Total Talus Replacement Following Avascular Necrosis after Open Talar Neck Fracture: A 2-year Follow-up Case Report

Aim and background: Avascular necrosis (AVN) of the talus is a devastating complication following high-energy trauma, often resulting in collapse of the talar body and progressive arthritis of the ankle and subtalar joints. Salvage procedures traditionally include arthrodesis, which sacrifices joint motion and may predispose adjacent joint degeneration. Recent advances in 3D printing have enabled the development of custom total talus replacements (TTRs) as a motion-preserving alternative. This report presents a 2-year follow-up of a patient with post-traumatic talar AVN successfully managed with a custom 3D-printed TTR. Case description: A 70-year-old female sustained a complete talar extrusion following a motor vehicle accident. The talus was reduced, and she initially managed nonweight-bearing for 3 months, recovering well before developing progressive pain. Radiographs, computed tomography (CT), and magnetic resonance imaging (MRI) demonstrated AVN with collapse of the talar body, medial subtalar subluxation, and osteoarthritis of the ankle and subtalar joints. After discussion of treatment options, she underwent a custom 3D-printed TTR combined with calcaneal and first metatarsal osteotomies. Postoperatively, she reported minimal pain, initiated weight-bearing in a controlled ankle motion (CAM) boot at 1 month, and transitioned to full activity by 4 months. At 2 years, she remained pain-free with stable implant positioning on radiographs and reported an American Orthopaedic Foot and Ankle Society (AOFAS) score of 90. Conclusion: Custom TTR can restore alignment, relieve pain, and preserve ankle and hindfoot motion in patients with advanced talar AVN and collapse. At 2-year follow-up, this patient demonstrated excellent pain relief, functional recovery, and radiographic stability. Clinical significance: This case highlights TTR as a viable alternative to arthrodesis for post-traumatic talar AVN. By preserving ankle motion and restoring function, this approach may improve long-term outcomes and quality of life for patients with severe talar collapse.