Tibiotalocalcaneal Arthrodesis With 3D-Titanium Implants for Management of Critical-Sized Osseous Defects of the Hindfoot and Ankle: A Systematic Review and Meta-Analysis

Abstract

Background

Managing critically sized osseous defects of the hindfoot and ankle remains challenging, particularly in the setting of failed arthrodesis, trauma, Charcot, or failed total ankle arthroplasty. Custom 3D-printed titanium implants have emerged as a potential alternative to structural allografts, offering mechanical stability and biologic incorporation through patient-specific geometry and engineered porosity.

Methods

A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. A search of major databases identified studies reporting outcomes of tibiotalocalcaneal (TTC) arthrodesis using 3D-printed titanium implants for critical-sized defects. Union rates, complications, and limb-salvage outcomes were extracted and synthesized. A random-effects model was used to calculate pooled rates.

Results

Fifteen studies comprising 142 patients met the inclusion criteria. Indications included segmental bone loss (n = 32), failed total ankle replacement (n = 31), avascular necrosis (n = 21), and nonunion (n = 20). The pooled union rate was 88.2% (95% CI: 82.0%-94.5%), and the limb-salvage rate was 92.3% (95% CI: 87.3%-97.3%). The complication rate was 16.9%, with infection and nonunion being the most frequent types. Functional outcome scores improved significantly in multiple studies. Only 6.3% of patients required below-knee amputation.

Conclusion

Custom 3D-printed titanium implants demonstrate high union and limb-salvage rates with acceptable complication profiles in the treatment of large osseous hindfoot and ankle defects. These implants may offer a favorable alternative to traditional grafting in complex salvage scenarios.