The use of a 3D printed titanium implant for arthrodesis in the management of large osseous defects in the ankle

Andrew Strydom; Nikiforos P Saragas; Paulo Nf Ferrao

doi:10.1016/j.fas.2023.05.005

The use of a 3D printed titanium implant for arthrodesis in the management of large osseous defects in the ankle

Foot Ankle Surg. 2023 Dec;29(8):576-583. doi: 10.1016/j.fas.2023.05.005. Epub 2023 May 24.

Authors

Andrew Strydom¹, Nikiforos P Saragas², Paulo Nf Ferrao³

Affiliations

¹ Consultant Foot and Ankle Surgeon, Suite 3A, -2 Level, Westwing, Netcare Sunninghill Hospital, Cnr Nanyuki & Witkoppen Road, Sunninghill, 2157, South Africa. Electronic address: drewstrydom@hotmail.com.
² The Orthopaedic Foot and Ankle Unit, Suite 303 Netcare Linksfield Hospital, 24 12th Avenue, Linksfield West, 2192, Johannesburg, South Africa; Honorary Adjunct Professor and Head, Foot and Ankle Unit, Division of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa.
³ The Orthopaedic Foot and Ankle Unit, Suite 303 Netcare Linksfield Hospital, 24 12th Avenue, Linksfield West, 2192, Johannesburg, South Africa; Foot and Ankle Unit, Division of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa.

PMID: 37833130
DOI: 10.1016/j.fas.2023.05.005

Abstract

Background: Large osseous defects (LOD) in the ankle occur because of multiple aetiologies. Advancement in 3-dimensional (3D) printing technologies has led to the use of custom implants and instrumentation their management. A 3D printed patient-specific porous titanium cage which allows for peripheral osteo-integration and autogenous bone-grafting could be an ideal implant in these cases.

Methods: Retrospective review of a multi-centre, multi-surgeon consecutive cohort of patients requiring either TTC or AA for a large osseous defect between June 2019 - August 2020. A custom titanium prosthesis was 3D-printed according to CT measurements for implantation.

Results: Mean follow up was 19.5 months (range 12-24 months). Plain radiographs and CT scans at 12 months confirmed osseointegration (stability) in 11of 13 patients (84%). Two patients developed late infection, one requiring revision surgery.

Conclusions: 3D-Printed titanium implants in the management of LODs in the ankle offer a comparable success rate to other reported procedures, with unlimited geometric possibilities in the design allowing for accurate length correction. Their structural stability may offer an advantage over conventional bone graft techniques and limits the amount of bone-graft required.

Levels of evidence: LOE III.

Keywords: 3D-printed implants; Large osseous defect; Revision total ankle arthroplasty.

MeSH terms

Ankle*
Arthrodesis
Humans
Printing, Three-Dimensional
Prostheses and Implants
Titanium*

Substances

Titanium