Use of Patient-Specific 3D-Printed Titanium Implants for Complex Foot and Ankle Limb Salvage, Deformity Correction, and Arthrodesis Procedures

Background: The advancement of 3D printing technology has allowed for the use of custom-designed implants for difficult-to-treat foot and ankle pathologies. This study reports on the radiographic and functional outcomes of a case series of patients treated with patient-specific 3D-printed titanium implants. Methods: Fifteen consecutive patients treated with custom-designed 3D-printed implant cages for severe bone loss, deformity correction, and/or arthrodesis procedures were included in this study. A minimum of 1 year of clinical and radiographic follow-up was required. No patients were lost to follow-up. Patients completed a visual analog scale for pain, the Foot and Ankle Ability Measure Activities of Daily Living score, and the American Orthopaedic Foot & Ankle Society Score outcomes questionnaires preoperatively and at most recent follow-up. All patients had postoperative radiographs and computed tomography (CT) scans to assess bony incorporation. The mean age was 53.3 years (range, 22-74 years) with a mean follow-up of 22 months (range, 12-48 months) for these 15 patients. Results: Radiographic fusion verified by CT scan occurred in 13 of 15 patients. There was significant improvement in pain and all functional outcome score measures. All patients who went on to fusion were satisfied with their surgery. There were 2 failures, consisting of 1 infection and 1 nonunion, with an overall clinical success rate of 87%. Conclusion: These patients demonstrated the successful use of patient-specific 3D-printed titanium implants to treat complex large bony defects, deformities, and arthrodesis procedures. These implants offer surgeons a novel and promising approach to treat both lower extremity pain and deformity that is not always available with current techniques. Level of Evidence: Level IV, retrospective case series.

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The Use of Patient-Specific 3D Printed Titanium Implants for Complex Foot and Ankle Limb Salvage, Deformity Correction, and Arthrodesis Procedures

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000018 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0000

Author(s):

Samuel Adams ◽

Travis Dekker ◽

John Steele ◽

Kamran Hamid

Keyword(s):

Lower Extremity ◽

Deformity Correction ◽

Titanium Implants ◽

Patient Specific ◽

Allograft Bone ◽

Foot And Ankle ◽

Sf 36 ◽

3D Printed ◽

The Mean

Category: Ankle,Ankle Arthritis,Basic Sciences/Biologics,Trauma Introduction/Purpose: Large lower extremity bony defects, complex foot and ankle deformities, and high-risk arthrodesis situations can be difficult to treat. These challenging pathologies, often require a critical-sizes and/or shaped structural bone void filler which may not be available with allograft bone. The advancement of 3D printing technology has allowed for the use of custom designed implants for foot and ankle surgery. This study reports on the radiographic and functional outcomes of a case series of patients treated with patient-specific 3D printed titanium implants. Methods: Seven consecutive patients who were treated with custom designed 3D printed implant cages for severe bone loss, deformity correction, and arthrodesis procedures were included in this study. A minimum of 1-year follow-up was required. No patients were lost to follow-up. Patients completed preoperative and most recent follow-up VAS for pain, FAAM, and SF-36 outcomes questionnaires. All patients had post-operative radiographs and CT scans to assess bony incorporation. Results: The mean age of these patients was 54.6 (35-73 years of age). The mean follow-up of these seven patients was 17.1 months (range 12 to 31). Radiographic fusion with cage ingrowth and integration occurred in all seven patients verified by CT scan. There was statistically significant improvement in all functional outcome score measures (VAS for pain, FAAM, and SF-36). All patients returned were satisfied with surgery. There were no failures. Case examples are demonstrated in Figure 1. Conclusion: This cohort of patients demonstrated the successful use of custom 3D printed implants to treat complex large bony defects, deformities and arthrodesis procedures of the lower extremity. These implants offer the surgeon a patient specific approach to treat both pain and deformity that is not necessarily available with allograft bone.

