The use of a 3D printed titanium implant for arthrodesis in the management of large osseous defects in the ankle.

Background: Large osseous defects (LOD) in the ankle occur because of multiple aetiologies. Advancement in 3-dimensional (3D) printing technologies has led to the use of custom implants and instrumentation their management. A 3D printed patient-specific porous titanium cage which allows for peripheral osteo-integration and autogenous bone-grafting could be an ideal implant in these cases.

Methods: Retrospective review of a multi-centre, multi-surgeon consecutive cohort of patients requiring either TTC or AA for a large osseous defect between June 2019 - August 2020. A custom titanium prosthesis was 3D-printed according to CT measurements for implantation.

Results: Mean follow up was 19.5 months (range 12-24 months). Plain radiographs and CT scans at 12 months confirmed osseointegration (stability) in 11of 13 patients (84%). Two patients developed late infection, one requiring revision surgery.

Conclusions: 3D-Printed titanium implants in the management of LODs in the ankle offer a comparable success rate to other reported procedures, with unlimited geometric possibilities in the design allowing for accurate length correction. Their structural stability may offer an advantage over conventional bone graft techniques and limits the amount of bone-graft required.

Levels Of Evidence: LOE III.