3D Printed Total Talus Replacement
What is Avascular Necrosis of the Talus (AVN)?
Avascular Necrosis of the Talus (AVN) is a condition in which the blood supply to the talus is cut off. A number of conditions can result in avascular necrosis of the talus (AVN) including fractures, autoimmune disease, and certain medications. When the blood supply is cut off to the talus, the bone may break down causing it to become soft and collapse. The talus bone is unique as its surface is greater than 90% cartilage allowing for motion at the ankle and the subtalar joint. When avascular necrosis of the talus (AVN) causes collapse of the talus, it may result in painful arthritis at the joint.
What Treatments are Available for Avascular Necrosis of the Talus (AVN)?
Many treatments exist today for the treatment of avascular necrosis of the talus (AVN). Treatments will depend on a number of factors:
- How much of the talus is involved
- Has there been collapse of the talus
- Is there arthritis at the ankle or subtalar joint
After being examined in the office and undergoing x-ray, a CT scan and MRI are often necessary to determine the best treatment for avascular necrosis of the talus (AVN).
Surgical options for avascular necrosis of the talus (AVN) include:
- Ankle fusion
- Decompression of the talus
- A muscle flap to restore blood flow
- A bone graft
- Partial talus replacement (hemi-talar allograft)
- Total talus replacement (3D printed total talus)
What is 3D Printed Total Talus Replacement?
In a custom 3D printed talus replacement surgery, the damaged talus bone is replaced with a patient-specific implant that is usually made of metal. Prior to surgery, a CT scan of your foot and ankle is obtained. Based on the CT scan, a 3D model of the talus is generated. Using the 3D bone model, your surgeon can design a patient-specific implant is developed that matches your specific foot and ankle anatomy.
A custom 3D printed total talus implant restores the natural ankle joint anatomy and mobility. It offers better fit and is more suited to individual needs.
Before this procedure existed, patients with advanced avascular necrosis of the talus (AVN) often needed surgery to remove the collapsed talus and replace it with bone graft resulting in a fusion of the ankle joint. 3D printing technology has allowed surgeons to maintain motion at the ankle while removing the talus and restoring pain-free function.
3D printing technology has been available for decades but has only recently been used in foot and ankle surgery. Over the last ten years, this technology has become more frequently used and patient-outcomes are being evaluated with encouraging results.
Why 3D Total Talus Replacement with OINT?
At the Orthopedic Institute of North Texas (OINT) we have fellowship trained orthopedic foot and ankle surgeons, like Dr. Justin Kane, M.D. and Dr. Leroy Butler, D.O. They routinely perform surgery incorporating 3D printing technology. From 3D printed ankle replacement technology, to bone replacements, even the most complex surgeries involving 3D printing are performed on a weekly basis.
Indications for Custom 3D Printed Total Talus Replacement
Your surgeon may recommend a custom 3D printed total talus replacement for:
- Avascular necrosis of the talus
- Advanced osteoarthritis of the ankle that has not responded to non-surgical treatments
- Severe injury to the ankle joint
- Revision for a failed implant
- Restoration of ankle joint mobility after removal of a talar tumor
Contraindications for Custom 3D Printed Total Talus Replacement
Custom 3D printed total talus replacement is contraindicated for:
- Acute or chronic infections
- Osteomyelitis and severe osteoporosis
- Charcot foot
- Severe osteonecrosis of the talus
What to expect before a 3D Printed Total Talus Replacement Surgery?
Before determining if you are a candidate for a 3D printed total talus, you will be seen at our clinic in Frisco or Flower Mound, Texas. Our fellowship-trained orthopedic foot and ankle surgeons will perform a thorough physical exam and obtain specialized x-rays to help guide treatment. A patient-centered approach to care is always followed helping us understand your specific needs and goals for treatment.
Prior to undergoing surgery, a CT scan and MRI will be necessary to help plan for your surgery. The images will then be used to create a custom implant designed specifically for you. Our surgeons will meet with the engineers to design the implant and once the process is complete, it will take 4-6 weeks before the implant will be ready. Until your surgery you may have restrictions regarding your food intake, work schedule, and exercise prior to the surgery.
How is the 3D Printed Total Talus Replacement Surgery performed?
- Custom 3D printed total talus replacement is performed under general anesthesia. Our surgeons at OINT usually use a nerve block to help with pain after surgery.
- Your surgeon makes an incision over the front of your ankle.
- The muscles are retracted, and tendons and ligaments are moved away to expose the ankle joint.
- Then, the damaged talus bone is removed.
- The 3D printed custom talus implant is placed in the ankle joint.
- Depending on your ankle, the implant may have to be screwed into the heel bone or may be placed in conjunction with an ankle replacement to address the arthritis on the tibia.
- Your surgeon will assess the range of motion of the ankle.
- At the end of the surgery, tendons and other soft tissue structures are positioned back to cover the new joint.
- The wound is sutured and covered with a sterile dressing.
How is the recovery after a 3D Printed Total Talus Replacement Surgery?
- You may be required to stay in the hospital for 2-3 days after your surgery.
- The treated ankle will be immobilized with the help of splints and a custom dressing.
- For an isolated total talus replacement, you will be allowed to begin walking and physical therapy at around 2 weeks
- For a total talus replacement with a subtalar fusion, you will need to avoid bearing weight on the ankle for around 6 weeks and use crutches for walking.
- You will be prescribed medications to prevent blood clots.
- Swelling and discomfort can be managed with prescription pain medicines, applying ice packs, and by elevating your ankle above the heart level while resting.
- Sutures are removed after 10-15 days. You should take care that the incision is kept clean and dry.
- You may be referred to a physical therapist soon after your surgery to regain range of motion of the new ankle.
- You should go for follow-up examination after about two weeks.
What are the Benefits of 3D Printed Total Talus Replacement Surgery?
Custom 3D printed total talus replacement offers the following benefits:
- Personalized prostheses/subject-specific customization
- Provides a consistent motion pattern
- Restores mobility and stability like a natural ankle joint
- Reduces and eliminates ankle pain and stiffness
What are the risks and complications of 3D Printed Total Talus Replacement Surgery?
Every surgical procedure carries some amount of risk. Similarly, custom 3D printed total talus replacement may also have certain risks and complications. These include:
- Fracture of the tibia or fibula
- Dislocation of the ankle
- Damage to nerves or blood vessels
- Blood clots (DVT or deep venous thrombosis)
Success Stories and Patient Testimonials
This patient had been suffering from avascular necrosis (dead talus) for about 6 months before coming to the Orthopedic Institute of North Texas to see Dr. Justin Kane, our Foot and Ankle Board-Certified Orthopedic Specialist.
Dr. Kane performed a total talus replacement surgery with ligament reconstruction using 3D printed technology. The surgery he performed is a very new procedure that was not possible in the past. It is a specialty and not many doctors perform this surgery. In the past, the options for patients with these conditions were to fuse the ankle or to live with the pain. And now they have the option to try new technology. (3D printed technology)
Thanks to this new innovative surgery performed by Dr. Justin Kane, this patient is back on his feet and he's even running 5k’s again!
Watch this patient testimonial 1 year after a total talus replacement surgery with ligament reconstruction using 3D printed technology with Dr. Justin Kane. When we asked him if he would recommend Dr. Kane, his immediate answer was “100%!”
In the second video you can see this patient at his 2-year office visit…. He continues to remain pain-free and is able to enjoy an active lifestyle that before surgery he never thought he would be able to resume.