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Lateral open wedge calcaneus osteotomy with bony allograft augmentation in adult acquired flatfoot deformity. Clinical and radiological results

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-021-02888-3 ◽

2021 ◽

Author(s):

Gabriele Colo’ ◽

Mattia Alessio Mazzola ◽

Giulio Pilone ◽

Giacomo Dagnino ◽

Lamberto Felli

Keyword(s):

Range Of Motion ◽

Case Series ◽

Deformity Correction ◽

Tibialis Posterior ◽

Open Wedge ◽

Foot And Ankle ◽

Retrospective Case ◽

Level Of Evidence ◽

Adult Acquired Flatfoot Deformity

Abstract The aim of this study is to evaluate the results of patients underwent lateral open wedge calcaneus osteotomy with bony allograft augmentation combined with tibialis posterior and tibialis anterior tenodesis. Twenty-two patients underwent adult-acquired flatfoot deformity were retrospectively evaluated with a minimum 2-year follow-up. Radiographic preoperative and final comparison of tibio-calcaneal angle, talo–first metatarsal and calcaneal pitch angles have been performed. The Visual Analog Scale, American Orthopedic Foot and Ankle Score, the Foot and Ankle Disability Index and the Foot and Ankle Ability Measure were used for subjective and functional assessment. The instrumental range of motion has been also assessed at latest follow-up evaluation and compared with preoperative value. There was a significant improvement of final mean values of clinical scores (p < 0.001). Nineteen out of 22 (86.4%) patients resulted very satisfied or satisfied for the clinical result. There was a significant improvement of the radiographic parameters (p < 0.001). There were no differences between preoperative and final values of range of motion. One failure occurred 7 years after surgery. Adult-acquired flatfoot deformity correction demonstrated good mid-term results and low recurrence and complications rate. Level of evidence Level 4, retrospective case series.

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Three-Dimensional-Printed Patient-Specific Osteotomy Guides, Repositioning Guides and Titanium Plates for Acute Correction of Antebrachial Limb Deformities in Dogs

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0040-1709702 ◽

2020 ◽

Author(s):

Darren R. Carwardine ◽

Mark J. Gosling ◽

Neil J. Burton ◽

Ffion L. O'Malley ◽

Kevin J. Parsons

Keyword(s):

Kirschner Wire ◽

Three Dimensional ◽

Case Series ◽

Deformity Correction ◽

Patient Specific ◽

Kirschner Wire Fixation ◽

Limb Deformities ◽

Acute Correction ◽

3D Printed

Abstract Objectives The aim of this study was to describe the use of patient-specific three-dimensional (3D)-printed osteotomy guides, repositioning guides and custom-printed titanium plates for acute correction of antebrachial limb deformities in four dogs. Methods Retrospective review of antebrachial limb deformities in small breed chondrodystrophic dogs that were surgically corrected using a closing wedge ostectomy of the radius at a predetermined site using patient-specific osteotomy guides. Reduction was achieved without the need for intraoperative measurements using patient-specific 3D-printed repositioning guides secured and manipulated using temporary Kirschner wire fixation. The ostectomy of the radius was stabilized with a patient-specific 3D-printed titanium plate. Results All limbs were corrected to within 3.5 degrees (standard deviation [SD]: 1 degree) and 7.5 degrees (SD: 3 degrees) of the pre-planned deformity correction in the frontal and sagittal planes, respectively. No complications were encountered. Owners completed a canine orthopaedic index survey at a median postoperative follow-up time of 19 months. Surgery eliminated the main presenting complaint of buckling over of the manus in all cases. Clinical Significance The 3D-printed osteotomy repositioning guides and titanium plates facilitated accurate acute correction of antebrachial deformities in this case series. The methodology described simplifies intraoperative surgical decision-making on limb position with good clinical outcomes seen in a small number of clinical cases.

