Total Talectomy and Reconstruction Using a 3-dimensional Printed Talus Prosthesis for Ewing's Sarcoma: A 3.5-Year Follow-up

Abstract

Ewing's sarcoma is extremely rare in the foot. Below the knee amputation is indicated for most primary malignant bone tumors of the hindfoot, with few cases of successful limb salvage surgery having been reported. The use of 3-dimensional printed implants may successfully address reconstruction challenges after tumor resection. The authors present a case of a 30-year-old woman with a Ewing's sarcoma of the talus who underwent total talectomy and replacement of the entire talus with a custom-made 3-dimensional printed talar prosthesis. [ Orthopedics . 2019; 42(4):e405–e409.]

Reconstruction after Talar Tumor Resection: A Systematic Review

“…The mean ankle joint ROM in plantar/dorsiflexion in the tibiocalcaneal fusion group was 32.5 (range 30–35) [ 18 , 19 ], while that of the talar prosthesis group was 36.7 (range 25–45; Table 3 ) [ 11 , 24 , 30 ]. The mean AOFAS score in the tibiocalcaneal fusion group was 77 (range 71–83) [ 25 , 28 ], while that of the talar prosthesis group was 89 (range 86–91) [ 11 , 24 , 30 ]. The AOFAS score was higher in the group reconstructed using a talar prosthesis ( Table 3 ).…”

“…The mean leg length difference was 0.4 cm (range 0–1.5 cm) in the tibiocalcaneal fusion group [ 10 , 13 , 18 , 28 ] and 0 cm in the talar prosthesis and frozen autograft groups ( Table 3 ) [ 8 , 11 , 12 , 23 , 24 , 30 ]. The mean leg length difference in the tibiocalcaneal fusion group treated with an autograft or allograft was 0.2 cm (range 0–1 cm) [ 10 , 13 , 28 ], whereas that in the tibiocalcaneal fusion group treated without an autograft or allograft was 1.5 cm [ 18 ] ( Table 2 ).…”

“…Of the 156 studies identified in the search, 20 were finally included ( Figure 1 ; Table 1 , Table 2 and Table 3 ) [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 27 , 28 , 29 , 30 ]. There were no RCTs among them.…”

“…The previous standard surgical procedure for talar malignant tumors was below-the-knee amputation. However, with the development of effective chemotherapy agents, treatment plans, and modern surgical techniques, wide resection and limb salvage have become feasible for talar malignant tumors [ 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. Patients with sarcoma of the lower extremities who undergo limb salvage reportedly have higher Musculoskeletal Tumor Society (MSTS) scores than those who undergo amputation [ 14 , 15 , 16 ].…”

“…In patients with intermediate-grade tumors, such as osteoblastoma, giant cell tumor of the bone, epithelioid hemangioma or desmoplastic fibroma with large extraskeletal lesions, poor residual cortical bone, and curettage difficulty, marginal tumor resection is required [ 6 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. A variety of reconstruction techniques have been described for treating bone defects after talar tumor resection, including tibiocalcaneal fusion [ 7 , 9 , 10 , 13 , 17 , 18 , 19 , 20 , 21 , 22 , 25 , 27 , 28 , 29 ], reconstruction with a frozen autograft [ 8 ], and talar prostheses [ 11 , 12 , 23 , 24 , 30 ]. However, owing to their rarity, the results of each reconstruction method are not well known as they are mostly case reports.…”