1
|
Mitra K, Anastasio AT, Wu KA, Abar B, Schweitzer KM, Parekh SG, Easley ME, Adams SB. Outcomes of cobalt-chrome 3D-printed total talus replacement with and without combined total ankle replacement. Foot Ankle Surg 2024:S1268-7731(24)00161-9. [PMID: 39097425 DOI: 10.1016/j.fas.2024.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 07/08/2024] [Accepted: 07/26/2024] [Indexed: 08/05/2024]
Abstract
BACKGROUND Collapse of the talus and peri-talar arthritis pose treatment challenges due to the anatomy and location of the talus as a keystone of the foot and ankle. Custom 3D-printed total talus replacement (TTR) and combined total ankle total talus replacement (TATTR) have emerged as treatment options for these pathologies. However, the safety and efficacy of these implants is unknown due to the limited number of cases and short follow-up durations. METHODS This was a retrospective study to assess surgical outcomes of patients who underwent a TTR and TATTR with or without subtalar fusion. Patient demographics, intraoperative parameters, device related surgical and non-surgical events, imaging and clinical evaluations, and patient reported outcome (PRO) measures were compiled. RESULTS A total of 38 patients received a custom 3D-printed implant with mean follow-up time of 22.1 (range: 12-45) months. In this cohort, 7 (18.4 %) required secondary surgery and 3 (7.9 %) required implant removal. Multivariate logistic regression revealed that patient diagnosis of depression was a significant predictor of secondary surgery with an OR 17.50 (p = 0.037). Significant postoperative improvements were observed in the talocalcaneal height (p = 0.005) and talar declination angle (p = 0.013) for the TATTR group. VAS and PROMIS pain interference (PI) scores demonstrated an initial significant improvement in pain, but this improvement did not maintain significance at most recent follow-up. However, there was a significant increase in the PROMIS physical function (PF) scores (p = 0.037) at most recent follow-up. CONCLUSION These results demonstrate that TTR and TATTR provide significant improvement in post-operative radiographic foot and ankle alignment and physical function at the two-year timepoint. PRO findings suggest that patients are more active after surgery. Surgeons considering proceeding with either of these procedures should counsel patients about pain and functional outcomes as well as realistic expectations in patients with depression. LEVEL OF EVIDENCE Level 3.
Collapse
Affiliation(s)
- Kishen Mitra
- Dept. of Biomedical Engineering, Duke University, Durham, NC, United States.
| | - Albert T Anastasio
- Dept. of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States.
| | - Kevin A Wu
- Duke University School of Medicine, Durham, NC, United States.
| | - Bijan Abar
- Duke University School of Medicine, Durham, NC, United States; Dept. of Mechanical Engineering and Materials Science, Duke University, Durham, NC, United States.
| | - Karl M Schweitzer
- Dept. of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States.
| | | | - Mark E Easley
- Dept. of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States.
| | - Samuel B Adams
- Dept. of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States.
| |
Collapse
|
2
|
Pan T, Monahan KT, Zavras AG, Reynolds MJ, Weiser M, Hammarstedt JE, Westrick ER. The 3D-Printed Custom Elbow Prosthesis for Salvage Treatment of Complex Intra-Articular Distal Humerus Fracture Malunion. Hand (N Y) 2024:15589447241257642. [PMID: 38853770 DOI: 10.1177/15589447241257642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Intra-articular fractures of the distal humerus are complex injuries that often require surgery with the goal of restoring elbow range-of-motion and function. Open reduction and internal fixation has been the preferred surgical modality; however, restoration of the medial and/or lateral columns can be complicated in fractures involving a major loss of the articular surface and bony structure. Over the past decade, 3-dimensional (3D) printing has made significant advances in the field of orthopedic surgery, specifically in guiding surgeon preoperative planning. Recently, the incorporation of 3D-printing has proven to provide a safe and reliable construct for the restoration of anatomy in complex trauma cases. We present a 47-year-old woman who sustained a complex, intra-articular distal humerus fracture with associated shearing of the capitellum that went onto malunion. Patient was treated with a patient-specific 3D-printed custom elbow prosthesis with excellent outcomes. Our goal was to shed light on the use of 3D-printing technology as a viable salvage option in treating complex, intra-articular distal humeral fractures associated with lateral condylar damage that subsequently went onto malunion.
