Surgical Management of Talar Avascular Necrosis

Abstract

Avascular necrosis (AVN) of the talus is often a life-altering diagnosis for a patient. A number of etiologies for avascular necrosis of the talus have been described and include trauma, long-term corticosteroid use, alcohol abuse, hyperlipidemia, hyperuricemia, hypertension, rheumatoid arthritis, systemic lupus erythematosus, sickle-cell disease, and occlusive vascular disease. Conservative management of the disease has historically led to poor outcomes. Surgical management options and their outcomes also remain a challenge. A stepwise approach to surgical management of talar AVN based on staging of the disease which has been described by several authors can aid in surgical procedure selection. Joint-sparing procedures are utilized in early stages of AVN and include core decompression or vascularized autograft. Isolated collapse of the talar dome may be amenable to fresh talar allograft replacement. Later stages of AVN with significant collapse and deformity may require hindfoot arthrodesis with or without talectomy. The disease, as well as the sequelae of any procedure, will have long-term consequences for the patient. Expectations of any procedure for the treatment of talar AVN must be clearly communicated to the patient, the end goals being improvement in pain and increase in overall function.