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Lewis TL, Walker R, Alkhalfan Y, Latif A, Abbasian A. Custom Patient-Specific 3D-Printed Titanium Truss Tibiotalocalcaneal Arthrodesis Implants for Failed Total Ankle Replacements: Classification, Technical Tips, and Treatment Algorithm. Foot Ankle Int 2024:10711007241255381. [PMID: 38872312 DOI: 10.1177/10711007241255381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
BACKGROUND The management of failed total ankle replacements, with significant loss of bone stock, is challenging with high rates of complications and associated morbidity. Recent technological advances have enabled the development of patient-customized 3D-printed titanium truss arthrodesis implants, which offer an alternative salvage option for failed total ankle replacements. METHODS A prospective observational study was performed of 6 cases of failed total ankle replacements that were managed using custom patient-specific 3D-printed titanium truss arthrodesis implants. Technical tips, classification, and a treatment algorithm were developed based on our initial experience. RESULTS Between November 2018 and March 2022, 6 patients underwent arthrodesis for failed total ankle replacements. Follow-up was available for all cases. The mean follow-up was 3.0 years (range 1-4.5). The mean MOXFQ Index improved from 73.1 to 32.3 (P < .05). The mean EQ-5D-5L Index improved from 0.366 to 0.743 (P < .05) and the EQ-VAS also improved from 53.0 to 63.3 (P = .36). The mean VAS-Pain score at final follow-up was 27.5. There were no cases of nonunion. None of the patients were smokers. The overall complication rate was 50%. Two patients returned to surgery: one for wound washout following TAR explantation and a second for removal of metalwork 2 years following surgery for a prosthetic joint infection secondary to hematogenous spread. No patients underwent revision fixation or amputation. CONCLUSION Custom patient-specific 3D-printed titanium truss arthrodesis implants are a viable treatment option for failed total ankle replacements.
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Affiliation(s)
- Thomas L Lewis
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Roland Walker
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Yousif Alkhalfan
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ahmed Latif
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ali Abbasian
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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2
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Abstract
Aims When a total ankle arthroplasty (TAA) fails, it can be converted to a fusion or a revision arthroplasty. Despite the increasing numbers of TAAs being undertaken, there is little information in the literature about the management of patients undergoing fusion following a failed TAA. The primary aim of this study was to analyze the survival of fusions following a failed TAA using a large dataset from the National Joint Registry (NJR). Methods A data linkage study combined NJR and NHS Digital data. Failure of a TAA was defined as a fusion, revision to a further TAA, or amputation. Life tables and Kaplan-Meier graphs were used to record survival. Cox proportional hazards regression models were fitted to compare the rates of failure. Results A total of 131 patients underwent fusion as a salvage procedure following TAA. Their mean age was 65.7 years (SD 10.6) and 73 (55.7%) were male. The mean follow-up was 47.5 months (SD 27.2). The mean time between TAA and fusion was 5.3 years (SD 2.7). Overall, 32 (24.4%) underwent reoperations other than revision and 29 (22.1%) failed. Of these 24 (18.3%) underwent revision of the fusion and five (3.8%) had a below-knee amputation. No patients underwent conversion to a further TAA. Failure usually occurred in the first three postoperative years with one-year survival of fusion being 96.0% (95% confidence interval (CI) 90.7 to 98.3) and three-year survival in 69 patients being 77.5% (95% CI 68.3 to 84.4). Conclusion Salvage fusion after a failed TAA shows moderate rates of failure and reoperations. Nearly 25% of patients required revision within three years. This study is an extension of studies using the same methodology reporting the failure rates and risk factors for failure, which have recently been published, and also one reporting the outcome of revision TAA for a failed primary TAA, using the same methodology, which will shortly be published.
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Affiliation(s)
- Toby Jennison
- Plymouth Hospitals NHS Trust, Plymouth, UK
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | | | - Ian Sharpe
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Andrew J Goldberg
- Wellington Hospital, London, UK
- UCL Division of Surgery, Royal Free Hospital, London, UK
- Imperial College London, London, UK
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Leslie MD, Schindler C, Rooke GMJ, Dodd A. CT-Verified Union Rate Following Arthrodesis of Ankle, Hindfoot, or Midfoot: A Systematic Review. Foot Ankle Int 2023; 44:665-674. [PMID: 37226736 PMCID: PMC10350704 DOI: 10.1177/10711007231171087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Ankle, hindfoot, and midfoot arthrodesis surgeries are standard procedures performed in orthopaedics to treat pain and functional disabilities. Although fusions can effectively improve pain and quality of life, nonunions remain a significant concern for surgeons. With the increased availability of computed tomography (CT), more surgeons rely on this modality for increased accuracy in determining whether a fusion was successful. The objective of this study was to report the rates of CT-confirmed fusion following ankle, hindfoot, or midfoot arthrodesis. METHODS A systematic review was performed using EMBASE, Medline, and Cochrane central register from January 2000 to March 2020. Inclusion criteria included studies with adults (<18 years) that received 1 or multiple fusions of the ankle, hindfoot, or midfoot. At least 75% of the study cohort must have been evaluated by CT postoperatively. Basic information was collected, including journal, author, year published, and level of evidence. Other specific information was collected, including patient risk factors, fusion site, surgical technique and fixation, adjuncts, union rates, criteria for successful fusion (%), and time of CT. Once data were collected, a descriptive and comparative analysis was performed. RESULTS Included studies (26, n = 1300) had an overall CT-confirmed fusion rate of 78.7% (69.6-87.7). Individual joints had an overall fusion rate of 83.0% (73-92.9). The highest rate of union was in the talonavicular joint (TNJ). CONCLUSION These values are lower than previous studies, which found the same procedures to have greater than 90% fusion rates. With these updated figures, as confirmed by CT, surgeons will have better information for clinical decision making and when having informed consent conversations.
