Mitra Kishen, Anastasio Albert T, Wu Kevin A, Abar Bijan, Schweitzer Karl M, Parekh Selene G, Easley Mark E, Adams Samuel B
Dept. of Biomedical Engineering, Duke University, Durham, NC, United States.
Dept. of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States.
Foot Ankle Surg. 2025 Feb;31(2):126-137. doi: 10.1016/j.fas.2024.07.011. Epub 2024 Aug 3.
Collapse of the talus and peri-talar arthritis pose treatment challenges due to the anatomy and location of the talus as a keystone of the foot and ankle. Custom 3D-printed total talus replacement (TTR) and combined total ankle total talus replacement (TATTR) have emerged as treatment options for these pathologies. However, the safety and efficacy of these implants is unknown due to the limited number of cases and short follow-up durations.
This was a retrospective study to assess surgical outcomes of patients who underwent a TTR and TATTR with or without subtalar fusion. Patient demographics, intraoperative parameters, device related surgical and non-surgical events, imaging and clinical evaluations, and patient reported outcome (PRO) measures were compiled.
A total of 38 patients received a custom 3D-printed implant with mean follow-up time of 22.1 (range: 12-45) months. In this cohort, 7 (18.4 %) required secondary surgery and 3 (7.9 %) required implant removal. Multivariate logistic regression revealed that patient diagnosis of depression was a significant predictor of secondary surgery with an OR 17.50 (p = 0.037). Significant postoperative improvements were observed in the talocalcaneal height (p = 0.005) and talar declination angle (p = 0.013) for the TATTR group. VAS and PROMIS pain interference (PI) scores demonstrated an initial significant improvement in pain, but this improvement did not maintain significance at most recent follow-up. However, there was a significant increase in the PROMIS physical function (PF) scores (p = 0.037) at most recent follow-up.
These results demonstrate that TTR and TATTR provide significant improvement in post-operative radiographic foot and ankle alignment and physical function at the two-year timepoint. PRO findings suggest that patients are more active after surgery. Surgeons considering proceeding with either of these procedures should counsel patients about pain and functional outcomes as well as realistic expectations in patients with depression.
Level 3.
距骨塌陷和距周关节炎因距骨作为足踝关键结构的解剖位置而给治疗带来挑战。定制3D打印全距骨置换术（TTR）和全踝关节联合全距骨置换术（TATTR）已成为治疗这些病症的选择。然而，由于病例数量有限和随访时间短，这些植入物的安全性和有效性尚不清楚。
这是一项回顾性研究，旨在评估接受TTR和TATTR手术（伴或不伴距下关节融合）患者的手术结果。收集了患者人口统计学资料、术中参数、与器械相关的手术和非手术事件、影像学和临床评估以及患者报告结局（PRO）指标。
共有38例患者接受了定制3D打印植入物，平均随访时间为22.1（范围：12 - 45）个月。在该队列中，7例（18.4%）需要二次手术，3例（7.9%）需要取出植入物。多因素逻辑回归显示，患者的抑郁症诊断是二次手术的显著预测因素，比值比为17.50（p = 0.037）。TATTR组在术后距跟高度（p = 0.005）和距骨倾斜角（p = 0.013）方面有显著改善。视觉模拟评分（VAS）和患者报告结局测量信息系统（PROMIS）疼痛干扰（PI）评分显示疼痛最初有显著改善，但在最近一次随访时这种改善未保持显著。然而，在最近一次随访时，PROMIS身体功能（PF）评分有显著提高（p = 0.037）。
这些结果表明，TTR和TATTR在两年时间点可使术后足部和踝关节的影像学对线及身体功能得到显著改善。PRO结果表明患者术后活动更积极。考虑进行这两种手术的外科医生应向患者咨询疼痛和功能结局以及对抑郁症患者的现实预期。
3级。
