3D printing in orthopedics at this point is not new, but it continues to surprise in the many ways it can help individualize medicine.
Thomas Philip San Giovanni, M.D., an orthopedic surgeon at the Miami Orthopedics & Sports Medicine Institute (MOSMI), recently talked with OTW about how 3D implants are offering total ankle replacement patients more patient-specific solutions.
He said, “We are seeing more 3D printing in orthopedics and now have solutions we didn’t have before in total ankle replacement and avascular necrosis of the talus. More people are needing revisions, but unlike in the hip and knee, revisions are not commonly done.”
“For these patients there is nothing currently on the market except for complex fusions or worse case, chronic pain or amputation. 3D printing solutions give these patients hope.”
San Giovanni recently performed a total ankle replacement with a 3D printed total talus—the first of its kind in Florida and only one of a handful of successful surgeries that have taken place in the country.
He performed it on a patient who had spent the past 15 years with an open fracture dislocation of his ankle due to a fall from the roof of his home. The patient’s fracture was in the talus neck, which has a very high incidence of going on to avascular necrosis. For many years, the patient’s only solution for treatment was to get a fusion, but given the difficulty of his particular fusion, he decided to put it off until a better solution became available.
According to San Giovanni, this is the case for many patients. For years, he said, patients haven’t had the best options available, but that now, due to the advancements in technology, such as 3D printing implants, there are better solutions and one’s quality of life no longer needs to be compromised.
He said, “In the past there were only one or two choices with 3D printing implants, and then they became modular, but not truly specific so you would still have to cut down the implant to make it fit.”
“Now they can be patient-specific. We can get a precision-specific CT of bone or joint and match the abnormal side to the normal side and then put the measurements into the Computer-aided design program (CAD). To design the implant, finite element analysis is done on patient characteristics to ensure that the implant can withstand daily stressors. Next we review the design with engineers and then reverse engineer that model to make implant out of plastic or metal like titanium. We can mix and match everything.”
San Giovanni said that they hope to create longer lasting implants that will allow for better quality of life. A part of the challenge is that a lot of this has never been done before so surgeons have to troubleshoot and think ahead, and there are some problems that just can’t be anticipated.
“For this particular patient, we can assume they had arthritis. This means joint space is tight so we made two implants and one had a 10% reduction in size and length and height as a Plan B. We will be seeing more patient-specific 3D implants in the coming years.”
San Giovanni also supports the establishment of a 3D Orthopedic Society as an incubator that can transcend specialties.
I live on Vancouver Canada. I hit a deer while riding my motorcycle on June 25, 2017.
The deer died, I didn’t but when my right foot hit the guard rail, the talus was extruded onto the road. The bone was retrieved, I was airlifted to Harborview Hospital in Seattle. When the surgeon reinserted the bone, he advised me that it will probably get infected.
It did and was removed 8 months later as the bone was still infected and the area packed with antibiotic cement. We discussed fusion and amputation, not acceptable. I went online and found the 3D talus option had been successful in North Carolina.
I called my orthopaedic surgeon, and on May 27, 2019 I received the first 3D printed talus in Canada.
It has been over 3 years, still painful, but I walk up to three miles daily with my dog and my OWN foot.
I would definitely do this again