Vascularized Pedicle Bone-Grafting from the Cuboid for Talar Osteonecrosis: Results of a Novel Salvage Procedure.
BACKGROUND: Osteonecrosis of the talar body represents a complex clinical challenge with treatment options currently limited to core decompression, vascularized and nonvascularized bone-grafting, total talar replacement, and hindfoot arthrodesis. Vascularized pedicle bone-grafting from the cuboid to the talus is a potential alternative to contemporary operative options for replacement of necrotic talar tissue with viable bone. We aimed to analyze functional and radiographic outcomes of vascularized pedicle bone-grafting from the cuboid for the treatment of talar osteonecrosis in a consecutive series of patients spanning a 12-year period. METHODS: Patients with osteonecrosis of the talar body and dome who underwent vascularized pedicle bone-grafting from the cuboid to the talus at our institution between 2003 and 2014 were retrospectively identified. All patients had preoperative radiographs and magnetic resonance imaging (MRI) scans and were monitored postoperatively with serial radiographs and MRI. For generic health-related quality-of-life (HRQoL) assessment, patients were given the preoperative Medical Outcomes Study Short Form-12 (SF-12) and postoperative 36-Item Short Form (SF-36) from which Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were derived and compared before and after surgery. RESULTS: Thirteen patients were identified and sequentially followed for 2 to 12 years (mean, 6 years). Two patients had failure of treatment and subsequently underwent total ankle replacement, 1 patient had arthroscopic debridement for soft-tissue impingement, and no other patient required secondary surgery. The average PCS score (and standard deviation) significantly improved by 23.3 ± 18.9 points with surgery (p = 0.006), and the average MCS score significantly increased by 39.4 ± 10.1 points (p < 0.001). CONCLUSIONS: HRQoL outcomes suggest that vascularized pedicle bone-grafting from the cuboid combined with bracing for 1 year may be a viable treatment option for osteonecrosis of the talus that provides good pain relief and improved physical function without necessitating a secondary procedure for the majority of patients. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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