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Ceramic 3D-Printed Titanium Cranioplasty

Craniomaxillofacial Trauma & Reconstruction ◽

10.1177/1943387520927916 ◽

2020 ◽

Vol 13 (4) ◽

pp. 329-333

Author(s):

Maurice Y. Mommaerts ◽

Paul R. Depauw ◽

Erik Nout

Keyword(s):

Calcium Phosphate ◽

Case Series ◽

Titanium Implants ◽

Border Zone ◽

Implant Design ◽

Patient Specific ◽

Time Range ◽

Free Calcium ◽

Cranial Implant ◽

3D Printed

Study Design: Inlay cranioplasties following partial craniectomy in tumor or trauma cases and onlay cranioplasties for reconstructions of residual developmental skull anomalies are frequently performed using CAD-CAM techniques. Objective: In this case series, we present a novel cranial implant design, being a combination of 3D-printed titanium grade 23 and calcium phosphate paste (CeTi). Methods: The titanium patient-specific implant, manufactured using selective laser melting, has a latticed border with interconnected micropores. The cranioplasty is miniscrew fixed and its border zone subsequently partially filled with calcium phosphate paste to promote osteoinduction and osteoconduction. From April 2017 to April 2019, 8 patients have been treated with such a CeTi implant. The inlay cranioplasties were each time revision surgeries of complicated cases. Results: All implants were successful after a limited follow-up time (range 18-42 months). There were no dehiscences and no infections, and no complaints of thermal conduction. Conclusions: The proposed CeTi cranial implant combines the strength of titanium implants with the biological integration potential of ceramic implants and seems particularly resistant to infection, probably due to the biofunctionalized titanium surface and the antimicrobial activity of elevated intracellular free calcium levels.

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Early Outcomes of 3D Printed Total Talus Arthroplasty

Foot & Ankle Specialist ◽

10.1177/1938640019873536 ◽

2019 ◽

Vol 13 (5) ◽

pp. 372-377 ◽

Cited By ~ 3

Author(s):

Daniel J. Scott ◽

John Steele ◽

Amanda Fletcher ◽

Selene G. Parekh

Keyword(s):

Treatment Option ◽

Treatment Options ◽

Case Series ◽

Level Of Evidence ◽

Ankle Motion ◽

Motion Data ◽

Number Of Patients ◽

3D Printed ◽

Radiographic Alignment

Background. Patients with talar avascular necrosis (AVN) have limited treatment options to manage their symptoms. Historically, surgical options have been limited and can leave patients with little ankle motion and have high failure rates. The use of custom 3D printed total talar replacements (TTRs) has arisen as a treatment option for these patients, possibly allowing better preservation of hindfoot motion. We hypothesized that patients undergoing TTR will demonstrate a statistically significant improvement in Foot and Ankle Outcome Score (FAOS) at 1 year after surgery. Methods. We retrospectively reviewed 15 patients who underwent a TTR over a 2-year period. Patient outcomes were reviewed, including age, sex, comorbidities, etiology of talar pathology, number and type of prior surgeries, radiographic alignment, FAOS and Visual Analog Scale (VAS) score, and range of motion. Data analysis was performed with Student t-tests and multivariate regression. Results. FAOSs and VAS scores showed statistically significant improvements postoperatively as compared with preoperative scores. There was a statistically significant decrease in VAS pain scores from 7.0 preoperatively to 3.6 (P < .001). Average follow-up was 12.8 months. With the number of patients available, there was no statistically significant change in radiographic alignment parameters postoperatively as compared with preoperatively (P values ranged from .225 to .617). Conclusion. Our hypothesis that these patients show statistically significant improvements in FAOSs at 1 year was confirmed. TTR represents an exciting treatment option for patients with talar AVN, though longer-term follow-up is needed. Level of Evidence: Level IV: Case series

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Derotation of the Talus and Arthrodesis Treatment of Stages II-V Müller-Weiss Disease: Midterm Results of 36 Cases

Foot & Ankle International ◽

10.1177/1071100719829457 ◽

2019 ◽

Vol 40 (5) ◽

pp. 506-514 ◽

Cited By ~ 1

Author(s):

Chengjie Yuan ◽

Chen Wang ◽

Chao Zhang ◽

Jiazhang Huang ◽

Xu Wang ◽

...

