Abstract
Category:
Hindfoot
Introduction/Purpose:
Many patients with talar avascular necrosis have limited treatment options to manage their symptoms. Historically, surgical options have included pan-talar fusions, tibio-talar-calcaneal fusions, and revascularization procedures. Unfortunately, these treatment options can leave patients with little ankle and hind-foot motion, can increase adjacent joint arthritis, and have significant failure rates. Recently, the use of custom 3D printed total talar replacements has arisen as a treatment option for these patients. Theoretically, this allows for better preservation of hind-foot motion as well as possibly less adjacent joint arthritis.
Methods:
We retrospectively reviewed 15 patients who underwent a 3D printed total talus replacement by a single surgeon over 2 years. Each patient had pre-operative CT scans of both the affected and non-affected talus. Custom 3D printed implants were made in two sizes based on templating performed on the contralateral talus. All total talus replacements were performed through a direct anterior approach. Patient outcomes were reviewed pre and post-operatively including age, sex, comorbidities, etiology of talar pathology, number and type of prior surgeries, as well as VAS scores, range of motion, and number of additional or subsequent procedures.
Results:
The average patient age was 45. 6/15 patients had previously undergone surgery on the ipsilateral hind-foot/ankle. There was a statistically significant decrease in VAS pain scores from 7.0 pre-operatively to 2.5 at final follow up. There was a statistically significant increase in both ankle and sub-talar motion at final follow up when compared to pre-op. Average follow-up was 8.4 months, with a minimum follow up of 3 months. Of the four patients with 1 year or longer follow up (average 13.3 months), VAS scores and ROM were similar to patients with shorter follow up duration. 3 patients had concomitant procedures, most commonly tendo-achillies lengthening. One patient required an additional procedure (incision and drainage) for treatment of wound dehiscence.
Conclusion:
3D printed total talus replacements represent an exciting treatment options for patients with significant talar avascular necrosis. At early follow up, patients showed good improvement in VAS pain scores and actually improved their hindfoot and ankle motion. Certainly, longer term follow-up will be needed to evaluate the longevity of these implants. However, these implants represent an intriguing option for patients that lack an ideal surgical solution and show promise at very early follow up.