Early results of combined total ankle total talus replacement in the revision setting

• Published in: Foot and ankle surgery Vol. 30; no. 6; pp. 493 - 498
• Main Authors: Wang, Joyce En-Hua, Day, Jonathan, McCann, Julia, Cooper, Paul
• Format: Journal Article
• Language: English
• Published: France Elsevier Ltd 01-08-2024
• Subjects: 3D printing; Ankle replacement; Failure; Total ankle arthroplasty; Ankle replacement; Total ankle arthroplasty; 3D printing; Failure
• ISSN: 1268-7731; 1460-9584; 1460-9584
• DOI: 10.1016/j.fas.2024.03.012

Revision of failed total ankle replacement (TAR) is challenging and associated with increased morbidity. Given the increased popularity of TAR in treating end-stage ankle arthritis (ESAA), viable revision options are needed. The objective of this case series is to present a minimum 2-year clinical and radiographic outcomes of patient-specific custom 3D-printed total ankle total talus (TATR) prostheses in this unique subset of patients.
19 participants with ESAA and failed primary TAR who underwent TATR by a single surgeon at our institution from 2019 to 2021 were retrospectively identified. All participants were indicated for revision of primary STAR implant (Stryker, Kalamazoo, MI) and underwent replacement with 3D-printed titanium implants based on preoperative CT analysis (Additive Orthopaedics, Little Silver, NJ). Custom components included a mobile-bearing total talus and stemmed tibial system, performed through an anterior approach. Pre- and postoperative patient-reported outcomes were assessed using the Patient Reported Outcomes Measurement Information System (PROMIS). Pre- and postoperative implant alignment was assessed using medial distal tibial angle (MDTA) and tibiotalar angle (TTA) on anteroposterior, and sagittal tibial angle (STA) on lateral weight-bearing plain films.
The average patient age was 60.6 (range, 39–77) years, with an average follow-up of 37.9 (range, 25.3–57.5) months. There was statistically significant improvement in all PROMIS domains. Short-term survivorship was 100%, with two participants (11.0%) requiring reoperation for postoperative complications: one underwent open reduction internal fixation of the tibia for a periprosthetic fracture, and another underwent medial gutter debridement and tarsal tunnel release for recurrent pain. There were no significant differences in pre- versus postoperative radiographic alignment measured by MDTA (89.9 vs 86.4), TTA (89.7 vs 88.1), or STA (85.2 vs 85.3).
Custom 3D-printed TATR is a promising option for revision TAR. There was significant short-term improvement in pain and physical function, with excellent short-term survivorship and an acceptable postoperative complication rate.