Collapse
Affiliation(s)
- Tommy Pan
- Allegheny General Hospital, Pittsburgh, PA, USA
| | | | | | | | - Michael Weiser
- Drexel University College of Medicine, Philadelphia, PA, USA
| | | | | |
Collapse
|
3
|
Faldini C, Mazzotti A, Langone L, Arceri A, Bonelli S, Zielli SO, Artioli E. Custom-made total ankle arthroplasty with patient-specific instrumentation for severe bone loss conditions: a case series. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:379-387. [PMID: 37540244 DOI: 10.1007/s00590-023-03658-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/25/2023] [Indexed: 08/05/2023]
Abstract
PURPOSE Management of bone loss around the ankle is a challenging condition. This retrospective study describes the design process, the surgical technique, and the preliminary results of custom-made total ankle arthroplasties (TAA) with patient-specific instrumentation (PSI) for different severe bone loss conditions. METHODS Consecutive patients that underwent custom-made TAA for severe bone loss conditions were included. The primary outcome was to describe the implant design in relation to the bone defect. Moreover, pre-operative and final follow-up clinical scores were compared. RESULTS Seven patients were included. Post-operative radiographs showed good correspondence between the pre-operative planning and the prosthesis alignment in all patients. Improvement in clinical scores was observed in all patients at the final follow-up. One patient developed a deep infection. CONCLUSION Short-term results reported herein are encouraging suggesting that custom-made TAA implants with PSI may represent an effective solution for ankle bone loss conditions.
Collapse
Affiliation(s)
- Cesare Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123, Bologna, Italy
| | - Antonio Mazzotti
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123, Bologna, Italy.
| | - Laura Langone
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Alberto Arceri
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Simone Bonelli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Simone Ottavio Zielli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Elena Artioli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| |
Collapse
|
4
|
Cui Y, Chen B, Wang G, Wang J, Liu B, Zhu L, Xu Q. Partial talar replacement with a novel 3D printed prosthesis. Comput Assist Surg (Abingdon) 2023; 28:2198106. [PMID: 37070416 DOI: 10.1080/24699322.2023.2198106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND The treatment of talus avascular necrosis (AVN) is challenging owing to its unique anatomical features. Despite decades of studies, till date, there is no appropriate treatment for talus AVN. Therefore, surgeons need to develop newer surgical methods. In the present study we introduce a new surgical method, 3D printed partial talus replacement (PTR), to treat partial talus necrosis and collapse (TNC). METHODS A male patient with talus AVN underwent PTR in our hospital. The morphology of the talus was quantified using 3D computed tomography (CT) imaging. A novel 3D printed titanium prothesis was designed and manufactured according to the findings of the CT imaging. The prosthesis was applied during talus replantation surgery to reconstruct the anatomical structure of the ankle. The follow-up period for this patient was 24 months. The visual analog scale (VAS) scores before and after surgery, American Orthopedic Foot and Ankle Score (AOFAS), ankle range of motion, and postoperative complications were recorded to evaluate the prognosis. RESULTS The anatomical structure of the talus was reconstructed. The patient was satisfied with the effects of treatment, recovery, and function. The VAS score decreased from 5 to 1. The AOFAS improved from 70 to 93. The range of motion remained the same as that during the pre-operation. The patient returned to a normal life. CONCLUSION 3D printed PTR is a new surgical method for talus AVN that can provide satisfactory outcomes. In future, PTR might be an effective and preferential treatment for the treatment of partial talus AVN and collapse.
Collapse
Affiliation(s)
- Yidong Cui
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Bin Chen
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Gang Wang
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Juntao Wang
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Ben Liu
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Lei Zhu
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Qingjia Xu
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, P.R. China
| |
Collapse
|
5
|
Anastasio AT, Peairs EM, Tabarestani TQ, Krez AN, Shaffrey I, Henry JK, Demetracopoulos CA, Adams SB. Evaluating Failure Mechanisms for Total Talus Replacement: Contemporary Review. Foot Ankle Spec 2023:19386400231206041. [PMID: 37905516 DOI: 10.1177/19386400231206041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
BACKGROUND As total talus replacement (TTR) grows in popularity as a salvage option for talar collapse, a critical evaluation of the complications associated with this procedure is indicated. METHODS In this review of the literature, we present a patient report and provide a review of several complications seen after TTR, including ligamentous instability, infection, and adjacent joint osteoarthritis, which we have encountered in our practice. RESULTS Total talus replacement has the potential to reduce pain and preserve range of motion. However, the treating surgeon must be cognizant of the variety of adverse outcomes. We have presented cases of potential devastating complications from our own clinical experience and the literature. CONCLUSIONS In conclusion, TTR may have utility in the properly selected patient with end-stage talar collapse, but implant composition, indications, and patient demographic variables complicate the interpretation of the literature.Levels of Evidence: Level III.
Collapse
Affiliation(s)
- Albert T Anastasio
- Department of Orthopedic Surgery, Duke University Hospital, Durham, North Carolina
| | - Emily M Peairs
- Duke University School of Medicine, Durham, North Carolina
| | | | | | - Isabel Shaffrey
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York City, New York
| | - Jensen K Henry
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York City, New York
| | | | - Samuel B Adams
- Department of Orthopedic Surgery, Duke University Hospital, Durham, North Carolina
| |
Collapse
|
6
|
Cottom JM, Badell JS, Wolf JR. Management of Talar Avascular Necrosis with Total Talus. Clin Podiatr Med Surg 2023; 40:735-747. [PMID: 37716749 DOI: 10.1016/j.cpm.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Avascular necrosis (AVN) of the talus is a difficult pathology to treat. Patient-specific factors such as functional status, comorbidities should be considered. Previous standard care for talar AVN was centered around arthrodesis procedures and loss of motion about the joints of the rearfoot and ankle. With the advent of 3D printed talar implants, patients are afforded an option to maintain ankle joint motion. Literature is limited due to the recent development of total talus replacement (TTR) technology. This article aims to review literature, surgical techniques, and pearls to better help foot and ankle surgeons treat cases of talar AVN.
