3D Printed Total Talus Replacement for Avascular Necrosis of the Talus

Abstract

Background: Talus avascular necrosis (AVN) is a challenging entity to treat. Management options depend on disease severity and functional goals. Total talus replacement (TTR) is a treatment option that maintains joint range of motion. The literature on TTR is limited with variability in implant design and material. The purpose of this study was to evaluate outcomes following TTR with a custom 3D printed metal implant. Methods: Patients who underwent TTR were retrospectively reviewed over a 3-year period. Basic demographic data and comorbidities were collected. Medical records were reviewed to obtain postoperative and preoperative visual analog scale (VAS) scores, Foot and Ankle Outcome Scores (FAOSs), ankle range of motion, and postoperative complications. Statistical analysis was conducted to compare clinical and patient-reported outcomes pre- and postoperatively. Twenty-seven patients underwent TTR for talar AVN with a mean follow-up of 22.2 months. Results: Ankle range of motion remained unchanged postoperatively. VAS pain scores improved postoperatively from 7.1 to 3.9 ( P < .001). FAOSs improved postoperatively with regard to pain ( P < .001), symptoms ( P = .001), quality of life ( P < .001), and activities of daily living ( P < .001). There were 3 complications requiring reoperation in this cohort. Discussion: 3D printed TTRs represent a unique surgical option for patients with severe talar AVN. Patients in this cohort demonstrated significant improvements in pain scores and patient-reported outcomes. TTR allows for symptomatic improvement with the preservation of motion in individuals with talar collapse and AVN. Level of Evidence: Level IV, retrospective case series.

WITHDRAWN: Establishment of a Finite Element Model and Biomechanical Analysis of Different Fixation Methods for Total Talar Prosthesis Replacement

“…Regardless of whether the subtalar joint or subtalar joint is fused, the degree of exibility and range of motion of the foot are affected [13]. If we choose not to x the talar prosthesis [11,12] and use the bony structure of the talus between the ankle points and the ankle-foot complex to obtain self-stability, damage to the adjacent articular cartilage and complications such as prosthesis dislocation may occur. The clinical e cacy of different xation methods has also been assessed in many studies.…”

“…The casting process and surgical indications for the prosthesis are very similar to those used for the conventional method, but the method of prosthesis xation is different. In previous studies by Kadakia et al [11] and Tracy et al [12], the peritalar soft tissue was directly removed without xation of the talar prosthesis with screws. In studies conducted in China, screws have been used to x only the subtalar joint [13] or both the subtalar joint and the subtalar joint at the same time.…”

Three dimension printing talar prostheses for total replacement in talar necrosis and collapse

“…Considering the newly published study about 3D-printed custom talar prothesis by Rishin J. Kadakia [28,29], this study is quite different. The concrete differences are as follows: (1) different casting methods of prostheses, each adjacent joint surface of the prosthesis has been specially treated; there is also the difference between the bioactive 3D-printed personalized talus prosthesis and the traditional 3D-printed talus prosthesis.…”

Avascular Necrosis of the Talus After Subchondroplasty

“…Although a causal relationship cannot be determined, it is important that surgeons be aware of this devastating potential complication. 11 It is also important to note that 3 of the 7 patients that developed AVN had prior risk factors. Although some risk factors may be uncovered in a normal history and physical examination, many of these risk factors are not routinely solicited by the treating physician.…”