Tibiocalcaneal Arthrodesis for Ankle Arthropathy Using Patient-Matched Modular 3D-Printed Porous Titanium Implants and Locked Intramedullary Fixation
DOI:
https://doi.org/10.56929/jseaortho-2026-0338Keywords:
Ankle arthropathy, tibiocalcaneal arthrodesis, patient-matched modular, 3D-printed implant, limb salvageAbstract
Purpose: To evaluate the clinical and radiographic outcomes of tibiocalcaneal arthrodesis using patient-matched modular 3D-printed porous titanium implants combined with locked intramedullary nails for advanced ankle arthropathy with substantial bone loss.
Methods: This prospective cohort study included seven consecutive patients who underwent tibiocalcaneal arthrodesis using patient-matched modular 3D-printed porous titanium implants between January 2024 and December 2025. Functional outcomes were assessed using the Foot and Ankle Ability Measure (FAAM). Osseous union, alignment, and implant position were evaluated using radiographs and computed tomography at 1 year.
Results: The mean patient age was 58.4 years (71.4% female). Mean follow-up was 12 months. Median reconstruction volume was 9,862 mm³ (interquartile range, 4,049–11,118 mm³). The median FAAM score improved from 60 preoperatively to 80 at 1 year (p = 0.018). At 1 year, complete osseous union was observed in two patients (28.6%), partial union in four (57.1%), and nonunion in one (14.3%). Complications occurred in three patients (42.9%): persistent nonunion with mechanical instability (n = 1), transient instability requiring supplemental fixation (n = 1), and superficial wound maceration that resolved with conservative care (n = 1). No major complications were reported.
Conclusions: Patient-matched modular 3D-printed porous titanium implants combined with locked intramedullary nails may offer a limb-salvage option for advanced ankle arthropathy with massive bone loss. However, the high complication rate (42.9%) and low complete union rate (28.6%) at 1 year highlight the limitations of this approach. Long-term postoperative mechanical protection and regular monitoring are essential to prevent late structural failure.
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