Collapse
Affiliation(s)
- James M Cottom
- Florida Orthopedic Foot & Ankle Center, 5741 Bee Ridge Road, Suite 490, Sarasota, FL 34233, USA.
| | - Jay S Badell
- Florida Orthopedic Foot & Ankle Center, 5741 Bee Ridge Road, Suite 490, Sarasota, FL 34233, USA
| | - Joseph R Wolf
- Florida Orthopedic Foot & Ankle Center, 5741 Bee Ridge Road, Suite 490, Sarasota, FL 34233, USA
| |
Collapse
|
7
|
Bischoff A, Stone R, Dao T, Anderson S, Hill Z, Steginsky B, Mendicino R. Functional Outcomes and Complications Associated With Total Talus Arthroplasty: A Systematic Review. Foot Ankle Spec 2023; 16:259-266. [PMID: 35993310 DOI: 10.1177/19386400221118887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Total talus arthroplasty (TTA) is a motion sparing procedure which can be utilized in specific and unique cases of talar necrosis and/or collapse. Literature on TTA is limited and predominantly composed of case studies or case reports. The purpose of this publication is to compile a systematic review of functional outcomes and complications associated with TTA. A search of current literature on TTA with >1-year follow-up was performed. Studies that described talar body implants or talonavicular implants were excluded. Twenty articles met inclusion criteria, which represented 161 TTAs. The average follow-up was 37.35 months (9-60 months). The indication for a TTA was predominately avascular necrosis of the talus, comprising 75.78% (122/161) of cases. The overall complication rate was 9.32% (15/161), with wound healing complications (5/161), replacement or implantation of a tibial component (4/161), and medial malleolus fracture (3/161) being the most common. One patient required proximal amputation due to residual pain and deformity. Functionally, American Orthopedic Foot and Ankle Score increased from 27.93 preoperative to 81.99 postoperative and Japanese Society for Surgery of the Foot Score increased from 43.2 preoperative to 89.34 postoperative. Visual analog scale pain score decreased from 6.44 to 2.60. Total ankle range of motion increased from 36.60° to 46.74°. Ankle plantarflexion increased by 3.45° and ankle dorsiflexion increased by 6.69°. Overall, available literature on TTA appears to be in favor of the procedure when indicated.Levels of Evidence: 4.
Collapse
Affiliation(s)
- Alex Bischoff
- OhioHealth Grant Medical Center, Columbus, Ohio (AB, RS, TD, SA, ZH, BS, RM)
| | - Ryan Stone
- OhioHealth Grant Medical Center, Columbus, Ohio (AB, RS, TD, SA, ZH, BS, RM)
| | - Tung Dao
- OhioHealth Grant Medical Center, Columbus, Ohio (AB, RS, TD, SA, ZH, BS, RM)
| | - Steven Anderson
- OhioHealth Grant Medical Center, Columbus, Ohio (AB, RS, TD, SA, ZH, BS, RM)
| | - Zachary Hill
- OhioHealth Grant Medical Center, Columbus, Ohio (AB, RS, TD, SA, ZH, BS, RM)
| | - Brian Steginsky
- OhioHealth Grant Medical Center, Columbus, Ohio (AB, RS, TD, SA, ZH, BS, RM)
| | - Robert Mendicino
- OhioHealth Grant Medical Center, Columbus, Ohio (AB, RS, TD, SA, ZH, BS, RM)
| |
Collapse
|
8
|
Jennison T, Dalgleish J, Sharpe I, Davies M, Goldberg A. Total Talus Replacements. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114221151068. [PMID: 36741680 PMCID: PMC9893085 DOI: 10.1177/24730114221151068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background Total talus replacements are a surgical treatment for talar avascular necrosis (AVN) replacing the entire talus. The potential for total talus replacements has increased with the advent of patient-specific implants using 3D printing based on computed tomographic scanning of the ipsilateral or contralateral talus. The primary aim of this review is to summarize the literature on total talus replacements, providing a historical survey, indications, controversies, complications, survival, and functional outcomes. Methods A systematic review was performed. Articles with survival of total talus replacements were included. Basic percentages and a critical review of the literature was performed. Results Nine articles with 115 patients were included. The mean age ranged from 27.6 to 72 years, but with 5 studies having a mean age of <50 years. Mean follow-up ranged from 12.8 to 152 months. The most common indication was avascular necrosis in 67 patients (58%). Five studies used customized implants and 4 studies used 3D printing. Four studies used ceramic prostheses, 3 cobalt chromium, 1 stainless steel, and 1 titanium with ceramic surface. Three studies involved a talus replacement in conjunction with an ankle replacement. Postoperative complications ranged from 0% to 33%. Of 24 functional outcomes scores, 66.7% demonstrated significant improvement. Conclusion Total talus replacements are a promising alternative to tibiotalocalcaneal fusion for patients with avascular necrosis of the talus; however, further studies are required to ensure reliable outcomes prior to widespread adoption of this technology. Level of Evidence Level IV, review of case series.
