Outcomes of Total Talus Replacement Using a 3D-Printed Reinforced Pure Titanium Prosthesis.

Background: Total talus replacement (TTR) using a customized implant is an effective joint-salvaging option for severe talar destruction. Although favorable results have been reported with ceramic, cobalt-chrome, and titanium alloy prostheses, outcomes of pure titanium implants have not been described.

Purpose: To evaluate clinical outcomes of TTR using a pure titanium prosthesis.

Study design: Retrospective cohort study.

Methods: Thirty-nine patients underwent TTR for primary or post-traumatic avascular necrosis (AVN) of the talus with a mean follow-up of 23.2 ± 10.2 months (range, 12-55). Each prosthesis was fabricated from commercially pure titanium (Cp-Ti). Patient-reported outcomes, satisfaction, range of motion (ROM), and complications were assessed.

Results: Pain VAS improved from 8.2 ± 1.0 preoperatively to 2.1 ± 2.4 at final follow-up (p < 0.001). FAOS, FFI, EQ-5D, and EQ-VAS showed significant improvement. ROM increased from 52.2 ± 31.3° to 95.9 ± 23.3° (p < 0.001). Asymptomatic tibial osteophytes developed in 5 cases (12.8%), and subchondral cysts in 3 (7.7%), including two with mild implant settling. Thirty-six patients (92.3%) were very satisfied and three (7.7%) satisfied; all would undergo the same procedure again. The post-traumatic group had stiffer ankles and more concomitant procedures but achieved comparable improvement.

Conclusion: Short-term outcomes of TTR using pure titanium prostheses were favorable, showing significant pain relief, functional recovery, and high satisfaction. Pure titanium TTR is a feasible and effective treatment for primary or post-traumatic talar AVN.

Level of clinical evidence: Level 3, Retrospective cohort study.