3D printing technologies have evolved tremendously over the last decade for uses in orthopaedic surgical applications, including being used to manufacture implants for spine, upper extremity, foot ...and ankle, oncologic, and traumatic reconstructions. Materials used for 3D-printed orthopaedic devices include metals, degradable and nondegradable polymers, and ceramic composites. There are 2 primary advantages for use of 3D printing technologies for orthopaedics: first, the ability to create complex porous lattices that allow for osseointegration and improved implant stability and second, the enablement of complex geometric designs allowing for patient-specific devices based on preoperative imaging. Given continually evolving technology, and the relatively early stage of the materials and 3D printers themselves, the possibilities for continued innovation in orthopaedics are great.
Treatment of traumatic critical-sized bone defects remains a challenge for orthopaedic surgeons. Autograft remains the gold standard to address bone loss, but for larger defects, different strategies ...must be used. The use of 3D-printed implants to address lower extremity trauma and bone loss is discussed with current techniques including bone transport, Masquelet, osteomyocutaneous flaps, and massive allografts. Considerations and future directions of implant design, augmentation, and optimization of the peri-implant environment to maximize patient outcome are reviewed.
Salvage arthrodesis for failed total ankle replacement can be a successful procedure. The decision to perform salvage arthrodesis is based on many factors, but the following are the most important ...indications: severe loss of bonestock (tibia, talus, or both), inadequate soft tissue coverage, or the inability to eradicate an infection. With few revision implants on the market, salvage arthrodesis is currently the most common treatment for failed replacement and justification for revision ankle replacement is limited when any of these factors are present.
Background:
There is limited data evaluating the effect of obesity on outcomes following total ankle arthroplasty (TAA), especially in adequate sample sizes to detect impacts on patient-reported ...outcomes (PROs). The purpose of this study was to assess the effect of obesity on complication rates and PROs.
Methods:
This was a single-institution, retrospective study of 1093 primary TAA performed between 2001 and 2020. Minimum follow-up was 2 years. Patients were stratified by body mass index (BMI) into control (BMI = 18.5-29.9; n = 615), obesity class I (BMI = 30.0-34.9; n = 285), and obesity class II (BMI > 35.0; n = 193) groups. Patient information, intraoperative variables, postoperative complications, and PRO measures were compared between groups using univariable statistics. Multivariable Cox regression was performed to assess risk for implant failure. Mean follow-up was 5.6 years (SD: 3.1).
Results:
Compared to control and class I, class II patients had the lowest mean age (P = .001), highest mean ASA score (P < .001), and greatest proportion of female sex (P < .001) and Black/African American race (P = .005). There were no statistically significant differences in postoperative complications (infection, implant failure, or impingement) across the BMI classes (P > .05).
Preoperatively, class II had lower (worse) mean scores for Foot and Ankle Outcome Score pain and ADL subscales than controls (post hoc pairwise P < .001 for both). At final follow-up, both class II and class I had lower (worse) mean Short Musculoskeletal Function Assessment (post hoc pairwise P < .001 and P = .030, respectively) and 36-Item Short Form Health Survey scores (post hoc pairwise P < .001 and P = .005, respectively) than controls.
Conclusion:
At midterm follow-up, obesity was not associated with increased rates of complications after TAA. Patients with obesity reported worse musculoskeletal function and overall quality of life after TAA but there was no differential improvement in PROs across BMI classes. To our knowledge, this is the largest single-institution study to date examining the effect of obesity on outcomes after primary TAA.
Level of Evidence:
Level III, retrospective comparative study.
Background:
The advancement of 3D printing technology has allowed for the use of custom-designed implants for difficult-to-treat foot and ankle pathologies. This study reports on the radiographic and ...functional outcomes of a case series of patients treated with patient-specific 3D-printed titanium implants.
Methods:
Fifteen consecutive patients treated with custom-designed 3D-printed implant cages for severe bone loss, deformity correction, and/or arthrodesis procedures were included in this study. A minimum of 1 year of clinical and radiographic follow-up was required. No patients were lost to follow-up. Patients completed a visual analog scale for pain, the Foot and Ankle Ability Measure Activities of Daily Living score, and the American Orthopaedic Foot & Ankle Society Score outcomes questionnaires preoperatively and at most recent follow-up. All patients had postoperative radiographs and computed tomography (CT) scans to assess bony incorporation. The mean age was 53.3 years (range, 22-74 years) with a mean follow-up of 22 months (range, 12-48 months) for these 15 patients.
Results:
Radiographic fusion verified by CT scan occurred in 13 of 15 patients. There was significant improvement in pain and all functional outcome score measures. All patients who went on to fusion were satisfied with their surgery. There were 2 failures, consisting of 1 infection and 1 nonunion, with an overall clinical success rate of 87%.
Conclusion:
These patients demonstrated the successful use of patient-specific 3D-printed titanium implants to treat complex large bony defects, deformities, and arthrodesis procedures. These implants offer surgeons a novel and promising approach to treat both lower extremity pain and deformity that is not always available with current techniques.
Level of Evidence:
Level IV, retrospective case series.