Collapse
Affiliation(s)
- Toby Jennison
- Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom,Toby Jennison, FRCS, University Hospitals Plymouth NHS Trust, Derriford Road, Plymouth, PL6 8DH, United Kingdom.
| | - James Dalgleish
- Sheffield Teaching Hospitals NHS Foundation Trust, Broomhall, Sheffield, United Kingdom
| | - Ian Sharpe
- Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
| | - Mark Davies
- Sheffield Teaching Hospitals NHS Foundation Trust, Broomhall, Sheffield, United Kingdom
| | - Andrew Goldberg
- The Wellington Hospital, London, United Kingdom,Department of Surgery and Cancer, Imperial College London, London, United Kingdom,Department of Surgery, Royal Free Hospital, UCL, London, United Kingdom
| |
Collapse
|
9
|
Palmquist A, Jolic M, Hryha E, Shah FA. Complex geometry and integrated macro-porosity: Clinical applications of electron beam melting to fabricate bespoke bone-anchored implants. Acta Biomater 2023; 156:125-145. [PMID: 35675890 DOI: 10.1016/j.actbio.2022.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/16/2022] [Accepted: 06/01/2022] [Indexed: 01/18/2023]
Abstract
The last decade has witnessed rapid advancements in manufacturing technologies for biomedical implants. Additive manufacturing (or 3D printing) has broken down major barriers in the way of producing complex 3D geometries. Electron beam melting (EBM) is one such 3D printing process applicable to metals and alloys. EBM offers build rates up to two orders of magnitude greater than comparable laser-based technologies and a high vacuum environment to prevent accumulation of trace elements. These features make EBM particularly advantageous for materials susceptible to spontaneous oxidation and nitrogen pick-up when exposed to air (e.g., titanium and titanium-based alloys). For skeletal reconstruction(s), anatomical mimickry and integrated macro-porous architecture to facilitate bone ingrowth are undoubtedly the key features of EBM manufactured implants. Using finite element modelling of physiological loading conditions, the design of a prosthesis may be further personalised. This review looks at the many unique clinical applications of EBM in skeletal repair and the ground-breaking innovations in prosthetic rehabilitation. From a simple acetabular cup to the fifth toe, from the hand-wrist complex to the shoulder, and from vertebral replacement to cranio-maxillofacial reconstruction, EBM has experienced it all. While sternocostal reconstructions might be rare, the repair of long bones using EBM manufactured implants is becoming exceedingly frequent. Despite the various merits, several challenges remain yet untackled. Nevertheless, with the capability to produce osseointegrating implants of any conceivable shape/size, and permissive of bone ingrowth and functional loading, EBM can pave the way for numerous fascinating and novel applications in skeletal repair, regeneration, and rehabilitation. STATEMENT OF SIGNIFICANCE: Electron beam melting (EBM) offers unparalleled possibilities in producing contaminant-free, complex and intricate geometries from alloys of biomedical interest, including Ti6Al4V and CoCr. We review the diverse range of clinical applications of EBM in skeletal repair, both as mass produced off-the-shelf implants and personalised, patient-specific prostheses. From replacing large volumes of disease-affected bone to complex, multi-material reconstructions, almost every part of the human skeleton has been replaced with an EBM manufactured analog to achieve macroscopic anatomical-mimickry. However, various questions regarding long-term performance of patient-specific implants remain unaddressed. Directions for further development include designing personalised implants and prostheses based on simulated loading conditions and accounting for trabecular bone microstructure with respect to physiological factors such as patient's age and disease status.