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Affiliation(s)
| | - Christin Schindler
- Department of Orthopaedics and Traumatology, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | | | - Andrew Dodd
- Department of Orthopaedic Surgery, University of Calgary, Calgary, AB, Canada
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Hur ES, Mehta N, Lee S, Bohl DD. Management of Periprosthetic Bone Cysts After Total Ankle Arthroplasty. Orthop Clin North Am 2023; 54:109-119. [PMID: 36402507 DOI: 10.1016/j.ocl.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Modern improvements in total ankle arthroplasty (TAA) have increased the performance of this procedure for treatment of end-stage ankle arthritis. A common finding after TAA is the formation of periprosthetic bone cysts, which can be clinically silent or result in TAA failure. The exact cause of periprosthetic bones cysts has not been established, but major theories are related to osteolysis secondary to implant wear, micromotion, and stress shielding. Treatment can be nonoperative with clinical observation for small, asymptomatic cysts. Large, progressive, and symptomatic cysts often merit surgical treatment with debridement and grafting, revision TAA, or salvage arthrodesis.
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Affiliation(s)
- Edward S Hur
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite 400, Chicago, IL 60612, USA
| | - Nabil Mehta
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite 400, Chicago, IL 60612, USA
| | - Simon Lee
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite 400, Chicago, IL 60612, USA
| | - Daniel D Bohl
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite 400, Chicago, IL 60612, USA.
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Martínez-de-Albornoz P, Monteagudo M. Tibiotalocalcaneal Arthrodesis in Severe Hindfoot Deformities. Foot Ankle Clin 2022; 27:847-866. [PMID: 36368801 DOI: 10.1016/j.fcl.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Tibiotalocalcaneal arthrodesis (TTCA) is the most common and reliable procedure in the treatment of patients with end-stage ankle arthritis combined with severe deformity. Many of these patients present with difficult previous sequelae that include nonunion, malunion, broken implants, vascular deficiencies, skin problems, or a combination of the previous. In that complex scenario, sometimes the only alternative treatment is a below-the-knee amputation. Image studies--weightbearing X-rays, tomography, and magnetic resonance - are fundamental to evaluate alignment and bone stock. When all conservative treatments fail to alleviate pain and dysfunction, the combination of osteotomies and arthrodesis is the procedure of choice. Surgical planning needs to be very detailed and thorough with a special focus on bone loss after debridement of non-healthy tissue and removal of metalwork. TTCA with grafting allows for the preservation of the limb in more than 80% of cases but at the expense of many complications with nonunion rates of approximately 20% of cases. There is controversy about the use of a retrograde nail versus specific TTCA plate and screws but results from biomechanical studies do not show a clear superiority of one specific construct. Amputation rates are close to 5% of cases after repeated failed surgeries. Bulk allografts increase the rate of nonunions but apparently do not have an influence on postoperative infections. Valgus positioning of the ankle/hindfoot is paramount to allow for maximal sagittal plane compensation from the midtarsal joints. Most patients are satisfied with the results of these salvage operations. The studies presented in this article have a considerable wide array of different scenarios that obviously bias some of the results, complications, and outcomes but together they present a persuasive pattern toward considering TTC with grafting and nail or plate fixation as a good salvage procedure that may help the patients to maintain their foot and ankle with a better alignment, function, and pain relief.
