Total Talus Replacement using a Custom 3D-Printed Titanium Implant for Post-Traumatic Avascular Necrosis of Talus...

Avascular necrosis (AVN) of the talus is a known complication following trauma due to the bone's unique anatomy and tenuous blood supply. A significant proportion of talar neck fractures may progress to AVN despite surgical fixation. Management of advanced talar AVN with collapse is challenging, with traditional salvage options including arthrodesis, which results in loss of ankle motion and may predispose to adjacent joint arthritis. Total talus replacement (TTR) has emerged as a motion-preserving alternative in selected cases. We report a case of post-traumatic talar AVN with non-union managed using a custom-made 3D-printed titanium talar implant.

A 37-year-old male presented with persistent pain, deformity, and functional limitation of the right ankle following open reduction and internal fixation of a talar fracture. Over time, the patient developed progressive symptoms with restricted ankle motion. Physical examination revealed visible deformity of the ankle joint with limited ankle and subtalar joint range of motion. Radiological evaluation with radiographs and computed tomography demonstrated non-union of the talus with features of AVN. In view of progressive talar collapse and failure of initial fixation, the patient underwent TTR using a patient-specific 3D-printed titanium implant. Post-operative recovery was uneventful, with early improvement in pain and ankle mobility noted at 6-week follow-up.

TTR using a custom-made 3D-printed titanium implant may be considered an emerging salvage option in selected patients with post-traumatic AVN of the talus with collapse, with the potential to preserve ankle and hindfoot motion and provide early clinical improvement as indicated by improvements in Visual Analog Scale and American Orthopaedic Foot and Ankle Society scores at short-term follow-up.