Collapse
Affiliation(s)
- Anders Palmquist
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Martina Jolic
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eduard Hryha
- Department of Materials and Manufacturing Technologies, Chalmers University of Technology, Gothenburg, Sweden
| | - Furqan A Shah
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| |
Collapse
|
10
|
Chen TLW, Wang Y, Peng Y, Zhang G, Hong TTH, Zhang M. Dynamic finite element analyses to compare the influences of customised total talar replacement and total ankle arthroplasty on foot biomechanics during gait. J Orthop Translat 2022; 38:32-43. [PMID: 36313976 PMCID: PMC9579782 DOI: 10.1016/j.jot.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 07/06/2022] [Accepted: 07/28/2022] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED Objective, Total talar replacement (TTR) using a customised talus prosthesis is an emerging surgical alternative to conventional total ankle arthroplasty (TAA) for treating ankle problems. Upon satisfying clinical reports in the literature, this study explored the advantages of TTR in restoring foot biomechanics during walking compared with TAA through computational simulations.Methods, A dynamic finite element foot model was built from the MRIs of a healthy participant and modified into two implanted counterparts (TTR and TAA) by incorporating the corresponding prosthetic components into the ankle joint. Twenty bony parts, thirty-nine ligament/tendon units, nine muscle contractors, and bulk soft tissue were included in the intact foot model. The TTR prosthesis was reconstructed from the mirror image data of the participant's contralateral talus and the TAA prosthesis was modelled by reproducing the Scandinavian ankle replacement procedure in the model assembly. The model was meshed with explicit deformable elements and validated against existing experimental studies that have assessed specific walking scenarios. Simulations were performed using the boundary conditions (time-variant matrix of muscle forces, segment orientation, and ground reaction forces) derived from motion capture analyses and musculoskeletal modelling of the participant's walking gait. Outcome variables, including foot kinematics, joint loading, and plantar pressure were reported and compared among the three model conditions. RESULTS Linear regression indicated a better agreement between the TTR model and intact foot model in plots of joint motions and foot segment movements during walking (R2 = 0.721-0.993) than between the TAA and intact foot (R2 = 0.623-0.990). TAA reduced talocrural excursion by 21.36%-31.92% and increased (MTP) dorsiflexion by 3.03%. Compared with the intact foot, TTR and TAA increased the midtarsal joint contact force by 17.92% and 10.73% respectively. The proximal-to-distal force transmission within the midfoot was shifted to the lateral column in TTR (94.52% or 210.54 N higher) while concentrated on the medial column in TAA (41.58% or 27.55 N higher). The TTR produced a plantar pressure map similar to that of the intact foot. TAA caused the plantar pressure centre to drift medially and increased the peak forefoot pressure by 7.36% in the late stance. CONCLUSION The TTR better reproduced the foot joint motions, segment movements, and plantar pressure map of an intact foot during walking. TAA reduced ankle mobility while increasing movement of the adjacent joints and forefoot plantar pressure. Both implant methods changed force transmission within the midfoot during gait progression.The translational potential of this article Our work is one of the few to report foot segment movements and the internal loading status of implanted ankles during a dynamic locomotion task. These outcomes partially support the conjecture that TTR is a prospective surgical alternative for pathological ankles from a biomechanical perspective. This study paves the way for further clinical investigations and systematic statistics to confirm the effects of TTR on functional joint recovery.
Collapse
Affiliation(s)
- Tony Lin-Wei Chen
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China,Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yan Wang
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China,The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, Guangdong, China,Research Institute for Sports Science and Technology, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Yinghu Peng
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology Chinese Academy of Sciences, Shenzhen, Guangdong, China
| | - Guoxin Zhang
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Tommy Tung-Ho Hong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Ming Zhang
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China,The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, Guangdong, China,Research Institute for Sports Science and Technology, The Hong Kong Polytechnic University, Hong Kong SAR, China,Corresponding author. Department of Biomedical Engineering, Faculty of Engineering The Hong Kong Polytechnic University, Hung Hom, Kowloon, SAR, Hong Kong, China.
| |
Collapse
|
11
|
Mazzotti A, Viglione V, Gerardi S, Bonelli S, Zielli S, Geraci G, Faldini C. Post-operative management after total ankle arthroplasty: A systematic review of the literature. Foot Ankle Surg 2022; 28:535-542. [PMID: 34088605 DOI: 10.1016/j.fas.2021.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/20/2021] [Accepted: 05/26/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Currently, there is no consensus on the most appropriate post-operative management for patients undergoing total ankle arthroplasty. The aim of this study is therefore to offer a systematic review of the pertaining literature to identify current post-operative protocols and describe possible differences. METHODS A systematic review to identify recent studies concerning the post-operative management after total ankle arthroplasty was conducted. Five topics were analyzed: length of hospital stay, type and duration of immobilization, weight-bearing management, post-operative pharmacological therapies, adopted rehabilitation scheme. RESULTS Eighty-four studies met the inclusion criteria and were included in the review process. Most of the papers appear to have conflicting opinions with no consensus and homogeneous protocols. CONCLUSION Due to various methodological limitations, it is not possible to provide sufficiently supported evidence-based recommendations, and it is therefore difficult to determine the superiority of one post-operative protocol over the others after total ankle arthroplasty.
Collapse
Affiliation(s)
- A Mazzotti
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
| | - V Viglione
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - S Gerardi
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - S Bonelli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - S Zielli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - G Geraci
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - C Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123, Bologna, Italy
| |
Collapse
|
12
|
Advances in the Application of Three-dimensional Printing for the Clinical Treatment of Osteoarticular Defects. Curr Med Sci 2022; 42:467-473. [PMID: 35451806 DOI: 10.1007/s11596-022-2565-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 10/26/2021] [Indexed: 11/03/2022]
Abstract
As a promising manufacturing technology, three-dimensional (3D) printing technology is widely used in the medical field. In the treatment of osteoarticular defects, the emergence of 3D printing technology provides a new option for the reconstruction of functional articular surfaces. At present, 3D printing technology has been used in clinical applications such as models, patient-specific instruments (PSIs), and customized implants to treat joint defects caused by trauma, sports injury, and tumors. This review summarizes the application status of 3D printing technology in the treatment of osteoarticular defects and discusses its advantages, disadvantages, and possible future research strategies.
