Talus Foot and Ankle X-ray Image

Dr. Kent Ellington

CHARLOTTE, N.C. (January 13, 2020) – An orthopedic surgeon with the OrthoCarolina Foot and Ankle Institute has performed the first total talus replacement not only at OrthoCarolina but in the western half of North Carolina. Dr. Ellington performed the procedure on a 69-year old female with long-term avascular necrosis (AVN) using a Restor3D custom talus implant. This is a relatively new procedure and only a few centers in the country have performed such a case.

The talus connects the foot to the lower leg and is crucial for foot and ankle mobility, but receives low blood supply compared to its neighboring bones—the tibia, fibula and calcaneus—resulting in difficulty healing. Total talus replacement is a new alternative surgical option for patients with AVN, a condition in which poor oxygenated blood flow causes eventual death of the bone. The specific root causes of AVN are somewhat unknown but may include high-impact trauma, drugs or corticosteroids.

Treatment of talar AVN has historically been ankle and hindfoot fusion, which generally severely limits range of motion in the ankle (up and down) as well as range of motion in the hindfoot (side to side). This fusion procedure also has a higher risk of failing to properly fuse due to the lack of blood flow in the talus. Even with successful fusion which helps alleviate pain, the lack of motion from the fusing of the two joints may leave the patient with a suboptimal outcome.

To perform the total talus replacement, Dr. Ellington made an incision over the ankle, removed the talus and replaced it with a custom cobalt chrome metal talus. The custom replacement was a 3D implant made from cobalt chrome metal by Restor3D a company in Durham developed as a completely anatomical replacement for the patient.

“The neck of the talus is a common site for avascular necrosis to occur, and it can be difficult to treat either conservatively or surgically simply because AVN is so detrimental to the bone,” said Dr. Ellington, who is also an Adjunct Assistant Professor of Biology at UNC Charlotte and Associate

Professor of Orthopaedics at AtriumHealth. “Technology like the Restor3D custom talar implant helps us create patient-centric custom devices that lead to better outcomes”. The patient is currently recovering from the surgery and progressing well, with no pain and excellent motion.

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