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Affiliation(s)
- Pilar Martínez-de-Albornoz
- Orthopaedic Foot and Ankle Unit, Orthopaedic and Trauma Department, Hospital Universitario Quirónsalud, Madrid, Spain; Faculty Medicine UEM, Madrid, Spain.
| | - Manuel Monteagudo
- Orthopaedic Foot and Ankle Unit, Orthopaedic and Trauma Department, Hospital Universitario Quirónsalud, Madrid, Spain; Faculty Medicine UEM, Madrid, Spain
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Mehdi N, Lintz F, Alsafi M, Laborde J, Bernasconi A. Revision tibiotalar arthrodesis with posterior iliac autograft after failed arthroplasty: A matched comparative study with primary ankle arthrodeses. Orthop Traumatol Surg Res 2022; 108:103269. [PMID: 35288327 DOI: 10.1016/j.otsr.2022.103269] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/31/2021] [Accepted: 09/06/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Tibiotalar arthrodeses performed after failed ankle arthroplasties are known to be complex procedures with often disappointing functional outcomes. This study reports the results of a revision technique using a posterior iliac crest autograft. HYPOTHESES We hypothesized that: (1) revision tibiotalar arthrodeses (RTTAs) had functional outcomes which were similar to those of a reference cohort of primary tibiotalar arthrodeses (TTAs) and that (2) the union rate was satisfactory. MATERIALS AND METHODS This retrospective study compared 16 RTTAs performed for failed arthroplasties that caused pain and a functional disability (4 aseptic loosening, 4 massive progressive periprosthetic cysts, 5 malpositioning of implants, and 3 cases of unexplained mechanical pain) with a series of 16 primary TTAs performed for painful ankle osteoarthritis. The groups were matched at a 1:1 ratio for age, sex, side and body mass index. The preoperative workup included a physical exam, the American Orthopaedic Foot and Ankle Society (AOFAS) score, weight bearing radiographs, CT and SPECT scans. Outcomes were assessed both clinically (AOFAS score) and radiographically (X-rays and scans). The mean duration of the procedure (DP), average length of stay (LOS), fusion and complication rates, and time to union were also compared. RESULTS At the mean follow-up of 30 months (range, 12-88) for the RTTA group and 59 months (range, 23-94) for the TTA group (p=.001), the AOFAS score increased from 27 to 70.8 points (p<.001) and from 29.8 to 76.2 points (p<.001), respectively; values were similar at the last follow-up (p=.442). Both groups had similar fusion (94%) and complication rates (12%). The DP was 196.9±33.6min (range, 179-213) vs. 130±28.4min (range, 118-141) (p<.001) and the LOS was 3.8 days (range, 2-6) vs. 3.9 days (range, 2-6) (p<.445) for both groups (RTTA vs. TTA). CONCLUSION This RTTA technique using a posterior iliac crest allograft for filling bone defects was validated by the quality of the functional outcomes obtained. LEVEL OF EVIDENCE IV; Comparative retrospective study.
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Affiliation(s)
- Nazim Mehdi
- Clinique de l'Union, Centre de Chirurgie de la cheville et du pied, Boulevard de Ratalens, 31240 Saint-Jean, France.
| | - François Lintz
- Clinique de l'Union, Centre de Chirurgie de la cheville et du pied, Boulevard de Ratalens, 31240 Saint-Jean, France
| | | | - Julien Laborde
- Clinique de l'Union, Centre de Chirurgie de la cheville et du pied, Boulevard de Ratalens, 31240 Saint-Jean, France
| | - Alessio Bernasconi
- University of Naples "Federico II", Department of Public Health, Orthopaedic and Traumatology Unit, Via S. Pansini 5, Napoli, 80131, Italy
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7
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Jennison T, Spolton-Dean C, Rottenburg H, Ukoumunne O, Sharpe I, Goldberg A. The outcomes of revision surgery for a failed ankle arthroplasty. Bone Jt Open 2022; 3:596-606. [PMID: 35880516 PMCID: PMC9350690 DOI: 10.1302/2633-1462.37.bjo-2022-0038.r1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims Revision rates for ankle arthroplasties are higher than hip or knee arthroplasties. When a total ankle arthroplasty (TAA) fails, it can either undergo revision to another ankle replacement, revision of the TAA to ankle arthrodesis (fusion), or amputation. Currently there is a paucity of literature on the outcomes of these revisions. The aim of this meta-analysis is to assess the outcomes of revision TAA with respect to surgery type, functional outcomes, and reoperations. Methods A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Medline, Embase, Cinahl, and Cochrane reviews were searched for relevant papers. Papers analyzing surgical treatment for failed ankle arthroplasties were included. All papers were reviewed by two authors. Overall, 34 papers met the inclusion criteria. A meta-analysis of proportions was performed. Results Six papers analyzed all-cause reoperations of revision ankle arthroplasties, and 14 papers analyzed failures of conversion of a TAA to fusion. It was found that 26.9% (95% confidence interval (CI) 15.4% to 40.1%) of revision ankle arthroplasties required further surgical intervention and 13.0% (95% CI 4.9% to 23.4%) of conversion to fusions; 14.4% (95% CI 8.4% to 21.4%) of revision ankle arthroplasties failed and 8% (95% CI 4% to 13%) of conversion to fusions failed. Conclusion Revision of primary TAA can be an effective procedure with improved functional outcomes, but has considerable risks of failure and reoperation, especially in those with periprosthetic joint infection. In those who undergo conversion of TAA to fusion, there are high rates of nonunion. Further comparative studies are required to compare both operative techniques. Cite this article: Bone Jt Open 2022;3(7):596–606.
