Ankle joint replacement for necrosis of the talus, crusarthrosis, equinovarus and adducted foot

Introduction Surgical treatment of patients with avascular osteonecrosis of the talus and post-traumatic hindfoot deformity is associated with high morbidity, difficulty of early disease detection, the discrepancy between patient expectations and orthopaedic requirements for surgical outcomes due to traditional methods. The use of customized ankle joint replacement may be a potential solution to this problem.

The objective was to evaluate the results of treatment of a patient with avascular osteonecrosis of the talus, crusarthrosis and hindfoot deformity using an original replacement method for the ankle joint and the talus.

Material and methods A 30-year-old patient with post-traumatic avascular osteonecrosis of the talus, crusarthrosis, equinovarus and adducted foot underwent replacement of the ankle joint and talus using the  method developed by the authors. Radiographic and tomographic methods were used for diagnosis. The  VAS  scale, AOFAS, FFI, EFAS questionnaires and pedobarography were used to assess clinical and functional results.

Results The results of treatment evaluated at 12 months showed maintained foot deformity correction, stability of a tailored construct with no signs of loosening and osteolysis. The clinical and functional result showed a 81/2 VAS decrease in pain, functional status improved by 4.3 times with functional foot index (FFI) improved by 2.2 times according to the AOFAS scale at 12 months.

Discussion Orthopaedic surgeons are conducting research aimed at preserving ankle motion in the treatment of  avascular osteonecrosis of the talus. A serious problem is associated with concomitant deformities of the hindfoot and available implants fail to solve this problem.

Conclusion The surgical method offered for the patient provided good clinical and functional results with the hindfoot deformity corrected within one stage reducing the treatment time.

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