TALAR OSTEOKONDRAL DEFEKTLERDE ŞEKİLLENDİRİLMİŞ METAL TALAR İMPLANT UYGULAMASI

Amaç: Osteokondral lezyonlar (OKL) posttravmatik veya gelişimsel olarak ortaya çıkabilen, eklem yüzeyindekihiyalin kıkırdağın ve subkondral kemiğin hasarıdır. Primer tedavi talus osteokondral defektlerin artroskopikdebritmanı ve kemik iliği stimulasyonudur. Özellikle başarısız primertedaviden sonra, cerrahi bir sorun olmayadevam etmektedir.Medialtalar çatının büyük lezyonlarının tedavisinde şekillendirilmiş artiküler implant(ŞAİ) (HemiCAP, Artrosurface)bir tedavi alternatifidir. Bu çalışmanın amacı, daha önce cerrahi tedavi ile başarısız olmuş medialtalarkubbenin OKL’ları için ŞA İimplantasyonundan sonra klinik sonuçları incelemektir.Gereç ve Yöntem: Bu çalışmada OKL tanısı ile tedavi edilen artroskopik debritman kemik iliği stimülasyonusonucu başarısız olanveya 50 yaş üstü primer OKL lezyonu nedeni, Haziran 2011-Haziran 2015 tarihleriarasında tedavi edilen ve ŞAİ yapılan 7 si erkek ve 10 kadın olmak üzere toplam 17 hasta retrospektif olarakincelenmiştir. Hastalar preoperatif ve postoperatif olarak takiplerinde dinlenme ve yürüme sırasında VAS ağrıskoru, AOFAS skorlaması, radyolojik olarak implant gevşemesi, osteotomi hattında pseudoartroz, malunionve osteoartrit gelişimi değerlendirildi.Bulgular: Ortalama yaş 49.5±10.3(29-68) dır. Takip süresi 44.2±11.7(24-63) aydır. VAS ağrı skoru dinlenmesırasında preoperatif dönemde 1.4±1.2 (0-4) tespit edilmiş iken postoperatif birinci yıl sonunda 0.5±0.7 (0-2)yürüme sırasında ise preoperatif dönemde 6±1.4(3-8) 1 yıl sonunda 1±0.7(0-2) olarak tespit edildi. AOFASpreoperatif olarak değerlendirildiğinde 67.3±12.1(38-80) postoperatif 1 yılda 92.5±9.2(68-100) tespit edildi.Tüm hastalarda osteotomi hattında kaynama görüldü. 1 hastada yara yerinde yüzeyel enfeksiyon izlendi, 1hastada ise osteotomi hattında kullanılan tespit vidasının uzunluğu nedeni ile erken dönemde implant çıkarılmışve 1 hastada osteotomi hattında bioabsorbable vida tespit için kullanılmış ve stabiliteden dolayı grafidekikonsolidasyon geç tespit edilmiş ve herhangi bir komplikasyon gelişmeden kaynama izlenmiştir. 1 hastanıntakiplerinde tibial yüzeyde subkondral skleroz tespit edilmiştir.Sonuç: Çalışmanın sonucu olarak metalik implantasyon tekniği medial çatı OKL tedavisinde başarılı bir cerrahiprosedürdür. Primer tedavinin başarısız olduğu durumlarda ve 50 yaş üstündeki vakalarda ayak bileğiartrodezi, ayak bileği artroplasti cerrahi seçeneklerinden önce tercih edilebilecek bir cerrahi yöntemdir.

Result of Partial Resurfacing Implant Ostecondral Lession as a Treatment of The Talus

Objectives: Osteochondral lesions (OCL) are the damage of the hyaline cartilage and subchondral bone on the joint surface, which may develop posttraumatically or developmentally. Primary treatment is arthroscopic debridement of the talus osteochondral defects and bone marrow stimulation. Especially after the failure of the failed primer, surgery remains a problem. Resurfacing articular implant (HemiCAP, Artrosurface) shaped in the treatment of large lesions of the medial talar roof is an alternative treatment. The purpose of this study was to examine the clinical results after HemiCAP implantation for the OCLs of the medialtalar dome, which had previously failed with surgical treatment. Material and Methods: In this study, were trospectively analyzed 17 patients who under went arthroscopic debridement bone marrow stimulation treated with OKL diagnosis, or who were treated between June 2011 and June 2015, and who were treated with a primary OCL lesion over 50 years of age and 7 men and 10 women. Patients were evaluated preoperatively and postoperatively during rest and walking on VAS pain score, AOFAS score, radiologically implant relaxation, pseudoarthros is of osteotomyline, malunion and osteoarthritis.Results:The mean age was 49.5 ± 10.3 (29-68) years. The follow-up period was 44.2 ± 11.7 (24-63) months. The VAS pain score was found to be 1.4 ± 1.2 (0-4) in the preoperative period at rest, 0.5 ± 0.7 (0-2) at the end of the first postoperative period and during walking, 6 ± 1.4 (3-8) in the preoperative period and 1 ± 0.7 (0-2) at the end of 1 year were determined. AOFAS was 67.3 ± 12.1 (38-80) preoperatively and 92.5 ± 9.2 (68-100) at 1 year postoperatively. All patients had union on the osteo to myline. In one patient, a superficial infection was observed. In one patient, the implant was remove dearly due to the length of the fixation screw used in the osteo to myline. One patient was used to fix the bioabsorbable screw in the osteo to myline and due to the stabilization, consolidation on the graft was detected late and union was observed without any complication. Subchondral scleros is was detected on the tibial surface in 1 patient’s follow-up. Conclusion: As a result of the study, metallic implantation technique is a successful surgical procedure in medial roof OKL treatment. In cases where primary care is unsuccessful and over 50 years of age, ankle arthrodesis is a surgical procedure that may be prefer red before ankle arthroplasty surgery.

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