Bilateral total ankle and total talus replacement (TATTR): A case report


  • Samuel D. Caine, DPM Resident, Franciscan Foot and Ankle Institute, Federal Way WA, USA
  • Lindsey R. Hjelm, DPM Fellow, Franciscan Foot and Ankle Institute, Federal Way WA, USA
  • Byron L. Hutchinson, DPM, FACFAS Fellowship Director, Franciscan Foot and Ankle Institute, Federal Way WA, USA



ankle, talus, arthroplasty, joint, implant, trauma


The combined custom 3D printed total ankle-total talus replacement, or TATTR, as previously described in the literature, is a procedure for the patient with substantial pathology of the ankle including the tibial plafond and the talus. The goals for a TATTR procedure are to provide pain relief, minimize limb length discrepancy, and maintain or improve motion of the ankle joint and functional mobility of the patient. A contralateral Computed Tomography (CT) has previously been used to recreate a “mirror image” for the talar implant design of the affected limb. To the best of our knowledge, no study has demonstrated the use of TATTR when there is pathology in bilateral tali. The purpose of this article is to discuss the process and utilization of bilateral TATTR procedures for a patient with bilateral talar avascular necrosis (AVN). 


Vallier HA, Nork SE, Barei DP, Benirschke SK, Sangeorzan BJ. Talar neck fractures: results and outcomes. J Bone Joint Surg Am. 2004;86(8):1616-1624.

Buza JA III, Leucht P. Fractures of the talus: Current concepts and new developments. Foot Ankle Surg. 2018;24(4):282-290.

Parekh SG, Kadakia RJ. Avascular Necrosis of the Talus. J Am Acad Orthop Surg. 2021;29(6):e267-e278.

Houdek MT, Wyles CC, Martin JR, Sierra RJ. Stem cell treatment for avascular necrosis of the femoral head: current perspectives. Stem Cells Cloning. 2014-4-9;7:65-70.

Kitaoka H, Patzer G. Arthrodesis of the Treatment of Arthrosis of the Ankle and Osteonecrosis of the Talus. J Bone and Joint Surgery. 1998;80-A(3):370-379.

Tenenbaum S, Stockton KG, Bariteau JT, Brodsky JW. Salvage of avascular necrosis of the talus by combined ankle and hindfoot arthrodesis without structural bone graft. Foot Ankle Int. 2015;36(3):282-287.

Myerson MS, Alvarez RG, Lam PW. Tibiocalcaneal arthrodesis for the management of severe ankle and hindfoot deformities. Foot Ankle Int. 2000;21(8):643-650.

Dennison MG, Pool RD, Simonis RB, Singh BS. Tibiocalcaneal fusion for avascular necrosis of the talus. J Bone Joint Surg Br. 2001;83(2):199-203.

Harnroongroj T, Vanadurongwan V. The talar body prosthesis. J Bone Joint Surg Am. 1997;79(9):1313-1322.

Fletcher AN, Balu A, Pereira GF, et al. Short-Term Efficacy and Safety of Combined Total Talus and Total Ankle Replacement. Foot Ankle Orthop. 2022;7(1):2473011421S00022.

Taniguchi A, Takakura Y, Tanaka Y, et al. An Alumina Ceramic Total Talar Prosthesis for Osteonecrosis of the Talus. J Bone Joint Surg Am. 2015;97(16):1348-1353.

Angthong C. Anatomic total talar prosthesis replacement surgery and ankle arthroplasty: an early case series in Thailand. Orthop Reviews. 2014;6(3):5486–5486.

Mauren NR, Hayden M, Brantingham S, Corcoran M. Reconstruction Following Talectomy Due to Disseminated Blastomycosis in Immunocompetent Adult Utilizing Total Talus Prosthesis: A Case Report. J Foot Ankle Surg. 2021;60(5):1063-1067.

Harnroongroj T, Harnroongroj T. The Talar Body Prosthesis: Results at Ten to Thirty-six Years of Follow-up. J Bone Joint Surg Am. 2014;96(14):1211-1218.

