Case 9: The Half Ankle Replacement: Talar Dome Replacement Utilizing 3D Printing
3D printing potential continues to unlock the possibilities of advanced ankle reconstruction. This is a 51-year-old commercial pilot who developed debilitating ankle pain over the past couple of years following a severe inversion injury and lateral ankle ligament rupture. He had undergone an ankle scope and lateral ankle ligament repair by a local surgeon. Unfortunately, he continued to have ankle pain. A MRI confirmed a rather large chondral defect in the central superior portion of the talus with significant underlying bone marrow edema.
Central talus lesions, especially those deep in the ankle mortise, present a major challenge in regards to access and treatment. Traditional repair techniques of the talar dome require either a fibular or tibial osteotomy, but these are better suited for talar shoulder lesions and not central dome lesions. The other issue with this approach is that you must create damage to the healthy side of the joint in order to access and repair the damaged surface which could accelerate the overall degradation of the joint.
Enter 3D printing. In this case a decision was made to replace the entire talar dome from an anterior approach. This would allow for an anatomic solution without the need damage healthy cartilage via a tibial osteotomy. It will also allow for the patient to initiate the weightbearing portion of recovery only a few weeks following the surgery. A customized and patient-specific implantation such as this can greatly delay or potentially prevent the need for a total ankle replacement while not burning bridges for future treatments or a relatively easy conversion to a traditional ankle replacement solution.