Total talus replacement is a cutting-edge procedure to replace the entire talus bone with a custom-made 3D-printed metal implant. It is an alternative to tibiotalocalcaneal fusion for patients with severe talar AVN, collapse, or failed previous surgery.
A pre-operative CT scan is used to design and 3D-print a custom cobalt-chrome talus implant matched to the patient's anatomy. Through anterior and/or lateral incisions, the damaged talus is removed. The custom implant is inserted, articulating with the tibial plafond above and the calcaneus below. The surrounding ligaments are repaired to stabilise the implant. The operation takes two to three hours.
Total talus replacement is considered for severe talar AVN with collapse, failed talar fracture treatment, post-infective talar destruction, and revision of failed ankle replacement or fusion where talar bone stock is insufficient. It preserves ankle and subtalar motion unlike tibiotalocalcaneal fusion.
Ankle-foot orthosis, tibiotalocalcaneal fusion (the established alternative — fuses ankle and subtalar joints), and custom-moulded footwear.
CT scan for implant design and manufacture (lead time four to six weeks for custom implant). MRI to assess surrounding soft tissues. This is performed at specialist centres only.
Preservation of ankle and subtalar motion. Functional weight-bearing. Early results are promising but long-term data is limited. It avoids the significant morbidity of tibiotalocalcaneal fusion.
This is an evolving procedure. Long-term outcomes are not yet established.
Some limitation of motion compared to normal.
Prolonged ankle swelling.
The implant may sink into surrounding bone.
The implant may subluxate if ligamentous support is insufficient.
Prosthetic joint infection.
Long-term bearing surface wear. Data is limited.
If the implant fails, salvage tibiotalocalcaneal fusion may be needed.
General or spinal anaesthesia.
Non-weight-bearing for six weeks. Progressive weight-bearing in a boot. Physiotherapy for ankle mobility. Full recovery six to twelve months.
Regular X-rays and clinical review. Long-term surveillance as outcomes data matures.
Total talus replacement is an established procedure in specialist centres, with published case series showing promising early results. However, it is relatively new and long-term data (beyond ten years) is not yet available.
Tibiotalocalcaneal fusion eliminates motion at both the ankle and subtalar joints, significantly affecting gait on uneven ground and stairs. Total talus replacement preserves motion at both joints, providing a more natural gait.