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He X, Lu M, Zou C, Li Z, Gong T, Kenmegne GR, Wang Y, Luo Y, Zhou Y, Min L, Tu C. Three-dimensional printed custom-made modular talus prosthesis in patients with talus malignant tumor resection. J Orthop Surg Res 2024; 19:273. [PMID: 38698477 PMCID: PMC11064297 DOI: 10.1186/s13018-024-04728-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 04/06/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Talar malignant tumor is extremely rare. Currently, there are several alternative management options for talus malignant tumor including below-knee amputation, tibio-calcaneal arthrodesis, and homogenous bone transplant while their shortcomings limited the clinical application. Three-dimensional (3D) printed total talus prosthesis in talus lesion was reported as a useful method to reconstruct talus, however, most researches are case reports and its clinical effect remains unclear. Therefore, the current study was to explore the application of 3D printed custom-made modular prosthesis in talus malignant tumor. METHODS We retrospectively analyzed the patients who received the 3D printed custom-made modular prosthesis treatment due to talus malignant tumor in our hospital from February 2016 to December 2021. The patient's clinical data such as oncology outcome, operation time, and volume of blood loss were recorded. The limb function was evaluated with the Musculoskeletal Tumor Society 93 (MSTS-93) score, The American Orthopedic Foot and Ankle Society (AOFAS) score; the ankle joint ranges of motion as well as the leg length discrepancy were evaluated. Plain radiography and Tomosynthesis-Shimadzu Metal Artefact Reduction Technology (T-SMART) were used to evaluate the position of prosthesis and the osseointegration. Postoperative complications were recorded. RESULTS The average patients' age and the follow-up period were respectively 31.5 ± 13.1 years; and 54.8 months (range 26-72). The medium operation time was 2.4 ± 0.5 h; the intraoperative blood loss was 131.7 ± 121.4 ml. The mean MSTS-93 and AOFAS score was 26.8 and 88.5 respectively. The average plantar flexion, dorsiflexion, varus, and valgus were 32.5, 9.2, 10.8, and 5.8 degree respectively. One patient had delayed postoperative wound healing. There was no leg length discrepancy observed in any patient and good osseointegration was observed on the interface between the bone and talus prosthesis in all subjects. CONCLUSION The modular structure of the prosthesis developed in this study seems to be convenient for prosthesis implantation and screws distribution. And the combination of solid and porous structure improves the initial stability and promotes bone integration. Therefore, 3D printed custom-made modular talus prosthesis could be an alternative option for talus reconstruction in talus malignant tumor patients.
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Affiliation(s)
- Xuanhong He
- Department of Orthopedics, Orthopedic Research Institute, Trauma Center West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
- Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Minxun Lu
- Department of Orthopedics, Orthopedic Research Institute, Trauma Center West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
- Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Chang Zou
- Department of Orthopedics, Orthopedic Research Institute, Trauma Center West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
- Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Zhuangzhuang Li
- Department of Orthopedics, Orthopedic Research Institute, Trauma Center West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
- Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Taojun Gong
- Department of Orthopedics, Orthopedic Research Institute, Trauma Center West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
- Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Guy Romeo Kenmegne
- Department of Orthopedics, Orthopedic Research Institute, Trauma Center West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yitian Wang
- Department of Orthopedics, Orthopedic Research Institute, Trauma Center West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
- Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yi Luo
- Department of Orthopedics, Orthopedic Research Institute, Trauma Center West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
- Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yong Zhou
- Department of Orthopedics, Orthopedic Research Institute, Trauma Center West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
- Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Li Min
- Department of Orthopedics, Orthopedic Research Institute, Trauma Center West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
- Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Chongqi Tu
- Department of Orthopedics, Orthopedic Research Institute, Trauma Center West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
- Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.
