Application of 3D‐printed Customized Guides in Subtalar Joint Arthrodesis

Abstract

Objective To explore the feasibility of 3D printed customized guides assisting the precise drilling of Kirschner wires in subtalar joint arthrodesis. Methods We retrospectively reviewed the data of 29 patients (30 subtalar joints) who underwent subtalar joint arthrodesis between 1 July 2013 and 31 December 2017. The customized guides were designed on a full‐scale 3D polylactic acid model made from computed tomography (CT) data of patients by Model Intestinal Microflora in Computer Simulation (MIMICS) software, which were manufactured by 3D printing technology. A total of 14 joints used customized guides (experimental group); the remained 16 joints used the traditional method (control group). The time of drilling the Kirschner wires to the correct position, the time of subtalar fusion, American Orthopaedic Foot & Ankle Society (AOFAS) scores, and complications were evaluated in both groups. Results All customized guides were successfully manufactured. In the experimental group, it took 2.1 ± 0.7 min to drill the Kirschner wire to the satisfactory position, and 2 cases needed to be re‐drilled; in the control group, it took 4.6 ± 1.9 min to drill the Kirschner wire to the satisfactory position (P < 0.05), and 8 cases needed to be re‐drilled. No serious complications occurred in both groups during and after the surgery. Postoperative radiographic fusion was confirmed in all cases. No significant difference was observed in the fusion time and AOFAS scores 1 year postoperatively between the two groups (P > 0.05). Conclusion It is safe to apply 3D‐printed customized guides for subtalar joint arthrodesis, which can assist the accurate drilling of Kirschner wires into the appropriate position according to the preoperative plan, and reduce the operation time as well as intraoperative radiation.

3D Printed Models Improve Surgical Planning for Correction of Severe Postburn Ankle Contracture With External Fixator

“…activity limitation and support requirement, maximum walking distance, walking surfaces, gait abnormality, sagittal motion, hindfoot motion, and ankle stability), and 10 points of alignment [36]. Duan et al [23] demonstrated comparable AOFAS scores between the 3DPM and control group in the treatment of ankle deformities. In the study by Zhang et al [35], comparable AOFAS scores between the 3D printing group and the conventional group (87.4 vs. 84.7) were noted.…”

“…Previous studies have shown that the use of 3DPM is associated with decreased surgical time and intraoperative X-ray exposure, as well as increased operative accuracy and safety compared to traditional imaging in the treatment of ankle deformities [21,22]. Duan et al [23] found that preoperative planning with 3DPM facilitated accurate drilling of K-wires into the appropriate position, reduced the operation time and intraoperative radiation in 29 patients who underwent subtalar joint arthrodesis. A randomized controlled trial by Zheng et al [24] showed that 3DPMassisted surgical planning had shorter operation duration, less blood loss and X-ray exposure, as well as better anatomic reduction and clinical outcomes than conventional surgery in 100 patient with Pilon fractures.…”

“…A randomized trial by Zheng et al [24] showed shorter operation time in the 3DPM-assisted group than the conventional group (74 mins vs. 90 mins) in the treatment of Pilon fractures in 100 patients. Duan et al [23] noted shorter time for accurate drilling of a K-wire to the satisfactory position (2.1 mins vs. 4.6 mins) and fewer number of re-drills (2 cases vs. 8 cases) in 14 joints under 3DPM assistance than 16 joints using traditional method during subtalar joint arthrodesis. In addition, Corona et al [27] reported that the average surgical time in 9 patients who underwent 3DPM-assisted preoperative surgical planning was about half of the time in 10 patients with traditional planning (172 mins vs. 329 mins) in the treatment of post-traumatic tibial malunion and non-union using circular external xation.…”

Clinical applications of custom 3D printed implants in complex lower extremity reconstruction

“…Several studies have demonstrated that patient specific instrumentation is accurate and reproducible performing total ankle arthroplasty [10,11]. 3D printed custom guides have also been designed for subtalar joint arthrodesis, and a recently published study found that these guides reduced operative time and radiation exposure from fluoroscopy [12].…”

Mid‐term Results of Subtalar Arthroereisis with Talar‐Fit Implant in Pediatric Flexible Flatfoot and Identifying the Effects of Adjunctive Procedures and Risk Factors for Sinus Tarsi Pain

“…However, they do not actually address the deformity of the subtalar joint complex, and patients are faced with the risk of nonunion or malunion and a longer recovery time. Arthrodesis should be avoided if at all possible because of the loss of the shock‐absorbing function of the subtalar joint complex and the tendency to develop early degenerative arthritis in adjacent joints 4–6 . STA refers to the implantation of a device in the sinus tarsi to restrict excessive eversion of the subtalar joint and consequently correct the flatfoot deformity.…”