Research progress in surgical treatment of avascular necrosis of talus_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Tao , LI Zhenhao , CUI Yan , XIONG Wanqi , WANG Zewen , HE Ting , LIU Jiahe , XU Jingyi ,  LIU Baoyi ,  YANG Fan , ZHANG Tao , LI Zhenhao , CUI Yan , XIONG Wanqi , WANG Zewen , HE Ting , LIU Jiahe , XU Jingyi ,  LIU Baoyi ,  YANG Fan

Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian Liaoning, 116001, P. R. China;

Corresponding author：

LIU Baoyi, Email: liubaoyi-513@163.com; YANG Fan, Email: surgeon_yangfan@163.com; LIU Baoyi, Email: liubaoyi-513@163.com; YANG Fan, Email: surgeon_yangfan@163.com

Keywords：

Avascular necrosis of talus; surgery; vascularized bone flap transplantation; arthroplasty; arthrodesis

DOI：

10.7507/1002-1892.202401007

Video：

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Objective To summarize the surgical treatment methods for avascular necrosis of the talus. Methods The recent domestic and international literature related to avascular necrosis of the talus was extensively conducted. The pathogenesis, surgical treatment methods, and prognosis were summarized. Results The clinical symptoms of avascular necrosis of the talus at early stage are not obvious, and most patients have progressed to Ficat-Arlet stages Ⅲ-Ⅳ and require surgical treatment. Currently, surgical treatments for this disease include core decompression, vascularized bone flap transplantation, arthroplasty, and arthrodesis, etc. Early avascular necrosis of the talus can be treated conservatively, and if treatment fails, core decompression can be considered. Arthrodesis is a remedial surgery for patients with end-stage arthritis and collapse, and in cases of severe bone loss, tibiotalocalcaneal arthrodesis and bone grafting are required. Vascularized bone flap transplantation is effective and plays a role in all stages of avascular necrosis of the talus, but the appropriate donor area for the flap still needs further to be studied. Conclusion The surgical treatment and the system of treatment for different stages of avascular necrosis of the talus still need to be refined.

Citation： ZHANG Tao, LI Zhenhao, CUI Yan, XIONG Wanqi, WANG Zewen, HE Ting, LIU Jiahe, XU Jingyi, LIU Baoyi, YANG Fan. Research progress in surgical treatment of avascular necrosis of talus. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(4): 493-497. doi: 10.7507/1002-1892.202401007 Copy

