Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.
Foot Ankle Int. 2020 Dec;41(12):1529-1536. doi: 10.1177/1071100720948461. Epub 2020 Aug 18.
Talus avascular necrosis (AVN) is a challenging entity to treat. Management options depend on disease severity and functional goals. Total talus replacement (TTR) is a treatment option that maintains joint range of motion. The literature on TTR is limited with variability in implant design and material. The purpose of this study was to evaluate outcomes following TTR with a custom 3D printed metal implant.
Patients who underwent TTR were retrospectively reviewed over a 3-year period. Basic demographic data and comorbidities were collected. Medical records were reviewed to obtain postoperative and preoperative visual analog scale (VAS) scores, Foot and Ankle Outcome Scores (FAOSs), ankle range of motion, and postoperative complications. Statistical analysis was conducted to compare clinical and patient-reported outcomes pre- and postoperatively. Twenty-seven patients underwent TTR for talar AVN with a mean follow-up of 22.2 months.
Ankle range of motion remained unchanged postoperatively. VAS pain scores improved postoperatively from 7.1 to 3.9 ( < .001). FAOSs improved postoperatively with regard to pain ( < .001), symptoms ( = .001), quality of life ( < .001), and activities of daily living ( < .001). There were 3 complications requiring reoperation in this cohort.
3D printed TTRs represent a unique surgical option for patients with severe talar AVN. Patients in this cohort demonstrated significant improvements in pain scores and patient-reported outcomes. TTR allows for symptomatic improvement with the preservation of motion in individuals with talar collapse and AVN.
Level IV, retrospective case series.
距骨坏死（AVN）是一种具有挑战性的疾病。治疗方法取决于疾病的严重程度和功能目标。全距骨置换（TTR）是一种维持关节活动范围的治疗选择。TTR 的文献报道因植入物设计和材料的差异而有所不同。本研究的目的是评估使用定制的 3D 打印金属植入物进行 TTR 的结果。
对 3 年内接受 TTR 的患者进行回顾性研究。收集了基本的人口统计学数据和合并症。查阅病历以获得术后和术前视觉模拟量表（VAS）评分、足踝结局评分（FAOSs）、踝关节活动范围和术后并发症。进行统计分析以比较术前和术后的临床和患者报告的结果。27 例距骨 AVN 患者接受 TTR，平均随访 22.2 个月。
术后踝关节活动范围保持不变。VAS 疼痛评分从 7.1 分改善至 3.9 分（<0.001）。FAOSs 在疼痛（<0.001）、症状（=0.001）、生活质量（<0.001）和日常生活活动（<0.001）方面术后均有改善。该队列中有 3 例并发症需要再次手术。
3D 打印 TTR 为严重距骨 AVN 患者提供了一种独特的手术选择。该队列中的患者在疼痛评分和患者报告的结果方面均有显著改善。TTR 允许在距骨塌陷和 AVN 的个体中保持运动的同时缓解症状。
IV 级，回顾性病例系列。