Collapse
|
13
|
Madi NS, Chopra A, Parekh SG. Three-Dimensional-Printed Lesser Metatarsal Replacement: The First Case Report. Foot Ankle Spec 2022:19386400221088455. [PMID: 35440185 DOI: 10.1177/19386400221088455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Different procedures have been reported for severe and recurrent lesser toes deformity. These included DuVries metatarsophalangeal joint arthroplasty, resection arthroplasty, partial proximal phalangectomy, syndactylization, or lesser toe amputation. In the presence of a failed metatarsal head resection, the surgeon is faced with limited salvage options including Hoffman procedure or lesser toe amputation. The 3D printing technology has allowed orthopaedic surgeons to expand the therapeutic arsenal to address challenging situations. We herein present the first case of 3D-printed second lesser metatarsal replacement performed after a failed second metatarsal head resection.Level of Evidence: V.
Collapse
Affiliation(s)
- Naji S Madi
- Foot & Ankle Surgery, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | | | - Selene G Parekh
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
14
|
Zhang H, Fletcher AN, Scott DJ, Nunley J. Avascular Osteonecrosis of the Talus: Current Treatment Strategies. Foot Ankle Int 2022; 43:291-302. [PMID: 34753345 DOI: 10.1177/10711007211051013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Avascular osteonecrosis (AVN) of the talus (AVNT) is a painful and challenging clinical diagnosis. AVNT has multiple known risk factors and etiologies and presents at different stages in severity. Given these unique factors, the optimal treatment solution has yet to be determined. Both joint-preserving and joint-sacrificing procedures are available, including core decompression and arthrodeses. Recently, new salvage and replacement techniques have been described including vascularized pedicle bone grafts and total talus replacement using patient-specific prosthesis; however, evidence remains limited. This review examines the current trends AVNT treatment and the emerging data behind these novel techniques.
Collapse
Affiliation(s)
- Hanci Zhang
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Amanda N Fletcher
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Daniel J Scott
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - James Nunley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
15
|
Grau D, Matamala A, Bernaus M, Veloso M, Anglès F, Poggio D, Font-Vizcarra L. A 3D-Printed Model of a Titanium Custom-Made Talus for the Treatment of a Chronic Infection of the Ankle. J Foot Ankle Surg 2022; 61:212-217. [PMID: 34702679 DOI: 10.1053/j.jfas.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/07/2020] [Accepted: 09/06/2021] [Indexed: 02/03/2023]
Abstract
Osteoarticular infections are challenging and difficult to treat. The use of innovative technologies like 3D printing already employed in other types of surgeries and pathologies can suppose a great asset to tackle the problem and improve functional results. We present a case of an osteoarticular infection of an ankle treated with a custom-made titanium talus made with 3D metal printing technology: A 63-year-old patient, with chronic infection of the ankle. A 2-staged surgery was performed, with a hand-made cement spacer used during the first stage and the implantation of a custom-made titanium talus with an arthrodesis nail in the second stage. After a 2-year follow-up, a good clinical evolution was achieved, with no signs of reactivation of the infection, no pain, good skin condition and optimal functionality: functional gait pattern without pain and any external aids.
Collapse
Affiliation(s)
- Daniel Grau
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, Spain
| | - Alfredo Matamala
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, Spain; Orthopaedic Surgeon, Bone and Joint Infection Unit, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, Spain
| | - Martí Bernaus
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, Spain; Orthopaedic Surgeon, Bone and Joint Infection Unit, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, Spain
| | - Margarita Veloso
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, Spain; Orthopaedic Surgeon, Bone and Joint Infection Unit, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, Spain
| | - Francesc Anglès
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, Spain; Professor, Department of Surgery, University of Barcelona, Barcelona, Spain
| | - Daniel Poggio
- Foot & Ankle Surgeon, Foot and Ankle Unit, Department of Orthopaedic Surgery, Hospital Clínic Barcelona, Barcelona, Spain
| | - Lluís Font-Vizcarra
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, Spain; Orthopaedic Surgeon, Bone and Joint Infection Unit, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, Spain.
