Clinical Outcomes of 3D Printed Titanium Cage Implantation for Foot and Ankle Surgery

Category Ankle; Trauma Introduction/Purpose: Critical Sized Defects (CSD) defined as bone loss greater than 1-2 cm in length or greater than 50% loss in circumference of bone remains a significant challenge in orthopaedic surgery. Patients can acquire these defects through trauma, nonunion post fracture, tumor removal, avascular necrosis, and congenital abnormalities. Custom 3D printed porous Titanium scaffolds are increasingly being used to treat CSD in Foot and Ankle Surgery. Implantation of 3D printed cages is considered a salvage procedure offered after the patient has failed other procedures. Implants fill the space of the defect, provide mechanical strength and provide opportunity for osseous integration. As implementation of this surgical technique is relatively new, further research is needed to assess surgical outcomes and inform future surgical decision making. Methods: This is a retrospective chart review study which examines surgical outcomes after using 3D printed Titanium cages. Patients who received a 3D printed Titanium cage between 1/1/2013 and 11/01/2018 with at least 1 year follow-up were included in this study. Primary outcome is device failure defined as removal of implant for any reason. If applicable, mechanism of failure was recorded for each case. Patient specific factors such as age, gender, race, BMI, diabetes status, Charlson Comorbidity Index, tobacco use, number of foot and ankle surgeries, prior limb infections and laterality of defect were recorded in addition to surgical variables including geometry of implant, duration of surgery, and perioperative antibiotics Results: 18 patients who received custom 3D printed Titanium cages were included in this study. Of the 18 patients, 5 patients (27.8%) had device failure, defined as removal of implant. Of the 5 failures, 2 were removed due to infection while the other 3 were removed due to hardware failure including fractured cage, broken screw and loose fixation. Conclusion: Custom 3D printed Titanium was successfully implemented in 72.2% of patients. Implants were only removed due to infection (2 patients) or mechanical failure of device (3 patients). Future studies need to be powered to determine if certain patient specific factors are associated with device failure. Data from this study and subsequent studies can be used to design better implants, decide who is a good surgical candidate, and create preoperative therapies to improve modifiable risk factors

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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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Incorporating 3D Printing Into Your Practice: Lessons Learned

Foot & Ankle Specialist ◽

10.1177/1938640020980912 ◽

2020 ◽

pp. 193864002098091

Author(s):

Akhil Sharma ◽

Kyle S. Kirkland ◽

Robert M. Holloway ◽

Selene G. Parekh

Keyword(s):

3D Printing ◽

Operative Time ◽

Three Dimensional ◽

Lessons Learned ◽

Foot And Ankle ◽

Level Of Evidence ◽

Ankle Surgery ◽

Engineering Team ◽

3D Printed ◽

Successful Technology

Three-dimensional (3D) printing has greatly benefited medicine, manufacturing vital organs like skin, hearts, kidneys, and livers. Early studies on 3D printing in surgery have consistently reported decreased operative time and improved precision. This technology has gained popularity with orthopaedic surgeons in knee, hip, and shoulder surgeries because 3D printing is associated with enhancing osseointegration. However, this innovation is still not commonly used among foot and ankle surgeons; one reason is that whereas the literature on 3D printing–assisted surgery is populated with studies on operative techniques and clinical outcomes, there exists an ambiguity on how to incorporate this feature into the clinic. Thus, the aim of this technology column is to consolidate and standardize a workflow to guide foot and ankle surgeons on integrating 3D printing into one’s practice. We describe a model developed by a single surgeon at one institution who directs a large caseload of 3D-printed foot and ankle surgeries. From the initial patient visit to the interaction between the surgeon and the implant engineering team, to documentation of data adding to the preliminary literature, this work has great implications on streamlining the assimilation of a highly successful technology to improve foot and ankle surgery for both surgeons and patients. Level of Evidence: Level V

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Five-Year Follow-Up of Distal Tibia Bone and Foot and Ankle Trauma Treated with a 3D-Printed Titanium Cage

Case Reports in Orthopedics ◽

10.1155/2019/7571013 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Eugene C. Nwankwo ◽

Fangyu Chen ◽

Dana L. Nettles ◽

Samuel B. Adams

Keyword(s):

Treatment Options ◽

Distal Tibia ◽

Titanium Implant ◽

Bone Transport ◽

Patient Specific ◽

Complication Rates ◽

Foot And Ankle ◽

Specific Patient ◽

3D Printed

Large bone defects from trauma or cancer are difficult to treat. Current treatment options include the use of external fixation with bone transport, bone grafting, or amputation. These modes of therapy continue to pose challenges as they are associated with high cost, failure, and complication rates. In this study, we report a successful case of bone defect treatment using personalized 3D-printed implant. This is the longest known follow-up using a 3D-printed custom implant for this specific application. Ultimately, this report adds to existing literature as it demonstrates successful and maintained incorporation of bone into the titanium implant. The use of patient-specific 3D-printed implants adds to the available arsenal to treat complex pathologies of the foot and ankle. Moreover, the technology’s flexibility and ease of customization makes it conducive to tailor to specific patient needs.

