Patient-Specific Bilateral Talus Replacement: A Case Report

Background. Avascular necrosis of the talus predominantly affects individuals of working age. In case of bilateral pathology, determining the optimal treatment strategy remains a relevant and debatable issue. The aim of the paper was to present the short-term outcomes of the surgical treatment of a patient with bilateral avascular necrosis of the talus using patient-specific ceramic implants. Case description. A 32-year-old female patient presented with the complaints of bilateral ankle pain, which significantly worsened during walking. Preoperative evaluation showed the following scores: Visual Analog Scale (VAS) — 9 points, American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS AH) — 25 points, and Foot Function Index (FFI) — 139 points. The diagnosis was confirmed: avascular necrosis of the talus in both feet with bilateral grade 3 post-traumatic ankle osteoarthritis. Based on computed tomography, patient-specific talus prostheses were designed for both feet. The hemiprostheses were made of yttria-stabilized zirconia ceramic. Operations were performed with a 4-month interval: patient-specific talus replacement combined with Broström-Gould lateral ligament reconstruction on the right foot, and patient-specific talus replacement on the left foot. At follow-up 12 months after the surgery on the right foot and 8 months after the surgery on the left foot, the patient was able to walk with full weight-bearing on both lower limbs. Range of motion in both ankle joints was full, with minor pain at extreme points. Postoperative scores were as follows: VAS — 1 point, AOFAS AH — 82 points, and FFI — 28 points. The axial alignment of both ankle joints was normal, with no signs of instability. Control X-rays demonstrated the proper alignment of the ankle joints, an even joint gap, and no evidence of bone destruction. Conclusion. The analysis of the short-term outcomes in the patient with bilateral avascular necrosis of the talus suggested that the patient-specific talus replacement was a promising treatment option. It preserved ankle joint function and lower limb weight-bearing capacity. Postoperative dynamic pedobarography revealed significant improvement in gait biomechanics. © 2025 Elsevier B.V., All rights reserved.