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Affiliation(s)
- Toby Jennison
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | | | | | - Ian Sharpe
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
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8
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Rony L, Aguado E, Verlee B, Pascaretti-Grizon F, Chappard D. Osseointegration of two types of titanium cylinders with geometric or trabecular microarchitecture: A nanotomographic and histomorphometric study. Morphologie 2022; 106:80-91. [PMID: 33812797 DOI: 10.1016/j.morpho.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 06/12/2023]
Abstract
Porous biomaterials promote osseointegration. We have prepared porous titanium cylinders by additive manufacturing from titanium beads. Two types of morphology were tested: cylinders with geometric pores or mimicking trabecular microarchitecture. Cylinders were decontaminated and cleaned by HF/HNO3 to remove unmelted balls. Surgical implantation in ewes was performed under general anesthesia and the animals were housed for 90 and 270days. The femoral condyles were collected and analyzed by nanoCT, embedded in pMMA and analyzed by histomorphometry. No significant difference was found in terms of bone volume or bone/titanium interface between the two types of cylinders. There was no evolution over time except for the mineralization rates which decreased, reflecting the effect of the aging of the animals. The influence of the pores (geometrical or "natural") did not influence osseointegration. HF/HNO3 etching treatments are effective on the outermost surfaces but do not seem to reach the central cavities of the samples. Finally, osseointegration seems to occur only in the few millimeters around the periphery of the implants and does not extend in the center. This is explained by the absence of stress transmission within the very rigid metal cylinders, preventing bone modeling and remodeling.
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Affiliation(s)
- L Rony
- GEROM - Groupe Etudes Remodelage Osseux et bioMatériaux, LabCom NextBone, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, 49933 Angers, France
| | - E Aguado
- GEROM - Groupe Etudes Remodelage Osseux et bioMatériaux, LabCom NextBone, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, 49933 Angers, France; ONIRIS, Ecole Vétérinaire de Nantes, 44307 Nantes Cedex 3, France
| | - B Verlee
- SIRRIS Liège Science Park, Rue du bois St Jean 12, 4102 Seraing, Belgium
| | - F Pascaretti-Grizon
- GEROM - Groupe Etudes Remodelage Osseux et bioMatériaux, LabCom NextBone, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, 49933 Angers, France
| | - D Chappard
- GEROM - Groupe Etudes Remodelage Osseux et bioMatériaux, LabCom NextBone, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, 49933 Angers, France; SCIAM, Service Commun d'Imagerie et Analyses Microscopiques, IRIS-IBS Institut de Biologie en Santé, Univ-Angers, 49933 Angers Cedex, France.
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9
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Buchhorn T, Baumbach SF, Böcker W, Szymski D, Polzer H. [Salvage options following failed total ankle arthroplasty]. Unfallchirurg 2022; 125:211-218. [PMID: 35091802 DOI: 10.1007/s00113-022-01141-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
The number of patients with osteoarthritis of the ankle, which are treated by arthroplasty, has continuously increased in recent years. The survival time of these implants is far below the results following hip and knee arthroplasty. In some cases a failure rate of approximately 1% per year or a survival rate of 70% after 10 years has been reported. The most frequent reasons for revision of an ankle prosthesis are aseptic loosening, technical implantation errors and persisting pain. For the revision of an ankle prosthesis there are basically two treatment options. For a long time, ankle arthrodesis was considered the gold standard after a failed prosthesis. In recent years, there has been an increasing trend towards re-implantation of an ankle prosthesis, as this preserves the functionality and mobility of the ankle joint as far as possible. Depending on the reason for failure and the size of the bony defect, a decision must be made regarding a one-stage and a two-stage procedure with bone augmentation. This article presents the advantages and disadvantages of arthrodesis and revision arthroplasty after failed primary ankle arthroplasty and highlights the special features of surgery.
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Affiliation(s)
- T Buchhorn
- Sporthopädicum Straubing-Regensburg-Berlin, 94315, Straubing, Deutschland
| | - S F Baumbach
- Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, Ziemssenstr. 5, 80336, München, Deutschland
| | - W Böcker
- Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, Ziemssenstr. 5, 80336, München, Deutschland
| | - D Szymski
- Sporthopädicum Straubing-Regensburg-Berlin, 94315, Straubing, Deutschland.,Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, 93053, Regensburg, Deutschland
| | - H Polzer
- Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, Ziemssenstr. 5, 80336, München, Deutschland.