| |
Collapse
|
16
|
Gunasekeran C, Bhowmick K, Ramasamy B, Jepegnanam TS. Ankle Height Preservation with the Hind Foot Nail and Iliac Crest Bone Blocks in Patients with Sequelae of Partial or Complete Talus Bone Loss. Malays Orthop J 2021; 15:91-98. [PMID: 34966501 PMCID: PMC8667246 DOI: 10.5704/moj.2111.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 08/06/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction: The management of talus bone loss in trauma is difficult and unsatisfactory. This study assessed whether the height of the ankle was preserved when entire or partial talar bone loss was managed with hind foot intramedullary nail augmented with autogenous rectangular or trapezoidal cortico-cancellous bone blocks from the iliac crest in the presence of active or latent infection. Materials and methods: Four patients were included in the study from January 2011 to December 2017. In the first stage, all four patients underwent debridement of the ankle, total or partial excision of the talus, and antibiotic-loaded bone cement spacer (ALBC) placement in the ankle joint. The second stage of the arthrodesis procedure was initiated six to eight weeks after the primary procedure, where these patients underwent arthrodesis with hindfoot nail and bone blocks from the iliac crest. Results: All patients were followed-up for an average of 17.6 months (range 12.0 – 32.0 months). The arthrodesis site had united in all these four patients. The AOFAS scores were satisfactory in all patients. One patient underwent nail removal after the arthrodesis site had united. Conclusions: The hind foot nail with iliac crest bone block maintains the ankle height and ensures successful arthrodesis. In patients with partial/ complete bone loss with suspicion or confirmation of infection, staging the arthrodesis procedure minimises the chance of complications.
Collapse
Affiliation(s)
- C Gunasekeran
- Department of Orthopaedics, Christian Medical College and Hospital Vellore, Vellore, India
| | - K Bhowmick
- Department of Orthopaedics, Christian Medical College and Hospital Vellore, Vellore, India
| | - B Ramasamy
- Department of Orthopaedics, Royal Adelaide Hospital, Adelaide, Australia
| | - T S Jepegnanam
- Department of Orthopaedics, Christian Medical College and Hospital Vellore, Vellore, India
| |
Collapse
|
17
|
Sharma A, Kirkland KS, Holloway RM, Parekh SG. Incorporating 3D Printing Into Your Practice: Lessons Learned. Foot Ankle Spec 2021; 14:361-365. [PMID: 33345599 DOI: 10.1177/1938640020980912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Three-dimensional (3D) printing has greatly benefited medicine, manufacturing vital organs like skin, hearts, kidneys, and livers. Early studies on 3D printing in surgery have consistently reported decreased operative time and improved precision. This technology has gained popularity with orthopaedic surgeons in knee, hip, and shoulder surgeries because 3D printing is associated with enhancing osseointegration. However, this innovation is still not commonly used among foot and ankle surgeons; one reason is that whereas the literature on 3D printing-assisted surgery is populated with studies on operative techniques and clinical outcomes, there exists an ambiguity on how to incorporate this feature into the clinic. Thus, the aim of this technology column is to consolidate and standardize a workflow to guide foot and ankle surgeons on integrating 3D printing into one's practice. We describe a model developed by a single surgeon at one institution who directs a large caseload of 3D-printed foot and ankle surgeries. From the initial patient visit to the interaction between the surgeon and the implant engineering team, to documentation of data adding to the preliminary literature, this work has great implications on streamlining the assimilation of a highly successful technology to improve foot and ankle surgery for both surgeons and patients.Level of Evidence: Level V.
Collapse
Affiliation(s)
- Akhil Sharma
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Kyle S Kirkland
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Robert M Holloway
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Selene G Parekh
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
18
|
West TA, Rush SM. Total Talus Replacement: Case Series and Literature Review. J Foot Ankle Surg 2021; 60:187-193. [PMID: 33218861 DOI: 10.1053/j.jfas.2020.08.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/23/2020] [Indexed: 02/03/2023]
Abstract
Custom 3D printed total talus implants have been used successfully as a functional alternative to arthrodesis or amputation in cases of severe talar destruction or loss. However, the ideal material and construct still remains to be elucidated. Current models have been made from aluminum ceramic, cobalt chrome, stainless steel, titanium, or metal combinations. The implants may be constrained (subtalar arthrodesis) or unconstrained (press fit within mortise). They may also be combined with a tibial prosthesis or used in isolation. The majority of currently published case studies examine unconstrained and isolated implants. This case study presents satisfactory 1-y outcomes in 3 cobalt chrome constrained total talar implants used in combination with a tibial prosthesis, and a literature review of total talus replacements.
Collapse
Affiliation(s)
- Tenaya A West
- Podiatric Surgical Fellow, Silicon Valley Reconstructive Foot and Ankle Fellowship, Palo Alto Medical Foundation, Mountain View CA.
| | - Shannon M Rush
- Attending Surgeon, Tri-Valley Orthopedic Specialists, Pleasanton CA
| |
Collapse
|
19
|
Dimitrov AS, Westover L, Jomha NM. Clinical Use of Talar Prostheses. JBJS Rev 2021; 9:01874474-202106000-00004. [PMID: 34101700 DOI: 10.2106/jbjs.rvw.20.00209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» The blood supply to the talus is vulnerable to damage, making the talus susceptible to osteonecrosis, with limited treatment options. » Talar bone replacement has been investigated as a treatment option to preserve ankle function and maintain limb length. » Successful talar bone replacements have been performed for the past >35 years, with variations in design, methods of fixation, materials, and manufacturing techniques. » The designs of talar prostheses range from custom-made partial (talar body) or total prostheses to prefabricated universal (non-custom-made) prostheses. » Total talar prostheses have been demonstrated to function better than partial talar prostheses; however, there is a need for long-term studies regarding custom-made total talar prostheses and prefabricated universal talar prostheses in order to determine their long-term effectiveness.
