PROMIS scores. Baseline demographics were similar between groups. No significant differences were found between TTR and TATTR in ΔPROMIS Global Health: Physical (p = 0.73), Global Health: Mental (p = 0.33), or Pain Interference (p = 0.31) scores. A trend toward greater improvement in ΔPROMIS Physical Function was observed in the TATTR group (p = 0.12), though not statistically significant.
Conclusion:
In this retrospective study, both total talus replacement (TTR) and combined total ankle-total talus replacement (TATTR) resulted in improvements in PROMIS scores in patients with avascular necrosis of the talus. While no statistically significant differences were found between the two groups, a trend toward greater improvement in physical function was observed in the TATTR group. These findings suggest that both procedures can provide functional benefits for patients with AVNT. Given the limitations of this study, further research with larger cohorts and longer follow-up is needed to establish definitive conclusions regarding the long-term efficacy of these procedures.
(TATTR). The left two images show anteroposterior and lateral views following TTR, while the right two images display similar views after TATTR. The images highlight the radiographic differences in implant design and alignment between the two procedures.