Feasibility and Early Experience of Custom Stemmed Tibial Trays in Revision Total Ankle Arthroplasty: A Case Series

Abstract

Background Total ankle arthroplasty (TAA) has become a reliable option for end-stage ankle arthritis management with good to excellent survivorship with modern 4th generation implant designs. In cases of implant failure, an array of revision implant options is necessary but not readily available to address all the nuanced requirements. We put forth a case series of revision total ankle arthroplasty (rTAA) to report the early experience and feasibility of 3D printed custom stemmed tibial trays (CSTT). Methods Six unique patients (7 ankles) who underwent revision TAA due to primary implant failure were retrospectively identified. The patient population was with a single surgeon at a tertiary care center from May 2023-March 2024. At time of revision, all patients had a CSTT inserted onto a total talus replacement, and a minimum 1-year follow-up. Demographic data and pertinent medical history were recorded. Alignment was recorded with the medial distal tibial angle (MDTA) and anterior distal tibial angle (ADTA) at first weight bearing radiograph and most recent follow-up. Other key outcomes included reoperation, visual analog scale (VAS) pain score, and radiographic evidence of lucency or subsidence. Results Six patients (7 ankles) underwent revision TAA with a custom implant with an average final follow-up of 21.0 months (range 13-30.3). On average, patients were 61 years old with a BMI of 25.7 kg/m2. All 7 revisions underwent concomitant total talus replacements, and 6 underwent subtalar arthrodesis. Mean VAS at final follow-up was 3.3 out of 10 (range 3-5.5). MDTA and ADTA were comparable between immediately postoperative and most recent radiographs. No patients required reoperation. Conclusion CSTTs can be a viable option in the armamentarium of a foot and ankle surgeon in the setting of rTAA and allow for minimal bone loss due to patient-specific instrumentation designed to fit unique morphologies. Further follow-up is necessary to examine implant longevity at mid- and long-term intervals.