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1. 刘彦林. 距骨形态及血液供应的解剖学研究. 长春: 吉林大学, 2008.
2. 刘彦林. 距骨形态及血液供应的解剖学研究. 长春: 吉林大学, 2008.
3. Bai L, Peng YB, Liu SB, et al. Anatomical basis of a pedicled cuboid bone graft based on the lateral tarsal artery for talar avascular necrosis. Surg Radiol Anat, 2021, 43(10): 1703-1709.
4. Bai L, Peng YB, Liu SB, et al. Anatomical basis of a pedicled cuboid bone graft based on the lateral tarsal artery for talar avascular necrosis. Surg Radiol Anat, 2021, 43(10): 1703-1709.
5. 金杰, 易丙奎, 杨群, 等. 距骨缺血坏死的治疗进展. 实用医学杂志, 2005, 21(14): 1605-1607.
6. 金杰, 易丙奎, 杨群, 等. 距骨缺血坏死的治疗进展. 实用医学杂志, 2005, 21(14): 1605-1607.
7. Gross CE, Haughom B, Chahal J, et al. Treatments for avascular necrosis of the talus: a systematic review. Foot Ankle Spec, 2014, 7(5): 387-397.
8. Gross CE, Haughom B, Chahal J, et al. Treatments for avascular necrosis of the talus: a systematic review. Foot Ankle Spec, 2014, 7(5): 387-397.
9. 赵顶云, 郑季南, 洪庆南. 创伤后距骨缺血性坏死的诊断和治疗. 实用骨科杂志, 2011, 17(11): 1007-1009, 1054. doi: 10.3969/j.issn.1008-5572.2011.11.014.
10. 赵顶云, 郑季南, 洪庆南. 创伤后距骨缺血性坏死的诊断和治疗. 实用骨科杂志, 2011, 17(11): 1007-1009, 1054. doi: 10.3969/j.issn.1008-5572.2011.11.014.
11. 江仲超. 距骨坏死相关因素的临床研究. 长春: 吉林大学, 2013.
12. 江仲超. 距骨坏死相关因素的临床研究. 长春: 吉林大学, 2013.
13. 唐一丁. 距骨缺血性坏死的评估与治疗进展. 中国骨与关节损伤杂志, 2022, 37(8): 893-896.
14. 唐一丁. 距骨缺血性坏死的评估与治疗进展. 中国骨与关节损伤杂志, 2022, 37(8): 893-896.
15. Saravi B, Lang G, Ruff R, et al. Conservative and surgical treatment of talar fractures: a systematic review and meta-analysis on clinical outcomes and complications. Int J Environ Res Public Health, 2021, 18(16): 8274. doi: 10.3390/ijerph18168274.
16. Saravi B, Lang G, Ruff R, et al. Conservative and surgical treatment of talar fractures: a systematic review and meta-analysis on clinical outcomes and complications. Int J Environ Res Public Health, 2021, 18(16): 8274. doi: 10.3390/ijerph18168274.
17. Al-Jabri T, Tan JYQ, Tong GY, et al. The role of electrical stimulation in the management of avascular necrosis of the femoral head in adults: a systematic review. BMC Musculoskelet Disord, 2017, 18(1): 319. doi: 10.1186/s12891-017-1663-5.
18. Al-Jabri T, Tan JYQ, Tong GY, et al. The role of electrical stimulation in the management of avascular necrosis of the femoral head in adults: a systematic review. BMC Musculoskelet Disord, 2017, 18(1): 319. doi: 10.1186/s12891-017-1663-5.
19. Lazik A, Landgraeber S, Claßen T, et al. Aspects of postoperative magnetic resonance imaging of patients with avascular necrosis of the femoral head, treated by advanced core decompression. Skeletal Radiol, 2015, 44(10): 1467-1475.
20. Lazik A, Landgraeber S, Claßen T, et al. Aspects of postoperative magnetic resonance imaging of patients with avascular necrosis of the femoral head, treated by advanced core decompression. Skeletal Radiol, 2015, 44(10): 1467-1475.
21. 袁超凡. 多孔钛合金支撑棒对早期距骨骨坏死骨修复的影响. 西安: 第四军医大学, 2013.
22. 袁超凡. 多孔钛合金支撑棒对早期距骨骨坏死骨修复的影响. 西安: 第四军医大学, 2013.
23. Marulanda GA, McGrath MS, Ulrich SD, et al. Percutaneous drilling for the treatment of atraumatic osteonecrosis of the ankle. J Foot Ankle Surg, 2010, 49(1): 20-24.
24. Marulanda GA, McGrath MS, Ulrich SD, et al. Percutaneous drilling for the treatment of atraumatic osteonecrosis of the ankle. J Foot Ankle Surg, 2010, 49(1): 20-24.
25. Issa K, Naziri Q, Kapadia BH, et al. Clinical characteristics of early-stage osteonecrosis of the ankle and treatment outcomes. J Bone Joint Surg (Am), 2014, 96(9): e73. doi: 10.2106/JBJS.M.00888.
26. Issa K, Naziri Q, Kapadia BH, et al. Clinical characteristics of early-stage osteonecrosis of the ankle and treatment outcomes. J Bone Joint Surg (Am), 2014, 96(9): e73. doi: 10.2106/JBJS.M.00888.
27. Nunley JA, Hamid KS. 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.
28. Nunley JA, Hamid KS. 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.
29. Doi K, Hattori Y. Vascularized bone graft from the supracondylar region of the femur. Microsurgery, 2009, 29(5): 379-384.
30. Doi K, Hattori Y. Vascularized bone graft from the supracondylar region of the femur. Microsurgery, 2009, 29(5): 379-384.
31. Haddock NT, Alosh H, Easley ME, et al. Applications of the medial femoral condyle free flap for foot and ankle reconstruction. Foot Ankle Int, 2013, 34(10): 1395-1402.
32. Haddock NT, Alosh H, Easley ME, et al. Applications of the medial femoral condyle free flap for foot and ankle reconstruction. Foot Ankle Int, 2013, 34(10): 1395-1402.
33. Kodama N, Takemura Y, Ueba H, et al. 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.
34. Kodama N, Takemura Y, Ueba H, et al. 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.
35. Gupta R, Pfennig M, Gannon J, et al. Utilization of the pedicled and free fibula flap for ankle arthrodesis. Plast Reconstr Surg Glob Open, 2022, 10(11): e4670. doi: 10.1097/GOX.0000000000004670.
36. Gupta R, Pfennig M, Gannon J, et al. Utilization of the pedicled and free fibula flap for ankle arthrodesis. Plast Reconstr Surg Glob Open, 2022, 10(11): e4670. doi: 10.1097/GOX.0000000000004670.
37. Saad A, Jimenez ML, Rogero RG, et al. Medial femoral condyle periosteal free flap for the treatment of talus avascular necrosis. Foot Ankle Int, 2020, 41(6): 728-734.
38. Saad A, Jimenez ML, Rogero RG, et al. Medial femoral condyle periosteal free flap for the treatment of talus avascular necrosis. Foot Ankle Int, 2020, 41(6): 728-734.
39. Kadakia RJ, Akoh CC, Chen J, et al. 3D printed total talus replacement for avascular necrosis of the talus. Foot Ankle Int, 2020, 41(12): 1529-1536.
40. Kadakia RJ, Akoh CC, Chen J, et al. 3D printed total talus replacement for avascular necrosis of the talus. Foot Ankle Int, 2020, 41(12): 1529-1536.
41. Jennison T, Dalgleish J, Sharpe I, et al. Total talus replacements. Foot Ankle Orthop, 2023, 8(1): 24730114221151068. doi: 10.1177/24730114221151068.
42. Jennison T, Dalgleish J, Sharpe I, et al. Total talus replacements. Foot Ankle Orthop, 2023, 8(1): 24730114221151068. doi: 10.1177/24730114221151068.
43. Harnroongroj T, Harnroongroj T. The talar body prosthesis: results at ten to thirty-six years of follow-up. J Bone Joint Surg (Am), 2014, 96(14): 1211-1218.
44. Harnroongroj T, Harnroongroj T. The talar body prosthesis: results at ten to thirty-six years of follow-up. J Bone Joint Surg (Am), 2014, 96(14): 1211-1218.
45. Taniguchi A, Tanaka Y. An alumina ceramic total talar prosthesis for avascular necrosis of the talus. Foot Ankle Clin, 2019, 24(1): 163-171.
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