Outcomes of cobalt-chrome 3D-printed total talus replacement with and without combined total ankle replacement

Kishen Mitra; Albert T Anastasio; Kevin A Wu; Bijan Abar; Karl M Schweitzer; Selene G Parekh; Mark E Easley; Samuel B Adams

doi:10.1016/j.fas.2024.07.011

Outcomes of cobalt-chrome 3D-printed total talus replacement with and without combined total ankle replacement

Foot Ankle Surg. 2024 Aug 2:S1268-7731(24)00161-9. doi: 10.1016/j.fas.2024.07.011. Online ahead of print.

Authors

Kishen Mitra¹, Albert T Anastasio², Kevin A Wu³, Bijan Abar⁴, Karl M Schweitzer⁵, Selene G Parekh⁶, Mark E Easley⁷, Samuel B Adams⁸

Affiliations

¹ Dept. of Biomedical Engineering, Duke University, Durham, NC, United States. Electronic address: kishen.mitra@duke.edu.
² Dept. of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States. Electronic address: albert.anastasio@duke.edu.
³ Duke University School of Medicine, Durham, NC, United States. Electronic address: kevin.a.wu@duke.edu.
⁴ Duke University School of Medicine, Durham, NC, United States; Dept. of Mechanical Engineering and Materials Science, Duke University, Durham, NC, United States. Electronic address: bijan.abar@duke.edu.
⁵ Dept. of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States. Electronic address: karl.schweitzer@duke.edu.
⁶ Rothman Orthopaedic Institute, Philadelphia, PA, USA. Electronic address: selene.parekh@gmail.com.
⁷ Dept. of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States. Electronic address: mark.e.easley@duke.edu.
⁸ Dept. of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States. Electronic address: samuel.adams@duke.edu.

PMID: 39097425
DOI: 10.1016/j.fas.2024.07.011

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.

Keywords: 3D printing; Additive manufacturing, avascular necrosis, fracture; Depression; Outcomes; Total ankle total talus replacement.