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Grau D, Matamala A, Bernaus M, Veloso M, Anglès F, Poggio D, Font-Vizcarra L. A 3D-Printed Model of a Titanium Custom-Made Talus for the Treatment of a Chronic Infection of the Ankle. J Foot Ankle Surg 2022; 61:212-217. [PMID: 34702679 DOI: 10.1053/j.jfas.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/07/2020] [Accepted: 09/06/2021] [Indexed: 02/03/2023]
Abstract
Osteoarticular infections are challenging and difficult to treat. The use of innovative technologies like 3D printing already employed in other types of surgeries and pathologies can suppose a great asset to tackle the problem and improve functional results. We present a case of an osteoarticular infection of an ankle treated with a custom-made titanium talus made with 3D metal printing technology: A 63-year-old patient, with chronic infection of the ankle. A 2-staged surgery was performed, with a hand-made cement spacer used during the first stage and the implantation of a custom-made titanium talus with an arthrodesis nail in the second stage. After a 2-year follow-up, a good clinical evolution was achieved, with no signs of reactivation of the infection, no pain, good skin condition and optimal functionality: functional gait pattern without pain and any external aids.
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Affiliation(s)
- Daniel Grau
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, Spain
| | - Alfredo Matamala
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, Spain; Orthopaedic Surgeon, Bone and Joint Infection Unit, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, Spain
| | - Martí Bernaus
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, Spain; Orthopaedic Surgeon, Bone and Joint Infection Unit, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, Spain
| | - Margarita Veloso
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, Spain; Orthopaedic Surgeon, Bone and Joint Infection Unit, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, Spain
| | - Francesc Anglès
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, Spain; Professor, Department of Surgery, University of Barcelona, Barcelona, Spain
| | - Daniel Poggio
- Foot & Ankle Surgeon, Foot and Ankle Unit, Department of Orthopaedic Surgery, Hospital Clínic Barcelona, Barcelona, Spain
| | - Lluís Font-Vizcarra
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, Spain; Orthopaedic Surgeon, Bone and Joint Infection Unit, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, Spain.
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Rony L, Aguado E, Verlee B, Pascaretti-Grizon F, Chappard D. Microarchitecture of titanium cylinders obtained by additive manufacturing does not influence osseointegration in the sheep. Regen Biomater 2021; 8:rbab021. [PMID: 34188953 PMCID: PMC8226111 DOI: 10.1093/rb/rbab021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/19/2021] [Accepted: 04/25/2021] [Indexed: 12/15/2022] Open
Abstract
Large bone defects are a challenge for orthopedic surgery. Natural (bone grafts) and synthetic biomaterials have been proposed but several problems arise such as biomechanical resistance or viral/bacterial safety. The use of metallic foams could be a solution to improve mechanical resistance and promote osseointegration of large porous metal devices. Titanium cylinders have been prepared by additive manufacturing (3D printing/rapid prototyping) with a geometric or trabecular microarchitecture. They were implanted in the femoral condyles of aged ewes; the animals were left in stabling for 90 and 270 days. A double calcein labeling was done before sacrifice; bones were analyzed by histomorphometry. Neither bone volume, bone/titanium interface nor mineralization rate were influenced by the cylinder's microarchitecture; the morphometric parameters did not significantly increase over time. Bone anchoring occurred on the margins of the cylinders and some trabeculae extended in the core of the cylinders but the amount of bone inside the cylinders remained low. The rigid titanium cylinders preserved bone cells from strains in the core of the cylinders. Additive manufacturing is an interesting tool to prepare 3D metallic scaffolds, but microarchitecture does not seem as crucial as expected and anchoring seems limited to the first millimeters of the graft.
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Affiliation(s)
- Louis Rony
- GEROM-Groupe Etudes Remodelage Osseux et bioMatériaux, LabCom NextBone, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, 49933 Angers, France
| | - Eric Aguado
- GEROM-Groupe Etudes Remodelage Osseux et bioMatériaux, LabCom NextBone, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, 49933 Angers, France
| | - Bruno Verlee
- SIRRIS Liège Science Park, Rue du bois St Jean 12, Seraing 4102, Belgium
| | - Florence Pascaretti-Grizon
- GEROM-Groupe Etudes Remodelage Osseux et bioMatériaux, LabCom NextBone, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, 49933 Angers, France
| | - Daniel Chappard
- GEROM-Groupe Etudes Remodelage Osseux et bioMatériaux, LabCom NextBone, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, 49933 Angers, France
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12
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Huang G, Pan ST, Qiu JX. The Clinical Application of Porous Tantalum and Its New Development for Bone Tissue Engineering. MATERIALS (BASEL, SWITZERLAND) 2021; 14:2647. [PMID: 34070153 PMCID: PMC8158527 DOI: 10.3390/ma14102647] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/06/2021] [Accepted: 05/13/2021] [Indexed: 12/13/2022]
Abstract
Porous tantalum (Ta) is a promising biomaterial and has been applied in orthopedics and dentistry for nearly two decades. The high porosity and interconnected pore structure of porous Ta promise fine bone ingrowth and new bone formation within the inner space, which further guarantee rapid osteointegration and bone-implant stability in the long term. Porous Ta has high wettability and surface energy that can facilitate adherence, proliferation and mineralization of osteoblasts. Meanwhile, the low elastic modulus and high friction coefficient of porous Ta allow it to effectively avoid the stress shield effect, minimize marginal bone loss and ensure primary stability. Accordingly, the satisfactory clinical application of porous Ta-based implants or prostheses is mainly derived from its excellent biological and mechanical properties. With the advent of additive manufacturing, personalized porous Ta-based implants or prostheses have shown their clinical value in the treatment of individual patients who need specially designed implants or prosthesis. In addition, many modification methods have been introduced to enhance the bioactivity and antibacterial property of porous Ta with promising in vitro and in vivo research results. In any case, choosing suitable patients is of great importance to guarantee surgical success after porous Ta insertion.