Keyword(s):

Case Series ◽

Deformity Correction ◽

Stage Iv ◽

Staging System ◽

Functional Improvement ◽

Midterm Results ◽

Retrospective Case ◽

Level Of Evidence ◽

Metatarsal Angle

Background: Various operative procedures have been reported for the treatment of Müller-Weiss disease (MWD). This study reports the midterm operative treatment results for stages II to V MWD with derotation of the talus and arthrodesis. Methods: Thirty-four patients (36 feet) with MWD were treated by talonavicular (TN) or talonavicular-cuneiform (TNC) arthrodesis in our center from 2008 to 2015. The affected feet were staged according to the Maceira staging system (stage II: 9; stage III: 10; stage IV: 9; stage V: 8). The American Orthopaedic Foot & Ankle Society (AOFAS) midfoot scale, the visual analog scale (VAS), and relative radiologic parameters were evaluated preoperatively and also during follow-up. The mean follow-up duration was 38.2 (range, 25-113 months). Results: The final follow-up showed satisfactory outcomes. Overall, the AOFAS scores improved from 41.5 (range, 20-56) to 85.3 (range, 68-100) points ( P <.001), and the VAS score decreased from 5.7 (range, 3-8) to 0.9 (range, 0-4) points ( P <.001). The Tomeno-Méary angle decreased from −6.7 (range, −26.4 to 17.7) to 0.7 (range, −5.3 to 7) degrees ( P=.001). The calcaneal pitch angle increased from 13.7 (range, 4.1-26.2) to 22.0 (range, 13.3-28.9) degrees ( P < .001). The anteroposterior (AP) talar–first metatarsal angle decreased from −15.8 (range, −30.1 to −13.7) to −7.0 (range, −25.9 to −8.9) degrees ( P < .001), and the AP talocalcaneal angle increased from 14.7 (range, 4.7-22.3) to 22.1 (range, 13.4-29.5) degrees ( P=.005). The AP talonavicular coverage angle decreased from −27.0 (range, −40.4 to −13.3) to −7.8 degrees (range, −20.7 to −1.8) degrees ( P < .001). Conclusion: The midterm results found that the TN or TNC joint fusion could achieve a favorable clinical and radiologic outcome for patients with MWD. Even for the patients with severe deformities (stages IV-V), this treatment strategy could also achieve satisfactory deformity correction and functional improvement. Intraoperative restoration of talus rotation was the key to normal alignment of the subtalar joint/TN joint. Level of Evidence: Level IV, retrospective case series.

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Three-Stage Masquelet Technique and One-Stage Reconstruction to Treat Foot and Ankle Tuberculosis

Foot & Ankle International ◽

10.1177/1071100719890854 ◽

2019 ◽

Vol 41 (3) ◽

pp. 331-341 ◽

Cited By ~ 1

Author(s):

Wenqiang Qu ◽

Chi Wei ◽

Li Yu ◽

Yu Deng ◽

Panfeng Fu ◽

...

Keyword(s):

