Early Experience of Additive Titanium Three-Dimensional Printed Prosthesis for Salvage Ankle and Foot Arthrodesis

ABSTRACT:

Osseous defects of the hindfoot following failed arthrodesis present a significant reconstructive challenge. Three-Dimensional printed titanium prostheses are a recent addition to the armamentarium for providing structural support in cases of significant bone loss. We present our institution’s experience with utilizing these cages in various clinical scenarios involving failed foot and ankle arthrodesis. Utilizing surgeon records, 5 patients were identified who underwent 3D cage reconstruction of the lower extremity. One patient underwent tibiotalar arthrodesis following subtalar arthrodesis, 1 patient had ankle arthrodesis alone, 2 patients had subtalar arthrodesis, and 1 patient underwent medial column reconstruction of the foot, all in combination with a custom 3D-printed titanium cage. Clinical information, including past medical and surgical history, infection history, imaging, patient-reported outcomes, and postoperative outcomes (including complications and radiographic measures), was extracted from the electronic medical record. Comparisons were made between pooled preoperative and final follow-up postoperative patient-reported outcomes. At an average follow-up of 23.6 months (14.8 to 34.4 mo) 4 of 5 patients showed improvement in Physical Function scores. Two out of 5 patients had improved Patient-Reported Outcomes Measurement Information System (PROMIS) Scores for Pain Interference; 3 patients had improvement in Depression; and 2 patients had improvement in Anxiety that met the minimal clinically important difference (MCID). Four of 5 cases maintained improved radiographic alignment, with 1 case of deformity recurrence and implant migration. There was 1 case of infection, which was successfully managed with serial aspirations and IV antibiotics, without the need for a return to the operating room for debridement or explantation. In conclusion, 3D-printed cages are a promising strategy for lower extremity reconstruction due to their high versatility. However, longer-term follow-up is necessary to assess the longevity of 3D-printed cage constructs.