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Affiliation(s)
| | | | - Jia-Xuan Qiu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China; (G.H.); (S.-T.P.)
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Wang G, Lin J, Zhang H, Pei Y, Zhu L, Xu Q. Three-dimension correction of Charcot ankle deformity with a titanium implant. Comput Assist Surg (Abingdon) 2021; 26:15-21. [PMID: 33625935 DOI: 10.1080/24699322.2021.1887356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Charcot neuroarthropathy of the ankle is an extremely challenging clinical dilemma, and its surgical management can be highly complicated. The goal of Charcot ankle treatment is to to restore a plantigrade and stable foot, and thus to avoid ulceration with subsequent infection. This report aims to introduce a method of correcting ankle deformity using a novel 3D printing technique. PATIENT AND METHODS One patient with Charcot ankle deformity was operated in this study. The ankle deformity of this patient was quantified in three dimensions through computed tomography. On the basis of the computed tomography scans, a new titanium implant was designed and manufactured using 3D printing. The implant was applied in the surgery of tibio-talo-calcaneal arthrodesis to restore local anatomy of the affected ankle of the patient with Charcot neuroarthropathy. RESULTS Evaluation of the post-operative radiography indicated union in the affected ankle. After surgery, the planar foot in this patient was restored. The patient was satisfied with the post-operative course, and joint fusion was successful as indicated by 2-year post-operative evaluation. The results of post-operative follow-up showed that the lower limb length of the patient with Charcot neuroarthropathy was salvaged, and the patient retained the plantigrade foot. CONCLUSION Three-dimensional printing technique combined with tibio-talo-calcaneal arthrodesis may help to correct ankle deformity in patients with Charcot neuroarthropathy.
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Affiliation(s)
- Gang Wang
- Department of Hand and Foot Surgery, Department of Orthropedics, Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Junhao Lin
- Department of Hand and Foot Surgery, Department of Orthropedics, Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Hong Zhang
- Department of Hand and Foot Surgery, Department of Orthropedics, Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Yantao Pei
- Department of Hand and Foot Surgery, Department of Orthropedics, Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Lei Zhu
- Department of Hand and Foot Surgery, Department of Orthropedics, Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Qingjia Xu
- Department of Hand and Foot Surgery, Department of Orthropedics, Qilu Hospital of Shandong University, Jinan, P.R. China
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Bernasconi A, Patel S, Malhotra K, Singh D, Welck M, Cullen N. Salvage Tibiotalocalcaneal Arthrodesis Augmented With Fibular Columns and Iliac Crest Autograft: A Technical Note. Foot Ankle Spec 2021; 14:79-88. [PMID: 33345604 DOI: 10.1177/1938640020980914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Failure of ankle arthrodesis or total ankle replacement (TAR) results in a challenging clinical situation and may take the form of symptomatic nonunion following arthrodesis and aseptic or infective loosening following TAR. Revision in these scenarios is technically demanding, and if associated with subtalar degeneration, conversion to tibiotalocalcaneal (TTC) arthrodesis may be required, with use of bone grafting to maintain length and reduce disability. Fibular strut grafting in the form of pillars or columns, potentially supplemented by tricortical and iliac graft, may be used in association with intramedullary TTC nailing or lateral plating and has demonstrated encouraging fusion rates. In this technical note, we review the history of this technique and report indications and surgical approach. Furthermore, of 6 cases (mean age 69.8 years) treated at our institution and followed at 13 months (range, 8 to 20 months), 5 (83%) were clinically and radiologically united, and patients were satisfied with the outcome of surgery. One patient with a background of chronic kidney disease remained dissatisfied with no union achieved, persistent pain, and awaiting a below-the-knee amputation. No other complications were observed. TTC fusion augmented with fibular columns and iliac crest autograft is an option to treat combined ankle and subtalar joint pathologies with significant talar bone loss.Levels of Evidence: Level V (technical note).
