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Outcomes of Surgical Reconstruction Using Custom 3D-Printed Porous Titanium Implants for Critical-Sized Bone Defects of the Foot and Ankle.

Publication ,  Journal Article
Abar, B; Kwon, N; Allen, NB; Lau, T; Johnson, LG; Gall, K; Adams, SB
Published in: Foot Ankle Int
June 2022

BACKGROUND: Treating critically sized defects (CSDs) of bone remains a significant challenge in foot and ankle surgery. Custom 3D-printed implants are being offered to a small but growing subset of patients as a salvage procedure in lieu of traditional alternates such as structural allografts after the patient has failed prior procedures. The long-term outcomes of 3D-printed implants are still unknown and understudied because of the limited number of cases and short follow-up durations. The purpose of this study was to evaluate the outcomes of patients who received custom 3D-printed implants to treat CSDs of the foot and ankle in an attempt to aid surgeons in selecting appropriate surgical candidates. METHODS: This was a retrospective study to assess surgical outcomes of patients who underwent implantation of a custom 3D-printed implant made with medical-grade titanium alloy powder (Ti-6Al-4V) to treat CSDs of the foot and ankle between June 1, 2014, and September 30, 2019. All patients had failed previous nonoperative or operative management before proceeding with treatment with a custom 3D-printed implant. Univariate and multivariate odds ratios (ORs) of a secondary surgery and implant removal were calculated for perioperative variables. RESULTS: There were 39 cases of patients who received a custom 3D-printed implant with at least 1 year of follow-up. The mean follow-up time was 27.0 (12-74) months. Thirteen of 39 cases (33.3%) required a secondary surgery and 10 of 39 (25.6%) required removal of the implant because of septic nonunion (6/10) or aseptic nonunion (4/10). The mean time to secondary surgery was 10 months (1-22). Multivariate logistic regression revealed that patients with neuropathy were more likely to require a secondary surgery with an OR of 5.76 (P = .03). CONCLUSION: This study demonstrated that 74% of patients who received a custom 3D-printed implant for CSDs did not require as subsequent surgery (minimum of 1-year follow-up). Neuropathy was significantly associated with the need for a secondary surgery. This is the largest series to date demonstrating the efficacy of 3D-printed custom titanium implants. As the number of cases using patient-specific 3D-printed titanium implant increases, larger cohorts of patients should be studied to identify other high-risk groups and possible interventions to improve surgical outcomes. LEVEL OF EVIDENCE: Level IV, case series.

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Published In

Foot Ankle Int

DOI

EISSN

1944-7876

Publication Date

June 2022

Volume

43

Issue

6

Start / End Page

750 / 761

Location

United States

Related Subject Headings

  • Titanium
  • Retrospective Studies
  • Printing, Three-Dimensional
  • Porosity
  • Orthopedics
  • Humans
  • Ankle
  • 4207 Sports science and exercise
  • 4201 Allied health and rehabilitation science
  • 3202 Clinical sciences
 

Citation

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Abar, B., Kwon, N., Allen, N. B., Lau, T., Johnson, L. G., Gall, K., & Adams, S. B. (2022). Outcomes of Surgical Reconstruction Using Custom 3D-Printed Porous Titanium Implants for Critical-Sized Bone Defects of the Foot and Ankle. Foot Ankle Int, 43(6), 750–761. https://doi.org/10.1177/10711007221077113
Abar, Bijan, Nicholas Kwon, Nicholas B. Allen, Trent Lau, Lindsey G. Johnson, Ken Gall, and Samuel B. Adams. “Outcomes of Surgical Reconstruction Using Custom 3D-Printed Porous Titanium Implants for Critical-Sized Bone Defects of the Foot and Ankle.Foot Ankle Int 43, no. 6 (June 2022): 750–61. https://doi.org/10.1177/10711007221077113.
Abar B, Kwon N, Allen NB, Lau T, Johnson LG, Gall K, et al. Outcomes of Surgical Reconstruction Using Custom 3D-Printed Porous Titanium Implants for Critical-Sized Bone Defects of the Foot and Ankle. Foot Ankle Int. 2022 Jun;43(6):750–61.
Abar, Bijan, et al. “Outcomes of Surgical Reconstruction Using Custom 3D-Printed Porous Titanium Implants for Critical-Sized Bone Defects of the Foot and Ankle.Foot Ankle Int, vol. 43, no. 6, June 2022, pp. 750–61. Pubmed, doi:10.1177/10711007221077113.
Abar B, Kwon N, Allen NB, Lau T, Johnson LG, Gall K, Adams SB. Outcomes of Surgical Reconstruction Using Custom 3D-Printed Porous Titanium Implants for Critical-Sized Bone Defects of the Foot and Ankle. Foot Ankle Int. 2022 Jun;43(6):750–761.
Journal cover image

Published In

Foot Ankle Int

DOI

EISSN

1944-7876

Publication Date

June 2022

Volume

43

Issue

6

Start / End Page

750 / 761

Location

United States

Related Subject Headings

  • Titanium
  • Retrospective Studies
  • Printing, Three-Dimensional
  • Porosity
  • Orthopedics
  • Humans
  • Ankle
  • 4207 Sports science and exercise
  • 4201 Allied health and rehabilitation science
  • 3202 Clinical sciences