Results of HemiCAP® Implantation as a Salvage Procedure for Osteochondral Lesions of the Talus

Sarah Ettinger; Christina Stukenborg-Colsman; Hazibullah Waizy; Christoph Becher; Daiwei Yao; Leif Claassen; Yvonne Noll; Christian Plaass

doi:10.1053/j.jfas.2017.04.001

Results of HemiCAP^® Implantation as a Salvage Procedure for Osteochondral Lesions of the Talus

J Foot Ankle Surg. 2017 Jul-Aug;56(4):788-792. doi: 10.1053/j.jfas.2017.04.001.

Authors

Sarah Ettinger¹, Christina Stukenborg-Colsman², Hazibullah Waizy³, Christoph Becher⁴, Daiwei Yao², Leif Claassen², Yvonne Noll⁵, Christian Plaass²

Affiliations

¹ Orthopedic Surgeon, Department of Orthopedic Surgery, Hannover Medical School, Hannover, Germany. Electronic address: sarah@ettinger.info.
² Orthopedic Surgeon, Department of Orthopedic Surgery, Hannover Medical School, Hannover, Germany.
³ Orthopedic Surgeon, Department of Orthopedic Surgery, Hessing-Stiftung, Augsburg, Germany.
⁴ Orthopedic Surgeon, ATOS Clinic Heidelberg, Germany.
⁵ Assistant, Department of Orthopedic Surgery, Hannover Medical School, Hannover, Germany.

PMID: 28633778
DOI: 10.1053/j.jfas.2017.04.001

Abstract

Osteochondral defects (OCDs) of the talus remain a surgical challenge, especially after failed primary treatment. The aim of the present study was to examine the clinical outcomes after HemiCAP^® implantation for OCDs of the medial talar dome after failed previous surgery. Our retrospective study included 11 patients, who had undergone surgery from June 2009 to September 2012 for an OCD of the medial talar dome and received a HemiCAP^® on the talus after failed previous surgery for OCD. The data were acquired using patients' medical records and standardized questionnaires, including the Foot and Ankle Outcome Score (FAOS), University of California at Los Angeles (UCLA) activity score, EQ-5D, numerical rating scale (NRS), and Short-Form 36-item Health Survey (SF-36). Using these scores, the possibility of returning to work and sports was determined. Any complications and the need for revision surgery were recorded. One patient refused to participate in the study, leaving 10 patients for evaluation. The mean age was 47.64 ± 10.97 years. The mean follow-up period was 43.5 ± 35.51 months. The FAOS and SF-36 subscale scores and the EQ-5D and UCLA activity scores did not improve significantly (p < .05). The mean postoperative pain score on the NRS improved significantly from 6.6 ± 1.77 preoperatively to 5.1 ± 2.02 postoperatively (p < .05). A greater body mass index led to worse postoperative outcomes with higher scores on the pain-NRS and less satisfaction (p < .05). Ten revisions for ongoing pain were performed in 7 patients (70.0%) within a mean of 28.4 ± 13.35 months of the initial procedure, and 6 patients (60%) indicated they would undergo surgery again. The results of the present study have shown that implantation of the HemiCAP^® as a salvage procedure for OCDs of the talus is challenging and does not consistently lead to good clinical results. Also, overweight patients appear to have an increased risk of postoperative dissatisfaction and persistent ankle pain.

Keywords: ankle; cartilage; metal resurfacing implant; osteochondral defect; subchondral bone; talus.

MeSH terms

Adult
Ankle Joint / surgery*
Cartilage Diseases / surgery*
Cartilage, Articular*
Female
Humans
Internal Fixators*
Male
Middle Aged
Reoperation
Retrospective Studies
Talus / surgery*
Treatment Outcome