2015 ISAKOS Biennial Congress ePoster #113

Metal Resurfacing Inlay Implant for Osteochondral Defects of the Talus After Failed Previous Surgery: A Prospective Study

Rogier Gerards, MD, Amsterdam NETHERLANDS
Christiaan J.A. Van Bergen, MD, Amsterdam NETHERLANDS
Mikel L. Reilingh, MD, Amsterdam NETHERLANDS
Inge Van Eekeren, MD, Amsterdam NETHERLANDS
C. Niek Van Dijk, MD, PhD, Abcoude NETHERLANDS

Academic Medical Center , Amsterdam, noord-hollland, NETHERLANDS

The FDA has not cleared the following pharmaceuticals and/or medical device for the use described in this presentation. The following pharmaceuticals and/or medical device are being discussed for an off-label use: Arthrosurface, Talus HemiCAP®

Summary: A metal resurfacing inlay implant for osteochondral defects of the talus is a promising treatment for osteochondral defects of the medial talar dome after failed previous surgery

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Abstract:

Introduction

Osteochondral ankle defects (OCDs) mainly occur in a young, active population. In 63% of cases the defect is located on the medial talar dome. Arthroscopic debridement and microfracture is considered the primary treatment for defects up to 15 mm. To treat patients with a secondary OCD of the medial talar dome and avoid donor site morbidity, a 15-mm diameter metal resurfacing inlay implant was developed. The present study aimed to evaluate the clinical effectiveness of the metal implant for OCDs of the medial talar dome.

Methods

We prospectively studied 24 consecutive patients for a median of 4 years (range, 2 – 5 years). We included patients with an OCD of the medial talar dome, with the largest diameter being between 12 mm and 20 mm as measured on CT scans. For inclusion patients had to have complained persistently for more than a year after previous surgical treatment. Exclusion criteria included an age < 18 years, ankle osteoarthritis grade III, other ankle pathology, and diabetes mellitus. The primary outcome measure was the Numeric Rating Scale of pain (NRS) at rest and during walking, running, and stair climbing. Secondary outcome measures were the Foot Ankle Outcome Score (FAOS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Short-Form 36 (SF-36) and radiographic evaluation.

Results

There was statistically significant reduction of the NRS pain in three of four situations (i.e., pain during walking, stair climbing and running; p = 0.01; repeated measures ANOVA). For example, the NRS during walking improved from a mean of 6.8 ± 1.3 preoperatively to 3.1 ± 2.6 at final follow-up. The mean NRS at rest was 3.5 ± 2.7 preoperatively and changed to 2.1 ± 2.2 at final follow (p = 0.16; repeated measures ANOVA). The FAOS improved on four out of five subscales (p = 0.01; repeated measures ANOVA), except for the subscale “other symptoms” (p = 0.78). The AOFAS score improved from a median of 62 (range, 28 – 75) preoperatively to 85 (range, 58 – 100) at final follow-up (p < 0.01; Friedman’s two-way analysis of variance by ranks). The SF-36 physical component scale improved from a mean of 35 ± 8 pre-operatively to 44 ± 13 at final follow-up (p < 0.01; repeated measures ANOVA); the mental component scale did not change significantly. On radiographs, degenerative changes were observed in two patients, and periprosthetic lucency was found in one patient. One patient required additional surgery for the OCD.

Conclusion

This study shows that a metal implant is a promising treatment for osteochondral defects of the medial talar dome after failed previous surgery.