Salvage of failed total ankle replacement using a custom 3D printed titanium truss cage: a case series and suggested treatment pathway

T. Lewis, R. Walker, Y. Alkhalfan, A. Latif, A. Abbasian

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 potentially offer an alternative salvage option for failed total ankle replacements.

Methods: A prospective observational study of five cases of failed total ankle replacements which 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 February 2020, 5 patients underwent arthrodesis for failed total ankle replacements. Follow up was available for 4 cases. The mean follow up was 2.0 years. The mean MOXFQ Index improved from 73.8 to 31.6 (p<0.05). The mean EQ-5D-5L Index improved from 0.310 to 0.730 and the EQ-VAS also improved from 48.8 to 83.8. The mean VAS-Pain score at final follow up was 25.7. There were no cases of non-union.

Conclusion: Custom patient-specific 3D-printed titanium truss arthrodesis implants are a viable alternative treatment option for failed total ankle replacements.