Akoh CC, Chen J, Adams SB. Total Ankle Total Talus Replacement Using a 3D Printed Talus Component: A Case Report. J Foot Ankle Surg. 2020;59(6):1306-1312.

Kurokawa H, Taniguchi A, Morita S, Takakura Y, Tanaka Y. Total ankle arthroplasty incorporating a total talar prosthesis: a comparative study against the standard total ankle arthroplasty. Bone Joint J. 2019;101-B(4):443-446.

Magnan B, Facci E, Bartolozzi P. Traumatic loss of the talus treated with a talar body prosthesis and total ankle arthroplasty. A case report. J Bone Joint Surg Am. 2004;86(8):1778-1782.

Kanzaki N, Chinzei N, Yamamoto T, Yamashita T, Ibaraki K, Kuroda R. Clinical Outcomes of Total Ankle Arthroplasty With Total Talar Prosthesis. Foot Ankle Int. 2019;40(8):948-954.

Tsukamoto S, Tanaka Y, Maegawa N, et al. Total talar replacement following collapse of the talar body as a complication of total ankle arthroplasty: a case report. J Bone Joint Surg Am. 2010;92(11):2115-2120.

Attarilar S, Ebrahimi M, Djavanroodi F, Fu Y, Wang L, Yang J. 3D Printing Technologies in Metallic Implants: A Thematic Review on the Techniques and Procedures. Int J Bioprint. 2020;7(1):306.

Regauer M, Lange M, Soldan K, et al. Development of an internally braced prosthesis for total talus replacement. World J Orthop. 2017;8(3):221-228.

West TA, Rush SM. Total Talus Replacement: Case Series and Literature Review. J Foot Ankle Surg. 2021;60(1):187-193.

Liu T, Ead M, Cruz SDV, et al. Polycarbonate-urethane coating can significantly improve talus implant contact characteristics. J Mech Behav Biomed Mater. 2022;125:104936.

Day J, Kim J, O'Malley MJ, et al. Radiographic and Clinical Outcomes of the Salto Talaris Total Ankle Arthroplasty. Foot Ankle Int. 2020;41(12):1519-1528.

Bidmos MA, Dayal MR, Adegboye OA. Measurements of the talus in the assessment of population affinity. Forensic Sci Int. 2018;287:221.e1-221.e7.

Mahakkanukrauh P, Praneatpolgrang S, Ruengdit S, Singsuwan P, Duangto P, Case DT. Sex estimation from the talus in a Thai population. Forensic Sci Int. 2014;240:152.e1-152.e8.

Hamid KS, Parekh SG, Adams SB. Salvage of Severe Foot and Ankle Trauma With a 3D Printed Scaffold. Foot Ankle Int. 2016;37(4):433-439.

Tracey J, Arora D, Gross CE, Parekh SG. Custom 3D-Printed Total Talar Prostheses Restore Normal Joint Anatomy Throughout the Hindfoot. Foot Ankle Spec. 2019;12(1):39-48.

Chappell TM, Ebert CC, McCann KM, Hutchinson BL, Rodriguez-Collazo E. Distal tibial distraction osteogenesis-an alternative approach to addressing limb length discrepancy with concurrent hindfoot and ankle reconstruction. J Orthop Surg Res. 2019;14(1):244.

Nwankwo EC, Chen F, Nettles DL, Adams SB. Five-Year Follow-Up of Distal Tibia Bone and Foot and Ankle Trauma Treated with a 3D-Printed Titanium Cage. Case Rep Orthop. 2019-11-26;2019:7571013.

Lu Y, Chen G, Long Z, et al. Novel 3D-printed prosthetic composite for reconstruction of massive bone defects in lower extremities after malignant tumor resection. J Bone Oncol. 2019-2-25;16:100220.




How to Cite

Caine S, Hjelm L, Hutchinson B. Bilateral total ankle and total talus replacement (TATTR): A case report. J Int Foot Ankle [Internet]. 2022 May 1 [cited 2023 Oct. 2];1(5). Available from:




Most read articles by the same author(s)