An orthopedic surgeon at Mercy Regional Medical Center in Durango, Colorado, is now performing talus replacement surgery with 3D-printed implants as an additional option for patients with avascular necrosis. Mercy is now one of the few hospitals in the country offering this procedure.
3D-Printed Implants Provide Additional Options for Patients
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Secondary#3dprintedimplant#ankle#talus
OTW spoke with Douglas E. Lucas, DO, the orthopedic surgeon who performed the surgery.
Dr. Lucas began performing the procedure when one of his patients, who suffered from avascular necrosis, was faced with the prospect of either fusion surgery or amputation. He initially suggested that his patient could travel to Duke University Health System to see Dr. Selene Parekh who performs talus replacement surgery with 3D-printed implants. Dr. Lucas’ patient requested that he perform her surgery, so he obtained approval to begin performing this surgery at Mercy.
Dr. Lucas said that the benefits of 3D-printed implants are that “the alternatives are either a complete fusion of the hind foot—so everything from the heel bone up to the leg bone, the tibia—which makes for a very stiff leg to walk on that’s not very functional. Amputation is the other option. There is nothing else available that would help preserve the joints around that talus once the talus is not in a condition to survive on its own.”
Dr. Lucas told OTW that he foresees many potential applications for this 3D technology. He said there are indications for “anybody that’s had surgery that has bone loss, frequent failed surgeries of the foot and ankle, or previous fusions where there are big segments of bone missing. This 3D technology can reproduce that and try to regenerate some motion through the joints that are previously fused or through areas that didn’t heal appropriately or malformed bones.”
“If you go a little bit higher up this technology has been used to replace the shaft of bones in between joints. For example, I saw a case of an osteosarcoma—a very aggressive bone tumor—they took out almost the entire tibia between the ankle and knee and replaced it with a 3D-printed lattice and they were able to ingrow a bone all the way through and connect it from one end to the other.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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