Outcomes of Charcot Arthropathy Limb Salvage with Patient-Specific 3D-Printed Cage and Dynamic Hindfoot Fusion Nail Combination Fixation

Abstract

Abstract Background The challenge of surgical treatment of hindfoot collapse can be exacerbated by host conditions that may limit healing potential and increase the risk of infection. Many patients with neuropathy, Charcot joint, or end-stage arthritis that undergo tibiotalocalcaneal (TTC) fusion with bulk allograft progress to nonunion and often require amputation. 3D-printed titanium implants provide benefits that may improve outcomes of limb salvage within this population, but long-term outcomes of these implants have not yet been reported, given their relatively recent development. This study reports mid-term outcomes of patients with Charcot arthropathy or end-stage arthritis who received 3D-printed titanium cage and dynamic hindfoot fusion nail combination fixation for limb salvage. Methods This study was a retrospective review of consecutive patients who underwent hindfoot arthrodesis with a combination of patient-specific 3D-printed titanium cage and dynamic hindfoot fusion nail by a single surgeon at a single institution. The primary outcome was to establish the safety of the 3D-printed cage in a medically complicated population. Medical records were reviewed for adverse events, including subsequent surgical intervention and implant survivorship. The secondary outcome was to evaluate the efficacy of the 3D-printed cage, as evaluated by patient-reported pre- and post-operative 11-point Numeric Rating Scale (NRS) pain score, ambulation status, and satisfaction. Deformity correction was evaluated by radiograph. Descriptive statistics were calculated, and a Kaplan-Meier curve of all-cause reoperation was produced. Results This study evaluated 13 cases with at least one year follow-up. Mean follow-up was 3.72 years (range 2.67–4.60 years). As of the most recent follow-up, 11 of 13 cages remain implanted, with two cages having been explanted in the setting of amputations indicated by conditions unrelated to the cage itself. Patients reported a mean pre-operative NRS pain of 6.6 ± 2.9 points. At the last follow-up, mean NRS pain was 2.0 ± 1.7 points. Pre-operatively, six of 13 patients reported the ability to ambulate independently without an assistive device. Post-operatively, 11 of 13 patients were able to ambulate independently. Conclusion This study reports mid-term outcomes of TTC arthrodesis with a patient-specific 3D-printed titanium cage and dynamic intramedullary nail in patients with Charcot arthropathy or non-traumatic arthritis. The results demonstrate no implant-related complications and promising outcomes in terms of fusion, deformity correction, and patient satisfaction, which are especially remarkable in the setting of Charcot arthropathy. While this data is promising as a technique for limb salvage in this patient population, further experimental studies are required to demonstrate superiority. Level of Evidence: Level IV