SLR - August 2021 - Zachary Brooks

Clinical Applications of Custom 3d Printed Implants in Complex Lower Extremity Reconstruction 

Reference: Kadakia RJ, Wixted CM, Allen NB, Hanselman AE, Adams SB. Clinical Applications of Custom 3d Printed Implants in Complex Lower Extremity Reconstruction. 3D Print Med. 2020 Oct 2;6(1):29. doi: 10.1186/s41205-020-00083-4. PMID: 33006702; PMCID: PMC7531160.

Level of Evidence: V Case series

Scientific Literature Review

Reviewed By: Zachary Brooks, DPM, EMT-P
Residency Program: Kaiser North Bay Consortium - Vallejo, CA 

Podiatric Relevance: This article offers surgical approach options for complex foot and ankle reconstructions involving deformity and bone loss.

Methods: Four surgical cases were presented by the author to demonstrate the uses of 3D printing in surgical planning and manufacturing of custom implants. Cases involved use of an intermedullary tibia-talar-calcaneal rod with a talar implant, a total talus replacement, navicular titanium replacement cage implant, creation of a custom cut guild with a custom implant/plate construct for a complex varus ankle deformity. Outcome was measured by the surgical case execution. 

Results: The author demonstrated successful use of a talus cage used for a failed total ankle replacement, use of a custom total talus for replacement of talar avascular necrosis. In addition, they demonstrated the use of a custom printed navicular cage with incorporated plate construct as well as the creation of a custom cut guide for a tibial defect and tibial implant with an incorporated plate construct. 

Conclusions: The authors described the use of cutting-edge 3D custom implants and their use in four complex situations. While this provides a great option for reconstruction, the authors described the setbacks of use of these implants such as duration to obtaining the implants (4-6 weeks), high costs, and difficulty using new custom-made equipment and implants. As manufacturing technologies advance, these custom implants will become quicker to manufacture and easier to budget into a surgery and therefore more common and practical for use. It would have been beneficial to the reader to learn what the follow up outcomes were even if this were short-term results.

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