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Eskew J, Reynolds Z, Jenkins J, Sridhar M. Primary total talus arthroplasty for Hawkins type IV talar neck fracture dislocation. BMJ Case Rep 2024; 17:e259005. [PMID: 38423577 PMCID: PMC10910409 DOI: 10.1136/bcr-2023-259005] [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: 03/02/2024] Open
Abstract
A woman in her 40s was involved in a motor vehicle collision and sustained a closed Hawkins type IV talar neck fracture dislocation. The injury was treated with reduction, percutaneous pinning and spanning external fixation, followed by definitive treatment with total talus arthroplasty (TTA) 2 months following injury. This is a unique example of definitive management for a severe talar neck fracture dislocation with arthroplasty in the subacute setting. TTA is perhaps a primary option for these injuries at high risk for avascular necrosis, non-union, malunion and post-traumatic arthritis.
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Affiliation(s)
- Joshua Eskew
- Orthopedic Surgery, Prisma Health Upstate, Greenville, South Carolina, USA
| | - Zachary Reynolds
- Orthopedic Surgery, Prisma Health Upstate, Greenville, South Carolina, USA
| | - Joshua Jenkins
- University of South Carolina School of Medicine Greenville Campus, Greenville, South Carolina, USA
| | - Michael Sridhar
- Orthopedic Surgery, Prisma Health Upstate, Greenville, South Carolina, USA
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3
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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.
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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
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4
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Tabarestani TQ, Anastasio AT, Lukosius EZ, Schweitzer KM. A Novel Technique for Lateral Ankle Ligament Reconstruction with Total Ankle Total Talus Replacement: A Case Report. JBJS Case Connect 2023; 13:01709767-202306000-00033. [PMID: 37205776 DOI: 10.2106/jbjs.cc.22.00643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
CASE A 65-year-old man with severe left talar avascular necrosis, arthritis, and chronic lateral ankle instability underwent total ankle total talus replacement (TATTR) with lateral ligament reconstruction. Tibial component placement was performed using preoperative computed tomography navigation and patient-specific guides. A custom, total talus replacement to mate with the fixed-bearing tibial component was implanted. Last, a modified Brostrom procedure was performed to restore lateral ankle stability. The patient has performed well through 1 year with improved pain-free function. CONCLUSION This case report details a novel technique for performing a modified Brostrom procedure in conjunction with TATTR to restore lateral ankle stability.
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Affiliation(s)
| | - Albert T Anastasio
- Department of Orthopedic Surgery, Duke University Hospital, Durham, North Carolina
| | - Eric Z Lukosius
- Department of Orthopedic Surgery, Duke University Hospital, Durham, North Carolina
| | - Karl M Schweitzer
- Department of Orthopedic Surgery, Duke University Hospital, Durham, North Carolina
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5
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Anastasio AT, Tabarestani TQ, Schweitzer Jr KM. Exploring the Possibilities of the Custom Total Ankle Total Talus Replacement (TATTR): Short-Form Technique for Adjunctive Lateral Ligamentous Reconstruction With TATTR. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231153141. [PMID: 36776532 PMCID: PMC9909055 DOI: 10.1177/24730114231153141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Affiliation(s)
- Albert T. Anastasio
- Department of Orthopedic Surgery, Duke University Hospital, Durham, NC, USA,Albert T. Anastasio, MD, Department of Orthopedic Surgery, Duke University Hospital, 2301 Erwin Rd, Durham, NC 27710, USA.