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Affiliation(s)
- Alessio Bernasconi
- Department of Public Health, Trauma and Orthopaedics, University of Naples Federico II, Naples, Italy.,Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Shelain Patel
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Karan Malhotra
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Dishan Singh
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Matthew Welck
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Nicholas Cullen
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, UK
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Sundet M, Johnsen E, Eikvar KH, Eriksen ML. Retrograde nailing, trabecular metal implant and use of bone marrow aspirate concentrate after failed ankle joint replacement. Foot Ankle Surg 2021; 27:123-128. [PMID: 32273230 DOI: 10.1016/j.fas.2020.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 03/04/2020] [Accepted: 03/06/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ankle fusion after removal of alloplasty is known to be a procedure with a high potential for non-unions and poor function, especially tibio-talo-calcaneal fusion. We wanted to review our results after using a novel method for the procedure, combining retrograde nailing with a trabecular metal implant and bone marrow aspirate concentration applied in an ostoconductive pad in addition to autologous bone grafting. MATERIALS AND METHODS Retrospective review of a patient series, with some prospectively registered data. 31 ankles in 30 patients were operated from January 2016 to February 2019. RESULTS There were two non-unions (6.5%), and one delayed union, none of these were reoperated. The mean postoperative Manchester-Oxford Foot and Ankle Questionnaire score (MOxFQ) was 33.6 points. 9 patients scored an average MOxFQ at 72.9 immediately before surgery, while at follow-up this had decreased to 36.2, an improvement of 36.7 points (95% CI 18.3-54.9). There were 1 minor infection and 5 possible nerve injuries. One patient had the leg amputated 1 year after the surgery due to a non-related necrotizing fasciitis. CONCLUSION We present reasonably good short to medium term patient satisfaction and fusion rates with this novel combination of techniques.
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Affiliation(s)
- Mads Sundet
- Consultant Foot and Ankle Surgeon, Diakonhjemmet Hospital, Oslo, Norway.
| | - Elena Johnsen
- Consultant Radiologist, Diakonhjemmet Hospital, Oslo, Norway.
| | - Kari Helene Eikvar
- Department of Professional Affairs,The Norwegian Medical Association, Oslo, Norway.
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Shanmuganantha L, Baharudin A, Sulong AB, Shamsudin R, Ng MH. Prospect of Metal Ceramic (Titanium-Wollastonite) Composite as Permanent Bone Implants: A Narrative Review. MATERIALS (BASEL, SWITZERLAND) 2021; 14:E277. [PMID: 33430455 PMCID: PMC7826931 DOI: 10.3390/ma14020277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/10/2020] [Accepted: 12/17/2020] [Indexed: 01/08/2023]
Abstract
This literature review discusses the influence of titanium ceramic composites as a biomaterial towards the fabrication of implants for orthopedic applications. The concept of applying metal-ceramic composites enable many novel combinations in the design and fabrication of complex materials which enhances functionality to improve cell and tissue matrix interactions particularly in the formation of bone. Specific focus is placed on its plethora of materials selected from the metals and ceramic group and identifying the optimal combination that matches them. The prospect of wollastonite as the ceramic counterpart is also highlighted. In this review, we have highlighted the different fabrication methods for such metal-ceramic materials as well as the role that these hybrids play in an in vitro and in vivo environment. Its economic potential as a bone implant material is also discussed.
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Affiliation(s)
| | - Azmi Baharudin
- Department of Orthopaedic and Traumatology, National University of Malaysia, Selangor Darul Ehsan 56000, Malaysia;
| | - Abu Bakar Sulong
- Department of Mechanical Engineering, National University of Malaysia, Selangor Darul Ehsan 43600, Malaysia;
| | - Roslinda Shamsudin
- Department of Science and Technology, National University of Malaysia, Selangor Darul Ehsan 43600, Malaysia;
| | - Min Hwei Ng
- Department of Tissue Engineering, National University of Malaysia, Selangor Darul Ehsan 56000, Malaysia;
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Abstract
Salvage arthrodesis for failed total ankle replacement can be a successful procedure. The decision to perform salvage arthrodesis is based on many factors, but the following are the most important indications: severe loss of bonestock (tibia, talus, or both), inadequate soft tissue coverage, or the inability to eradicate an infection. With few revision implants on the market, salvage arthrodesis is currently the most common treatment for failed replacement and justification for revision ankle replacement is limited when any of these factors are present.
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Affiliation(s)
- Samuel B Adams
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Duke University Medical Center, 4709 Creekstone Drive, Durham, NC 27703, USA.
