Abstract
BackgroundWith today’s expanding use of total ankle arthroplasty, the ever-present trauma patient, and patients with uncontrolled comorbid conditions, surgeons face significant challenges for lower extremity reconstruction. These patients highlight some of those who may present with unique anatomy, bone loss, infection, and various other local and systemic factors that affect treatment options for successful outcomes. Three dimensional (3-D) printing for medical devices is allowing for new and customized ways to meet patient and surgeon goals of limb salvage and reconstruction.Case presentationsWhile the majority of 3-D printing is done for the purpose of implantation, we present a technical tip for designing a 3-D printed mold from which to create an antibiotic cement spacer for implantation. With two case illustrations including a talus fracture nonunion and infected subtalar arthrodesis nonunion, we describe the process of patient selection, implant design, fabrication, and implantation of a custom molded antibiotic cement talus.DiscussionCase illustrations present two successful limb salvage patients while giving a thorough explanation of our technique, learned tips and tricks. This applied technology builds on prior use of antibiotic cement in limb salvage of the lower extremity, most of which are joint sacrificing. 3-D printing the mold for an anatomic talus cement spacer results in a joint sparing limb salvage solution.Innovative 3-D printing technology is merged with current, pertinent literature regarding antibiotic cement to offer surgeons expanded options for temporary or definitive reconstructive techniques in some of the most challenging patients.
Highlights
With today’s expanding use of total ankle arthroplasty, the ever-present trauma patient, and patients with uncontrolled comorbid conditions, surgeons face significant challenges for lower extremity reconstruction
Case illustrations present two successful limb salvage patients while giving a thorough explanation of our technique, learned tips and tricks. This applied technology builds on prior use of antibiotic cement in limb salvage of the lower extremity, most of which are joint sacrificing. 3-D printing the mold for an anatomic talus cement spacer results in a joint sparing limb salvage solution
Innovative 3-D printing technology is merged with current, pertinent literature regarding antibiotic cement to offer surgeons expanded options for temporary or definitive reconstructive techniques in some of the most challenging patients
Summary
We present two illustrative cases demonstrating utilization of 3-D generated prostheses for limb salvage in the treatment of end-stage talar pathology complicated by infection. Extrapolating from the arthroplasty literature, the authors suggested that articulating spacers for the foot and ankle might have similar advantages over static spacers such as delivering high doses of antibiotics locally while minimizing soft tissue contractures and maintaining some joint range of motion.[16, 17] In another case report, Huang and colleagues contoured a cement spacer by hand in a case of traumatic complete talar extrusion.[15] They used the available extruded talus to guide their back table fabrication of a replica antibiotic cement talus This closely-matched replica talus was implanted and an external fixator applied in order to preserve leg length, joint space, and hindfoot alignment.. Abbreviations 3D: Three dimensional; ORIF: open reduction internal fixation; CT: Computed tomography; IV: intravenous; SLM: Selective laser melting; CoCrMo: Cobalt chrome alloy; CAD: Computer aided design; TAR: total ankle replacement; AOFAS: American Orthopaedic Foot and Ankle Society; VAS: Visual analog scale; PJI: Prosthetic joint infection; TKR: Total knee replacement; THR: Total hip replacement; TSR: Total shoulder replacement
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