Total Talar Replacement With Custom-Made Vitallium Prosthesis for Talar Avascular Necrosis

Applications and Effectiveness of 3D Printing in Various Ankle Surgeries: A Narrative Review

BACKGROUND

Technological advancements have made three-dimensional printing prevalent in orthopedic surgery. It facilitates the production of customized implants and tailored patient instruments, enhancing surgical planning and results. This review focuses on the uses and effectiveness of patient-specific products manufactured using three-dimensional printing in ankle surgery.

METHODS

A search of databases-PubMed, Embase, Cochrane Library, and Google Scholar-yielded 41 articles for review.

RESULTS

Total talus replacement offers a viable alternative to standard treatments like arthrodesis and total ankle arthroplasty. Custom implants and patient-specific instrumentation in total ankle arthroplasty procedures guarantee a tailored fit and accurate alignment. For arthrodesis, three-dimensional printing enables the production of cages, effectively solving issues associated with conventional bone grafts, such as poor bone quality, significant defects, and nonunion. Additionally, patient-specific instrumentation facilitates the swift and accurate placement of Kirschner wires at the correct sites. When performing supramalleolar osteotomy, patient-specific instrumentation leads to shorter operation times, reduced blood loss, and less radiation exposure.

CONCLUSIONS

Three-dimensional printing is increasingly employed in ankle surgeries, and as technology advances, it is anticipated to become critical for addressing complex ankle issues.

Avascular Necrosis of the Talus: Diagnosis, Treatment, and Modern Reconstructive Options

Talar avascular necrosis (AVN) is a devastating condition that frequently follows type III and IV talar neck fractures. As 60% of the talus is covered by hyaline cartilage, its vascular supply is limited and prone to trauma, which may eventually lead to AVN development. Early detection of AVN (Hawkins sign, MRI) is crucial, as it may prevent the development of the irreversible stages III and IV of AVN. Alertness is advised regarding non-obvious conditions that may cause this complication (sub chondroplasty, systemic lupus erythematosus, diabetes mellitus). Although, in stages I-II, AVN may be treated with non-surgical procedures (ESWT therapy, non-weight bearing) or joint-sparing techniques (core drilling, bone marrow aspirate injections), stages III-IV require more advanced procedures, such as joint-sacrificing procedures (hindfoot arthrodesis/ankle arthrodesis), or replacement surgery, including total talar replacement (TTR) or combined total ankle replacement (TAR). The advancement of 3D-printing technology and increased access to implant manufacturing are contributing to a rise in the production rates of third-generation total talar prostheses. As a result, there is a growing frequency of alloplasty procedures and combined total ankle replacement (TAR) surgeries. By performing TTR as opposed to deses, the operator avoids (i) delayed union, (ii) a shortening of the limb, (iii) a lack of mobility, and (iv) the stiffening of adjacent joints, which are the main disadvantages of joint-sacrificing procedures. Simultaneously, TTR and combined TAR offer (i) a brief period of weight-bearing restriction, (ii) quick pain relief, and (iii) preservation of the length of the limb. Here, we summarize the most up-to-date knowledge regarding AVN diagnosis and treatment, with a special focus on the role of TTR.

[Research progress in surgical treatment of avascular necrosis of talus]

Objective

To summarize the surgical treatment methods for avascular necrosis of the talus.

Methods

The recent domestic and international literature related to avascular necrosis of the talus was extensively conducted. The pathogenesis, surgical treatment methods, and prognosis were summarized.

Results

The clinical symptoms of avascular necrosis of the talus at early stage are not obvious, and most patients have progressed to Ficat-Arlet stages Ⅲ-Ⅳ and require surgical treatment. Currently, surgical treatments for this disease include core decompression, vascularized bone flap transplantation, arthroplasty, and arthrodesis, etc. Early avascular necrosis of the talus can be treated conservatively, and if treatment fails, core decompression can be considered. Arthrodesis is a remedial surgery for patients with end-stage arthritis and collapse, and in cases of severe bone loss, tibiotalocalcaneal arthrodesis and bone grafting are required. Vascularized bone flap transplantation is effective and plays a role in all stages of avascular necrosis of the talus, but the appropriate donor area for the flap still needs further to be studied.

Conclusion

The surgical treatment and the system of treatment for different stages of avascular necrosis of the talus still need to be refined.

A Novel Technique for Lateral Ankle Ligament Reconstruction with Total Ankle Total Talus Replacement: A Case Report

CASE

A 65-year-old man with severe left talar avascular necrosis, arthritis, and chronic lateral ankle instability underwent total ankle total talus replacement (TATTR) with lateral ligament reconstruction. Tibial component placement was performed using preoperative computed tomography navigation and patient-specific guides. A custom, total talus replacement to mate with the fixed-bearing tibial component was implanted. Last, a modified Brostrom procedure was performed to restore lateral ankle stability. The patient has performed well through 1 year with improved pain-free function.

CONCLUSION

This case report details a novel technique for performing a modified Brostrom procedure in conjunction with TATTR to restore lateral ankle stability.