Pain Score ◽

Early Stage ◽

Distal Tibia ◽

Case Series ◽

Cement Spacer ◽

Foot And Ankle ◽

Aofas Score ◽

Level Of Evidence ◽

Masquelet Technique

Background: The purpose of this article was to report the feasibility and effectiveness of 3-stage Masquelet technique and 1-stage operation for different stages of foot and ankle tuberculosis (TB). Methods: Ten consecutive patients with foot and ankle TB were retrospectively analyzed between January 2014 and December 2018. Five patients were treated with the 3-stage Masquelet technique, including thorough debridement with vacuum sealing drainage, implantation of antibiotic cement spacer, and subsequent reconstruction. Five patients were treated with a 1-stage reconstruction. The American Orthopaedic Foot & Ankle Society (AOFAS) and visual analog scale (VAS) pain scores were recorded at the last follow-up. The follow-up was 30.3 ± 17.8 months. Results: No reactivation of TB was observed in any patients. For the 3-stage operation group, 1 patient developed a distal tibia fracture. The duration of anti-TB therapy was 12.0 ± 0.8 months. The AOFAS score increased from 39.5 ± 9.9 preoperatively to 75.3 ± 7.0 postoperatively ( P < .05). The VAS pain score decreased from 6.3 ± 1.9 to 1.5 ± 1.3 ( P < .05). For the 1-stage operation, 1 patient had wound necrosis. The duration of anti-TB therapy was 13.8 ± 1.1 months. The AOFAS score increased from 51.8 ± 15.0 to 81.8 ± 6.3 ( P < .05). The VAS pain score decreased from 5.4 ± 1.1 to 1.0 ± 0.7 ( P < .05). Conclusion: Three-stage operation was effective for foot and ankle TB with stage IV, sinus tracts or other infections, and 1-stage reconstruction was effective for early-stage TBs. Level of Evidence: Level IV, case series.

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Custom-made 3D printed subperiosteal titanium implants for the prosthetic restoration of the atrophic posterior mandible of elderly patients: a case series

3D Printing in Medicine ◽

10.1186/s41205-019-0055-x ◽

2020 ◽

Vol 6 (1) ◽

Cited By ~ 6

Author(s):

Carlo Mangano ◽

Andrea Bianchi ◽

Francesco Guido Mangano ◽

Jessica Dana ◽

Marco Colombo ◽

...

Keyword(s):

Elderly Patients ◽

Survival Rates ◽

Case Series ◽

Late Complications ◽

Titanium Implants ◽

High Survival ◽

Custom Made ◽

3D Printed ◽

Edentulous Patients

Abstract Purpose To present the application of custom-made 3D-printed subperiosteal implants for fixed prosthetic restoration of the atrophic posterior mandible of elderly patients. Methods Between January 2017 and June 2018, all partially edentulous patients aged over 65 years, with two or more missing teeth in the posterior atrophic mandible, and who did not want to undergo bone regenerative procedures, were included in this study. These patients were rehabilitated with custom-made subperiosteal implants, designed from cone beam computed tomography (CBCT) and fabricated in titanium by means of direct metal laser sintering (DMLS). The outcome measures were fit and stability of the implants at placement, duration of the intervention, implant survival, and early and late complications. All patients were followed for 1 year after surgery. Results Ten patients (four males, six females; mean age 69.6, SD ± 2.8, median 69, 95% CI 67.9–71.6) were included in the study. The fit of the implants was satisfactory, with a mean rating of 7 out of 10 (SD ± 1.6, median 7, 95% CI 6–8). Only two implants had insufficient fit, because of the presence of scattering in the CBCT; however, they were adapted to the sites during the interventions. The mean duration of the intervention was 44.3 min (SD ± 19.4, median 37, 95% CI 32.3–56.3). At the one-year follow-up, no implants were lost (survival rate 100%). One implant presented immediate postoperative complications with pain, discomfort and swelling, and two patients experienced late complications, having their provisional restorations fractured during the temporisation phase. All these complications were minor in nature, but the final complication rate amounted to 30% (three of ten patients). Conclusions Although this study has limits (small patient sample and short follow-up), DMLS has proven to be an effective method for fabricating accurate subperiosteal implants, with high survival rates. This may represent an alternative treatment procedure in elderly patients with a severely atrophic posterior mandible, since it allows avoidance of regenerative bone therapies. Further studies are needed to confirm these outcomes.

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Long-Term Results of the Modular Physiological Wrist Prosthesis (MPW®) in Patients with Inflammatory Diseases

Life ◽

10.3390/life11040355 ◽

2021 ◽

Vol 11 (4) ◽

pp. 355

Author(s):

Christoph Biehl ◽

Martin Stoll ◽

Martin Heinrich ◽

Lotta Biehl ◽

Jochen Jung ◽

...