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Sato G, Saengsin J, Sornsakrin P, Bhimani R, Lubberts B, Taniguchi A, DiGiovanni C, Tanaka Y. The stability of total talar prosthesis-How stable to dislocation? Cadaveric study. J Orthop Res 2022; 40:2189-2195. [PMID: 34897786 DOI: 10.1002/jor.25237] [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: 05/16/2021] [Revised: 09/24/2021] [Accepted: 11/27/2021] [Indexed: 02/04/2023]
Abstract
The aim of this study was to characterize ankle stability of total talar prosthesis (TTP) and to determine the effect of implant sizes on stability as well as the resistance to TTP dislocation. Twelve below-knee cadaveric specimens were divided into two groups. Group 1 received a size matched implant and Group 2 received downsized implant by 5%. The stability assessment under fluoroscopy was performed for each cadaver in its native state. Following TTP insertion process, each then underwent evaluation of the TTP ankle stability. The stability of pre- and post-TTP was compared. (1) Anterior drawer distance. (2) Talar tilt angle under varus and valgus stress. (3) Subtalar tilt angle under varus stress was measured. Finally, the dislocation test was performed using the aforementioned testing conditions, then the stress force was slowly increased from 0 to 350 N, during which time it was observed on fluoroscopy all the time. Compared to pre TTP ankles, varus and anterior drawer stress showed significant instability (p < 0.001-0.031). Only anterior drawer stress in smaller sized implants showed significant instability when compared to identical sized implants (p = 0.008). No dislocation was seen under varus, valgus, and subtalar stress. However, anterior dislocation was observed in all cases of smaller size implant group (p = 0.045). TTP implant was stable under valgus and subtalar stress. However, clinicians should pay attention to anterior instability. Notably, downsized implants should be considered carefully to minimize the chance of anterior dislocation.
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Affiliation(s)
- Go Sato
- Foot & Ankle Research and Innovation Laboratory (FARIL), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Orthopedic, Asahikawa Medical University, Asahikawa, Japan
| | - Jirawat Saengsin
- Foot & Ankle Research and Innovation Laboratory (FARIL), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Orthopedic, Chiangmai University, Chiang Mai, Thailand
| | - Pongpanot Sornsakrin
- Foot & Ankle Research and Innovation Laboratory (FARIL), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Naval Medical Department, Royal Thai Navy, Somdech Phra Pinklao Hospital, Bangkok, Thailand
| | - Rohan Bhimani
- Foot & Ankle Research and Innovation Laboratory (FARIL), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bart Lubberts
- Foot & Ankle Research and Innovation Laboratory (FARIL), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Akira Taniguchi
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan
| | - Christopher DiGiovanni
- Foot & Ankle Research and Innovation Laboratory (FARIL), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Massachusetts General Hospital, Foot and Ankle Surgery, Boston, Massachusetts, USA
| | - Yasuhito Tanaka
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan
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7
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Luo W, Zhang H, Han Q, Li Z, Zhong Z, Jia G, Liu Y, Chang F, Wang J. Total Talar Replacement With Custom-Made Vitallium Prosthesis for Talar Avascular Necrosis. Front Bioeng Biotechnol 2022; 10:916334. [PMID: 35669056 PMCID: PMC9163783 DOI: 10.3389/fbioe.2022.916334] [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: 04/09/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The current study investigated the application of three-dimensional (3D) printing technology in the treatment of talar avascular necrosis (TAN). Custom-made Vitallium talar prostheses were designed and generated via 3D printing. We hypothesized that these talar prostheses would facilitate more stable positioning, better ergonomically fit the ankle joint surfaces, and promote favorable long-term prognoses. Material and Methods: Computed tomography scans of both ankle joints were acquired from three patients diagnosed with TAN. The talar on the unaffected side was used as the design blueprint. Hence, with the aid of 3D printing technology a customized talar prosthesis made from a novel Vitallium alloy could be manufactured for each individual patient. Results: In all three cases there were no signs of prosthesis loosening or substantial degenerative change in the surrounding area of the joint, but small osteophytes were observed on the tibial side and navicular side. No chronic infection or other prosthesis-related complications were observed in any of the patients. All three were able to walk without pain at the most recent follow-up. Conclusion: With the aid of 3D printing and a novel Vitallium alloy, total talar replacement achieved encouraging results in 3/3 patients. All patients were satisfied with their joint function, and were able to return to their daily activities without limitations. Although more cases and longer-term follow-up periods are required, the success rate reported herein is encouraging.