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Han Q, Wang C, Chen H, Zhao X, Wang J. Porous Tantalum and Titanium in Orthopedics: A Review. ACS Biomater Sci Eng 2019; 5:5798-5824. [PMID: 33405672 DOI: 10.1021/acsbiomaterials.9b00493] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Porous metal is metal with special porous structures, which can offer high biocompatibility and low Young's modulus to satisfy the need for orthopedic applications. Titanium and tantalum are the most widely used porous metals in orthopedics due to their excellent biomechanical properties and biocompatibility. Porous titanium and tantalum have been studied and applied for a long history until now. Here in this review, various manufacturing methods of titanium and tantalum porous metals are introduced. Application of these porous metals in different parts of the body are summarized, and strengths and weaknesses of these porous metal implants in clinical practice are discussed frankly for future improvement from the viewpoint of orthopedic surgeons. Then according to the requirements from clinics, progress in research for clinical use is illustrated in four aspects. Various creative designs of microporous and functionally gradient structure, surface modification, and functional compound systems of porous metal are exhibited as reference for future research. Finally, the directions of orthopedic porous metal development were proposed from the clinical view based on the rapid progress of additive manufacturing. Controllable design of both macroscopic anatomical bionic shape and microscopic functional bionic gradient porous metal, which could meet the rigorous mechanical demand of bone reconstruction, should be developed as the focus. The modification of a porous metal surface and construction of a functional porous metal compound system, empowering stronger cell proliferation and antimicrobial and antineoplastic property to the porous metal implant, also should be taken into consideration.
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Affiliation(s)
- Qing Han
- Department of Orthopedics, Second Hospital of Jilin University, Changchun, 130000 Jilin Province, China
| | - Chenyu Wang
- Department of Orthopedics, Second Hospital of Jilin University, Changchun, 130000 Jilin Province, China
| | - Hao Chen
- Department of Orthopedics, Second Hospital of Jilin University, Changchun, 130000 Jilin Province, China
| | - Xue Zhao
- Department of Endocrine and Metabolism, The First Hospital of Jilin University, Changchun, 130000 Jilin Province, China
| | - Jincheng Wang
- Department of Orthopedics, Second Hospital of Jilin University, Changchun, 130000 Jilin Province, China
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Rony L, Lancigu R, Hubert L. Intraosseous metal implants in orthopedics: A review. Morphologie 2018; 102:231-242. [PMID: 30348489 DOI: 10.1016/j.morpho.2018.09.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/28/2018] [Accepted: 09/28/2018] [Indexed: 04/21/2023]
Abstract
Metal implants are biomaterials widely used in orthopedics. They are both used in osteosynthesis and arthroplasty. Their mechanical properties, biocompatibility and resistance to corrosion make them a widely used option in orthopedics. Alloys are the most commonly used metals in orthopedics. As far as physical traumas are concerned, implants such as screws, plates and/or nails are used for osteosynthesis as they ensure the stability of the fractured area and contribute to bone healing. Prostheses are used in arthroplasty to restore joint function for as long as possible. Contact between bone and the prosthesis induces bone remodeling at the interface between metal and bone even if the metal is recognized as biocompatible. Upon time, the interface between the metal implant and the bony tissue is continuously modified and adapted. Hip prosthesis is a typical example of intraosseous metal implant whose bone/implant interface has been extensively studied. Metal can be altered in vivo by different mechanisms including corrosion and fretting. An altered torque friction leads to wear debris that accumulate in the peri-prosthetic tissues causing metallosis.
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Affiliation(s)
- L Rony
- Groupe Études Remodelage Osseux et bioMatériaux (GEROM), LabCom NextBone, SFR 42 08, université d'Angers, CHU d'Angers, IRIS-IBS institut de biologie en santé, 49933 Angers cedex, France; Département de chirurgie osseuse, CHU d'Angers, 49033 Angers cedex, France.
| | - R Lancigu
- Département de chirurgie osseuse, CHU d'Angers, 49033 Angers cedex, France
| | - L Hubert
- Département de chirurgie osseuse, CHU d'Angers, 49033 Angers cedex, France
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Liu J, Zhou X, Wang H, Yang H, Ruan J. In vitro
cell response and in vivo
primary osteointegration of highly porous Ta-Nb alloys as implant materials. J Biomed Mater Res B Appl Biomater 2018; 107:573-581. [DOI: 10.1002/jbm.b.34149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/29/2018] [Accepted: 04/17/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Jue Liu
- State Key Laboratory of Powder Metallurgy; Central South University; Changsha 410083 People's Republic of China
| | - Xiongwen Zhou
- Department of Anesthesiology; The Second Xiang Ya Hospital, Central South University; Changsha 410011 People's Republic of China
| | - Huifeng Wang
- State Key Laboratory of Powder Metallurgy; Central South University; Changsha 410083 People's Republic of China
| | - Hailin Yang
- State Key Laboratory of Powder Metallurgy; Central South University; Changsha 410083 People's Republic of China
| | - Jianming Ruan
- State Key Laboratory of Powder Metallurgy; Central South University; Changsha 410083 People's Republic of China
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