Keyword(s):

Inflammatory Diseases ◽

Case Series ◽

Long Term Results ◽

Patient Specific ◽

Dash Score ◽

Level Of Evidence ◽

Good Pain Relief ◽

Clinical And Radiological Outcome

The wrist is among the predilection sites of over 90% of cases of rheumatoid arthritis (RA). In advanced cases, total wrist arthroplasty (TWA) is an alternative to arthrodesis. The aim of this study is to present the long-term results of the modular physiological wrist prosthesis (MPW®) and to match them in context with the results of a standard population survey. In a retrospective study with follow-up, patients with an MPW® endoprosthesis were evaluated concerning the clinical and radiological outcome, complications were reviewed (incidence and type), and conversion to wrist fusion was assessed. Patient function measurements included the Mayo wrist score, the patient-specific wrist test, and therefore the DASH score (arm, shoulder, and hand). Thirty-four MPW® wrist prostheses were implanted in 32 patients, including thirty primary implantations and four changes of the type of the endoprosthesis. Sixteen patients (18 prostheses) underwent clinical and radiological follow-up. The average follow-up time was 8.5 years (1 to 16). Poor results of the MPW prosthesis are caused by the issues of balancing with luxation and increased PE wear. Salvage procedures included revision of the TWA or fusion. In successful cases, the flexion and extension movement averaged 40 degrees. The grip force was around 2.5 kg. The common DASH score was 79 points, with limited and problematic joints of the upper extremity. The MPW wrist prosthesis offered good pain relief and functional movement in over 80% of cases. The issues of dislocation and increased PE wear prevent better long-term results, as do the joints affected. A follow-up study with fittings under a contemporary anti-rheumatic therapy with biologicals suggests increasing score results. Type of study/level of evidence: Case series, IV.

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Minimally invasive Chevron-Akin osteotomy

Journal of the Foot & Ankle ◽

10.30795/jfootankle.2020.v14.1208 ◽

2020 ◽

Vol 14 (3) ◽

pp. 264-268

Author(s):

Gustavo Nunes ◽

João Magalhães ◽

Tiago Baumfeld ◽

Roberto Pinto

Keyword(s):

Minimally Invasive ◽

Hallux Valgus ◽

Case Series ◽

Preoperative Assessment ◽

Foot And Ankle ◽

Level Of Evidence ◽

Intermetatarsal Angle ◽

Akin Osteotomy ◽

Severe Hallux Valgus

Objective: To present the clinical and radiographic results of surgical treatment of patients with moderate to severe hallux valgus (HV) by minimally invasive Chevron - Akin osteotomy (MICA). Methods: The case series comprises 25 patients (30 feet) with diagnoses of moderate to severe HV treated surgically with the MICA technique. All patients answered the American Orthopedic Foot and Ankle Score (AOFAS) and rated pain on visual analogue scale (VAS) at preoperative assessment and at the last follow-up consultation. Radiological assessment included measurement of the valgus angles of the hallux (HVA) and the 1st and 2nd ray intermetatarsal angle (IMA). Complications and satisfaction ratings were also documented. Results: Mean follow-up was 14.6 months. Mean AOFAS increased from 42.8 to 90 and VAS reduced from 8.6 to 1.7. Mean HVA reduced from 31.7o to 8.4o and IMA from 14o to 5o. All these improvements were statistically significant (p<0.001). The most common complication observed was discomfort caused by hardware, affecting five feet (16.6%). Two patients (6.6%) had transitory neurapraxia and one patient (3.3%) developed reflex sympathetic dystrophy. There were no cases of infection, relapse, pseudarthrosis, or malunion of osteotomies. Subjective satisfaction ratings classified 93.3% of results as good or excellent. Conclusion: Minimally invasive Chevron-Akin osteotomy is a safe and reproducible technique that achieves good clinical and radiographic results for treatment of moderate to severe hallux valgus. Level of Evidence IV; Therapeutic Studies; Case Series.

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