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Affiliation(s)
| | | | | | | | | | | | | | - Fei Chang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Jincheng Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
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8
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Kang Y, Kim S, Kim J, Lee JW, Park JC. Evaluating the validity of lightweight talar replacement designs: rational models and topologically optimized models. Biomater Res 2022; 26:10. [PMID: 35287743 PMCID: PMC8919543 DOI: 10.1186/s40824-022-00256-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 02/21/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Total talar replacement is normally stable and satisfactory. We studied a rational scaffold talus model for each size range created through topology optimization (TO) and comparatively evaluated a topologically optimized scaffold bone talus model using a finite element analysis (FEA). We hypothesized that the rational scaffold would be more effective for application to the actual model than the topologically optimized scaffold.
Methods
Size specification for the rational model was performed via TO and inner scaffold simplification. The load condition for worst-case selection reflected the peak point according to the ground reaction force tendency, and the load directions “plantar 10°” (P10), “dorsi 5°” (D5), and “dorsi 10°” (D10) were applied to select worst-case scenarios among the P10, D5, and D10 positions (total nine ranges) of respective size specifications. FEA was performed on each representative specification-standard model, reflecting a load of 5340 N. Among the small bone models selected as the worst-case, an arbitrary size was selected, and the validity of the standard model was evaluated. The standard model was applied to the rational structure during validity evaluation, and the TO model reflecting the internal structure derived by the TO of the arbitrary model was implemented.
Result
In worst-case selection, the highest peak von Mises stress (PVMS) was calculated from the minimum D5 model (532.11 MPa). Thereafter, FEA revealed peak von Mises stress levels of 218.01 MPa and 565.35 MPa in the rational and topologically optimized models, respectively, confirming that the rational model yielded lower peak von Mises stress. The weight of the minimum model was reduced from 1106 g to 965.4 g after weight reduction through rational scaffold application.
Conclusion
The rational inner-scaffold-design method is safer than topologically optimized scaffold design, and three types of rational scaffold, according to each size range, confirmed that all sizes of the talus within the anatomical dimension could be covered, which was a valid result in the total talar replacement design. Accordingly, we conclude that an implant design meeting the clinical design requirements, including patient customization, weight reduction, and mechanical stability, should be possible by applying a rational inner scaffold without performing TO design. The scaffold model weight was lower than that of the solid model, and the safety was also verified through FEA.
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9
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Vafaeian B, Riahi HT, Amoushahi H, Jomha NM, Adeeb S. A feature-based statistical shape model for geometric analysis of the human talus and development of universal talar prostheses. J Anat 2022; 240:305-322. [PMID: 34549428 PMCID: PMC8742977 DOI: 10.1111/joa.13552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/16/2021] [Accepted: 09/07/2021] [Indexed: 12/26/2022] Open
Abstract
Statistical data pertaining to anatomic variations of the human talus contain valuable information for advances in biological anthropology, diagnosis of the talar pathologies, and designing talar prostheses. A statistical shape model (SSM) can be a powerful data analysis tool for the anatomic variations of the talus. The main concern in constructing an SSM for the talus is establishing the true geometric correspondence between the talar geometries. The true correspondence complies with biological and/or mathematical homologies on the talar surfaces. In this study, we proposed a semi-automatic approach to establish a dense correspondence between talar surfaces discretized by triangular meshes. Through our approach, homologous salient surface features in the form of crest lines were detected on 49 talar surfaces. Then, the point-wise correspondence information of the crest lines was recruited to create posterior Gaussian process morphable models that non-rigidly registered the talar meshes and consequently established inter-mesh dense correspondence. The resultant correspondence perceptually represented the true correspondence as per our visual assessments. Having established the correspondence, we computed the mean shape using full generalized Procrustes analysis and constructed an SSM by means of principal component analysis. Anatomical variations and the mean shape of the talus were predicted by the SSM. As a clinically related application, we considered the mean shape and investigated the feasibility of designing universal talar prostheses. Our results suggest that the mean shape of (the shapes of) tali can be used as a scalable shape template for designing universal talar prostheses.