Collapse
Affiliation(s)
- Andrea S Dimitrov
- School of Medicine, College of Medicine, Nursing & Health Sciences, National University of Ireland Galway, Galway, Ireland.,Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Lindsey Westover
- Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Nadr M Jomha
- Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
20
|
Mu MD, Yang QD, Chen W, Tao X, Zhang CK, Zhang X, Xie MM, Tang KL. Three dimension printing talar prostheses for total replacement in talar necrosis and collapse. INTERNATIONAL ORTHOPAEDICS 2021; 45:2313-2321. [PMID: 33666766 PMCID: PMC8494653 DOI: 10.1007/s00264-021-04992-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 02/17/2021] [Indexed: 12/27/2022]
Abstract
Background Reconstructing bone structures and stabilizing adjacent joints are clinical challenges in treating talar necrosis and collapse (TNC). 3D printing technology has been demonstrated to improve the accuracy of talar replacement. This study aimed to evaluate anatomical talar replacement and the clinical results. Methods Nine patients with TNC were enrolled between 2016 and 2020. The prosthetic shape and size were designed by CT post-processing and mirror symmetry technology. The clinical outcomes included radiographic parameters of the forefoot, hindfoot, and ankle alignment, ankle activity, recurrent pain, and peri-operative complications. Results After a mean follow-up of 23.17 ± 6.65 months, degenerative arthritis and prosthetic dislocation and other complications were not observed on plain radiographs. Each 3D-printed talar prosthesis was placed in the original anatomical position. The parameters which have significant changes pre-operative and post-operative are as follows: talar height, 27.59 ± 5.99 mm and 34.56 ± 3.54 mm (95% CI − 13.05 to − 0.87, t = 2.94, P = 0.032) and Meary’s angle, 11.73 ± 4.79° and 4.45 ± 1.82° (95% CI 1.29~22.44, t = 2.89, P = 0.034). The AOFAS hindfoot score improved from 26.33 ± 6.62 to 79.67 ± 3.14 at the final follow-up (95% CI 43.36~63.30, t = 13.75, P = 0.000). The VAS score decreased from 6.33 ± 1.03 to 0.83 ± 0.75 (95% CI 4.40~6.60, t = 12.84, P = 0.000). The post-operative satisfaction scores regarding pain relief, activities of daily living, and return to recreational activities were good to excellent, and the change of activity range was statistically significant. Conclusions The 3D printing patient-specific total talar prostheses allowed anatomical reconstruction in TNC. This novel treatment with 3D-printed prostheses could serve as a reliable patient-specific alternative in TNC.
Collapse
Affiliation(s)
- Mi Duo Mu
- The First Affiliated Hospital of Military Medical University of the Army, Chongqing, China
| | - Qian Dong Yang
- The First Affiliated Hospital of Military Medical University of the Army, Chongqing, China
| | - Wan Chen
- The First Affiliated Hospital of Military Medical University of the Army, Chongqing, China
| | - Xu Tao
- The First Affiliated Hospital of Military Medical University of the Army, Chongqing, China
| | - Cheng Ke Zhang
- The First Affiliated Hospital of Military Medical University of the Army, Chongqing, China
| | - Xuan Zhang
- The First Affiliated Hospital of Military Medical University of the Army, Chongqing, China
| | - Mei Ming Xie
- The General Hospital of Western Theater Command, Chengdu, China.
| | - Kang Lai Tang
- The First Affiliated Hospital of Military Medical University of the Army, Chongqing, China.
| |
Collapse
|
21
|
Conti MS, Ellington JK, Behrens SB. Osteochondral Defects of the Talus: How to Treat Without an Osteotomy. Clin Sports Med 2020; 39:893-909. [PMID: 32892974 DOI: 10.1016/j.csm.2020.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Surgical management of osteochondral lesions of the talus without an osteotomy depends on the size, location, and chronicity of the lesion. Bone marrow stimulation techniques, such as microfracture, can be performed arthroscopically and have consistently good outcomes in lesions less than 1 cm in diameter. For lesions not amenable to bone marrow stimulation, one-stage techniques, such as allograft cartilage extracellular matrix and allograft juvenile hyaline cartilage, may be used. Arthroscopy may be used in many cases to address these lesions; however, an arthrotomy may be required to use osteochondral autograft and allograft transplantation techniques.
Collapse
Affiliation(s)
- Matthew S Conti
- Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY 10021, USA
| | - J Kent Ellington
- OrthoCarolina Foot & Ankle Institute, 2001 Vail Avenue, Charlotte, NC 28207, USA
| | - Steve B Behrens
- Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY 10021, USA.
| |
Collapse
|