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Preoperative Guidance With Weight-Bearing Computed Tomography and Patient-Specific Instrumentation in Foot and Ankle Surgery

HSS Journal ® ◽

10.1177/15563316211026325 ◽

2021 ◽

pp. 155633162110263

Author(s):

Jacob Zeitlin ◽

Jensen Henry ◽

Scott Ellis

Keyword(s):

Computed Tomography ◽

3D Imaging ◽

Weight Bearing ◽

Patient Specific ◽

Foot And Ankle ◽

Review Of The Literature ◽

3 Dimensional ◽

Implant Positioning ◽

Patient Specific Instrumentation ◽

Ankle Surgery

The use of preoperative and intraoperative guidance in foot and ankle surgery has grown substantially in recent years. Weight-bearing computed tomography (WBCT) and patient-specific instrumentation (PSI) are used in total ankle arthroplasty (TAA) to achieve precise bone cutting and implant positioning, and intraoperative 3-dimensional (3D) imaging has been used to reduce complications and improve clinical outcomes in other foot and ankle surgical procedures. This narrative review of the literature focuses on the evidence supporting the use of WBCT and PSI in TAA and looks at other promising technologies used to guide foot and ankle surgery.

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

Foot & Ankle International ◽

10.1177/1071100718770133 ◽

2018 ◽

Vol 39 (8) ◽

pp. 916-921 ◽

Cited By ~ 27

Author(s):

Travis J. Dekker ◽

John R. Steele ◽

Andrew E. Federer ◽

Kamran S. Hamid ◽

Samuel B. Adams

Keyword(s):

Clinical Success ◽

Case Series ◽

Deformity Correction ◽

Clinical Success Rate ◽

Titanium Implants ◽

Patient Specific ◽

Foot And Ankle ◽

Level Of Evidence ◽

3D Printed

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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3D Printed Cage in Patients with Tibiotalocalcaneal Arthrodesis Using a Retrograde Intramedullary Nail: Early Outcomes

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00104 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0010

Author(s):

Lorena Bejarano-Pineda ◽

Samuel B. Adams ◽

Selene G. Parekh

Keyword(s):

Intramedullary Nail ◽

Titanium Implants ◽

Salvage Procedure ◽

Hindfoot Alignment ◽

Titanium Cage ◽

Retrograde Intramedullary Nail ◽

Tibiotalocalcaneal Arthrodesis ◽

3D Printed ◽

Hindfoot Arthrodesis

Category: Diabetes, Hindfoot, Trauma, salvage procedure Introduction/Purpose: Segmental bone loss in the hindfoot hinders the chance of successful outcomes. Tibiotalocalcaneal arthrodesis is a reliable option; however, the risk of nonunion is high. Structural graft is needed to fill the gap, but the use of bone grafts are limited by the availability, risk of collapse, and disease transmission. Three-dimensional (3D) printed titanium implants offer a strong scaffold that can be customized and present similar healing rates. The purpose of the study was to describe the clinical outcomes and the radiologic union rate of a case series of patients with hindfoot arthrodesis, using a retrograde intramedullary nail associated to a 3D printed titanium cage. Methods: After obtaining approval from our institution review board, a retrospective chart review was performed on seven patients undergoing hindfoot arthrodesis, using a retrograde intramedullary nail associated to a custom 3D printed titanium cage from March 2015 to December 2017. Demographic and clinical data were collected. Functional outcomes were assessed using The American Orthopedic Foot and Ankle Score (AOFAS) and the Visual Analog Scale (VAS) for pain. Hindfoot alignment was evaluated using preoperative and postoperative weightbearing radiographs that included anteroposterior, lateral and Saltzman views. Radiographic union was assessed using computed tomography scan at 6 and 12 months postoperatively. Results: All patients had ankle arthritis and six of them (85%) had prior surgery in the compromised hindfoot. The average age at TTC fusion was 57 (range, 29 to 71) years. The mean follow-up time was 21 (range, 12 to 32) months. Six patients had a healed fusion and one patient underwent below knee amputation due to recurrence of chronic osteomyelitis in the ankle. Two additional patients had minor complications. The average AOFAS at pre-op was 35 (range, 20 to 42) points as compared to 68 (range, 53 to 78) points at final follow-up; P=0.004. Preoperative VAS pain was 80.4 (range, 70 to 85) points as compared to 26.8 (range, 6 to 60) points; P=0.002. Conclusion: Tibiotalocalcaneal arthrodesis using customized titanium cages for patients with large bone defects has shown a high rate of union in those at high risk of nonunion. Further research is needed to monitor the development of late complications.

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