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Affiliation(s)
- Behzad Vafaeian
- Faculty of Civil Engineering and TransportationDepartment of Civil EngineeringUniversity of IsfahanIsfahanIran
| | - Hossein Tajmir Riahi
- Faculty of Civil Engineering and TransportationDepartment of Civil EngineeringUniversity of IsfahanIsfahanIran
| | - Hossein Amoushahi
- Faculty of Civil Engineering and TransportationDepartment of Civil EngineeringUniversity of IsfahanIsfahanIran
| | - Nadr M. Jomha
- Division of Orthopaedic SurgeryDepartment of SurgeryUniversity of AlbertaEdmontonABCanada
| | - Samer Adeeb
- Department of Civil and Environmental EngineeringUniversity of AlbertaEdmontonABCanada
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10
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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.
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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
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11
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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.
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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
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12
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Yang QD, Mu MD, Tao X, Tang KL. Three-dimensional printed talar prosthesis with biological function for giant cell tumor of the talus: A case report and review of the literature. World J Clin Cases 2021; 9:3147-3156. [PMID: 33969102 PMCID: PMC8080752 DOI: 10.12998/wjcc.v9.i13.3147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/29/2021] [Accepted: 03/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Giant cell tumors (GCT) are most commonly seen in the distal femur. These tumors are uncommon in the small bones of the hand and feet, and a very few cases have been reported. A giant cell tumor of the talus is rarely seen clinically and could be a challenge to physicians.
CASE SUMMARY We report a rare case of GCT of the talus in one patient who underwent a new reconstructive surgery technique using a three-dimensional (3D) printing talar prosthesis. The prosthesis shape was designed by tomographic image processing and segmentation using technology to match the intact side by mirror symmetry with 3D post-processing technologies. The patient recovered nearly full range of motion of the ankle after 6 mo. The visual analogue scale and American Orthopaedic Foot and Ankle Society scores were 1 and 89 points, respectively.
CONCLUSION We demonstrated that 3D printing of a talar prosthesis is a beneficial option for GCT of the talus.
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Affiliation(s)
- Qian-Dong Yang
- Sports Medicine Center, The First Affiliated Hospital of Army Medical University, Chongqing 400038, China
| | - Mi-Duo Mu
- Sports Medicine Center, The First Affiliated Hospital of Army Medical University, Chongqing 400038, China
| | - Xu Tao
- Sports Medicine Center, The First Affiliated Hospital of Army Medical University, Chongqing 400038, China
| | - Kang-Lai Tang
- Sports Medicine Center, The First Affiliated Hospital of Army Medical University, Chongqing 400038, China
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13
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Custom-Made 3D-Printed Implants as Novel Approach to Reconstructive Surgery after Oncologic Resection in Pediatric Patients. J Clin Med 2021; 10:jcm10051056. [PMID: 33806387 PMCID: PMC7961419 DOI: 10.3390/jcm10051056] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/23/2021] [Accepted: 02/27/2021] [Indexed: 11/16/2022] Open
Abstract
Recently, custom-made 3D-printed prostheses have been introduced for limb salvage surgery in adult patients, but their use has not been described in pediatric patients. A series of 11 pediatric patients (mean age 10.8 years; range 2-13) with skeletal tumors treated with custom-made implants for the reconstruction of bony defects is described. Patients were followed up every 3 months. Functional results were evaluated by the Musculoskeletal Tumor Society Score (MSTS) for upper and lower limbs. The mean follow-up was 25.7 months (range 14-44). Three patients died after a mean of 19.3 months postoperatively-two because of disease progression and the other from a previous malignancy. Three patients experienced complications related to soft tissues. One patient required device removal, debridement, and antibiotic pearls for postoperative infection. Partial osseointegration between grafts and host bone was observed within a mean of 4 months. At the final follow-up, mean MSTS score was 75%. 3D prostheses may yield biological advantages due to possible integration with the host bone and also through the use of vascularized flaps. Further research is warranted.
