Abstract
Submission Type:
Ankle Arthritis
Research Type:
Level 4 – Case series
Introduction/Purpose:
Failed total ankle arthroplasty, hindfoot fusion, Charcot arthropathy, and infection can pose a significant reconstructive challenge. Previously, large bone defects were difficult to reconstruct, often requiring bone-transport lengthening procedures or large allograft placement with unfavorable results. The advent of custom, 3D-printed cages has allowed for addressing large, complex bone defects and deformities in potentially a single procedure. The purpose of this study is to evaluate the fusion and complication rates following treatment of critical bone defects of the ankle and hindfoot with a patient-specific, 3D-printed titanium cage.
Methods:
Retrospective review was performed at a single institution from 2019-2024. Demographic data including age, sex, comorbidities was obtained. The surgical indication for reconstruction of the ankle and hindfoot was recorded. Standard weightbearing radiographs of the ankle were obtained to evaluate for fusion. Complete fusion was defined as circumferential fusion mass on plain radiographs without evidence of hardware failure. CT scans were reviewed to confirm complete fusion with interdigitation of bone within and surrounding the implant. Fixation type used to secure the implant was recorded. Major and minor complications including surgical site infection, deep infection, subsequent surgery, hardware failure, and neuropathy were recorded.
Results:
A total of 20 patients were included in the study. The average age of the patient at the time of surgery was 60 years old. 64% of patients were male and 36% patients were female. The most common surgical indication was for a failed total ankle arthroplasty in the setting of previous infection. The average defect size was measured to be approximately 40 mm. 88% of patients went onto complete fusion with integration of the custom 3D printed cage. 90% of patients underwent fixation with a Nitinol dynamic compression nail. There were 2 major wound related complications requiring below knee amputation. There were 3 minor wound related complications which were successfully treated with irrigation and debridement or local wound care.
Conclusion:
The use of a dynamic compression hindfoot nail with a custom 3D printed cage is a promising treatment option for addressing critically sized defects, particularly in the setting of failed total ankle arthroplasty