Optimization of porous titanium alloy scaffolds designed for orthopedic implants requires balancing mechanical properties and osseointegrative performance. The tradeoff between scaffold porosity and ...the stiffness/strength must be optimized towards the goal to improve long term load sharing while simultaneously promoting osseointegration. Osseointegration into porous titanium implants covering a wide range of porosity (0%–90%) and manufactured by laser powder bed fusion (LPBF) was evaluated with an established ovine cortical and cancellous defect model. Direct apposition and remodeling of woven bone was observed at the implant surface, as well as bone formation within the interstices of the pores. A linear relationship was observed between the porosity and benchtop mechanical properties of the scaffolds, while a non-linear relationship was observed between porosity and the ex vivo cortical bone-implant interfacial shear strength. Our study supports the hypothesis of porosity dependent performance tradeoffs, and establishes generalized relationships between porosity and performance for design of topological optimized implants for osseointegration. These results are widely applicable for orthopedic implant design for arthroplasty components, arthrodesis devices such as spinal interbody fusion implants, and patient matched implants for treatment of large bone defects.
Outcome measures evaluate various aspects of patient health, and when appropriately utilized can provide valuable information in both clinical practice and research settings. The orthopedic community ...has placed increasing emphasis on patient-reported outcome measures, recognizing their value for understanding patients’ perspectives of treatment outcomes. Patient-reported outcomes are information directly reported by patients regarding their perceptions of health, quality of life, or functional status without interpretation by healthcare providers. The American Orthopaedic Foot & Ankle Society (AOFAS) supports the use of validated patient-reported outcome (PRO) instruments to assess patient general health, functional status, and outcomes of treatment. It is not possible to recommend a single instrument to collect quality orthopedic data as the selection is dependent on the population being examined and the question being asked. We support the use of the PROMIS Physical Function Computerized Adaptive Test (PF CAT) or Lower Extremity Computerized Adaptive Test (LE CAT), which can be assessed with other domains such as Pain Interference. In addition, a disease-specific measure can be used when available.
Background
Hallux valgus is a common condition with a complex etiology resulting in numerous treatment options. Recurrence of the deformity can occur following correction. Surgical technique and ...possibly also postoperative care play a role in reducing recurrence rates. This article highlights a postoperative surgical dressing technique which allows for semirigid support during the immediate postoperative period.
Methods
A wooden tongue depressor placed along the medial border of the hallux comprises the primary support for the dressing. The rigidity of the tongue depressor allows for the hallux to be drawn toward the depressor, encouraging neutral alignment of the hallux. Dressings are removed 2 weeks postoperatively, with new dressings applied in similar fashion and maintained in place until 6 weeks postoperatively.
Results
Based upon our observations, our surgical dressing technique provides sufficient support following hallux valgus correction surgery while being straightforward to replicate without the need for frequent dressing changes. The dressing materials are of negligible cost and are typically readily available. No associated wound complications have been observed.
Conclusions
We present an easily replicable and affordable option for postoperative hallux valgus correction surgical dressings.
Levels of Evidence:
Level V: Expert Opinion
Results of Total Ankle Arthroplasty Easley, Mark E; Adams, Samuel B; Hembree, W Chad ...
Journal of bone and joint surgery. American volume,
2011-August-3, Volume:
93, Issue:
15
Journal Article
Peer reviewed
Most published reports related to total ankle arthroplasty have a fair to poor-quality level of evidence.Comparative studies with a fair to good-quality level of evidence suggest that total ankle ...arthroplasty provides equal pain relief and possibly improved function compared with ankle arthrodesis.On the basis of the current literature, survivorship of total ankle arthroplasty implants, when measured as the retention of metal components, ranges from 70% to 98% at three to six years and from 80% to 95% at eight to twelve years.Several investigators have argued that, in the evolution of total ankle arthroplasty, some obligatory reoperation without removal of the metal implants is anticipated; examples of reoperation include relief of osseous or soft-tissue impingement, improvement of alignment or stability of the foot and ankle, bone-grafting for cystic lesions, and/or polyethylene exchange.A successful return to low-impact, recreational sporting activities is possible after total ankle arthroplasty.
Recent developments in robotic technologies in the field of orthopaedic surgery have largely been focused on higher volume arthroplasty procedures, with a paucity of attention paid to robotic ...potential for foot and ankle surgery. The aim of this paper is to summarize past and present developments foot and ankle robotics and describe outcomes associated with these interventions, with specific emphasis on the following topics: translational and preclinical utilization of robotics, deep learning and artificial intelligence modeling in foot and ankle, current applications for robotics in foot and ankle surgery, and therapeutic and orthotic-related utilizations of robotics related to the foot and ankle. Herein, we describe numerous recent robotic advancements across foot and ankle surgery, geared towards optimizing intra-operative performance, improving detection of foot and ankle pathology, understanding ankle kinematics, and rehabilitating post-surgically. Future research should work to incorporate robotics specifically into surgical procedures as other specialties within orthopaedics have done, and to further individualize machinery to patients, with the ultimate goal to improve perioperative and post-operative outcomes.