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Abstract
BACKGROUND Patients with talar avascular necrosis (AVN) have limited treatment options to manage their symptoms. Historically, surgical options have been limited and can leave patients with little ankle motion and have high failure rates. The use of custom 3D printed total talar replacements (TTRs) has arisen as a treatment option for these patients, possibly allowing better preservation of hindfoot motion. We hypothesized that patients undergoing TTR will demonstrate a statistically significant improvement in Foot and Ankle Outcome Score (FAOS) at 1 year after surgery. METHODS We retrospectively reviewed 15 patients who underwent a TTR over a 2-year period. Patient outcomes were reviewed, including age, sex, comorbidities, etiology of talar pathology, number and type of prior surgeries, radiographic alignment, FAOS and Visual Analog Scale (VAS) score, and range of motion. Data analysis was performed with Student t-tests and multivariate regression. RESULTS FAOSs and VAS scores showed statistically significant improvements postoperatively as compared with preoperative scores. There was a statistically significant decrease in VAS pain scores from 7.0 preoperatively to 3.6 (P < .001). Average follow-up was 12.8 months. With the number of patients available, there was no statistically significant change in radiographic alignment parameters postoperatively as compared with preoperatively (P values ranged from .225 to .617). CONCLUSION Our hypothesis that these patients show statistically significant improvements in FAOSs at 1 year was confirmed. TTR represents an exciting treatment option for patients with talar AVN, though longer-term follow-up is needed.Level of Evidence: Level IV: Case series.
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Affiliation(s)
- Daniel J Scott
- Duke University Department of Orthopaedic Surgery, Durham, North Carolina
| | - John Steele
- Duke University Department of Orthopaedic Surgery, Durham, North Carolina
| | | | - Selene G Parekh
- Department of Orthopaedic Surgery, North Carolina Orthopaedic Clinic/Duke Orthopaedics, Durham, North Carolina
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Papagelopoulos PJ, Sarlikiotis T, Vottis CT, Agrogiannis G, Kontogeorgakos VA, Savvidou OD. Total Talectomy and Reconstruction Using a 3-dimensional Printed Talus Prosthesis for Ewing's Sarcoma: A 3.5-Year Follow-up. Orthopedics 2019; 42:e405-e409. [PMID: 31136673 DOI: 10.3928/01477447-20190523-05] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 01/27/2019] [Indexed: 02/03/2023]
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.].
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Tracey J, Arora D, Gross CE, Parekh SG. Custom 3D-Printed Total Talar Prostheses Restore Normal Joint Anatomy Throughout the Hindfoot. Foot Ankle Spec 2019. [PMID: 29537314 DOI: 10.1177/1938640018762567] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND: Third generation total talar prostheses (TTPs) are viable options for talar avascular necrosis (AVN) in the absence of neighboring joint pathology. The use of modern three-dimensional (3D) printing allows the production of custom implants that exactly mimic the patient's anatomy. The aim of this study is to determine the accuracy of 3D printing in reproducing a synthetic talus and, in doing so, restoring more normal anatomical relationships. We hypothesize that this mode of replication will restore and maintain normal radiographic alignment of the ankle, subtalar, and forefoot joints in the setting of talar AVN. METHODS: A retrospective analysis was performed on all patients undergoing TTP implantation for the treatment of talar AVN between 2016 and 2017. Radiographic measurements were taken preoperatively and postoperatively to determine native talar dimensions, TTP implant dimensions, and the corresponding radiographic alignment about the forefoot, hindfoot, and ankle. RESULTS: A total of 14 patients were identified in our cohort. Talar arc length and width were not found to be significantly changed; however, talar height was significantly increased with use of TTP. Five alignment dimensions were measured, of which, only talar tilt angle was significantly changed. Instances of Meary's angle correction were observed in cavus and planus foot deformity. CONCLUSION: As a proof of concept, 3D-printed TTP was successful in restoring talar height and talar tilt in the setting of AVN. Additionally, the procedure maintained normal alignment in nonpathological joints. TTPs, based on our cohort, are a viable option to restore more normal anatomical alignment. LEVELS OF EVIDENCE: Level IV: Case series.
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Affiliation(s)
- Joseph Tracey
- Medical University of South Carolina, Charleston, South Carolina (JT, CEG).,University of Toronto at Scarborough, Toronto, ON, Canada (DA).,Duke University Medical Center, Orthopaedic Surgery, North Carolina Orthopaedic Clinic, Durham, North Carolina (SGP)
| | - Danny Arora
- Medical University of South Carolina, Charleston, South Carolina (JT, CEG).,University of Toronto at Scarborough, Toronto, ON, Canada (DA).,Duke University Medical Center, Orthopaedic Surgery, North Carolina Orthopaedic Clinic, Durham, North Carolina (SGP)
| | - Christopher E Gross
- Medical University of South Carolina, Charleston, South Carolina (JT, CEG).,University of Toronto at Scarborough, Toronto, ON, Canada (DA).,Duke University Medical Center, Orthopaedic Surgery, North Carolina Orthopaedic Clinic, Durham, North Carolina (SGP)
| | - Selene G Parekh
- Medical University of South Carolina, Charleston, South Carolina (JT, CEG).,University of Toronto at Scarborough, Toronto, ON, Canada (DA).,Duke University Medical Center, Orthopaedic Surgery, North Carolina Orthopaedic Clinic, Durham, North Carolina (SGP)
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Shnol H, LaPorta GA. 3D Printed Total Talar Replacement: A Promising Treatment Option for Advanced Arthritis, Avascular Osteonecrosis, and Osteomyelitis of the Ankle. Clin Podiatr Med Surg 2018; 35:403-422. [PMID: 30223950 DOI: 10.1016/j.cpm.2018.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Advanced ankle arthritis, avascular osteonecrosis, and osteomyelitis of the ankle remain a surgical challenge in the foot and ankle arena with limited treatment options. Multiple medical comorbidities contribute to total loss of the talus. Collapse of the talar body as a complication of total ankle arthroplasty, talectomy in infection, and septic talus necrosis or severe bone defects caused by tumor resection may result in need for total talar replacement. Ankle arthrodesis and tibiocalcaneal fusion after talectomy can produce severe disability of the ankle and foot. Total ankle replacement is a viable option for treatment of end-stage ankle arthritis in appropriate patient populations.
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Affiliation(s)
- Helen Shnol
- Department of Graduate Medical Education and Podiatric Surgery, Our Lady of Lourdes Memorial Hospital, 169 Riverside Drive, Binghamton, NY 13905, USA.
| | - Guido A LaPorta
- Department of Graduate Medical Education and Podiatric Surgery, Our Lady of Lourdes Memorial Hospital, 169 Riverside Drive, Binghamton, NY 13905, USA
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Simonds E, Wilson C, Iwanaga J, Laws T, Holley G, Oskouian RJ, Tubbs RS. A Comprehensive Review of Medical Imaging Equipment Used in Cadaveric Studies. Cureus 2018. [PMID: 29535907 PMCID: PMC5841925 DOI: 10.7759/cureus.2035] [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: 11/05/2022] Open
Abstract
Medical imaging techniques have led to great advances in clinical anatomy and forensic pathology. New and emerging technologies allow healthcare professionals to view and understand the human body from different perspectives. This gives way to new and improved interventions, treatment plans, and an overall understanding of the human body. Herein, we present a comprehensive review of the various medical imaging equipment used in cadaveric studies along with their individual strengths and limitations.
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