World’s First Patient Specific 3D Printed Trauma Total Talus Replacement

Dr. Rajiv Shah, an Orthopedic surgeon Global Hospital in Vadodara India has successfully implanted a 3D printed implant in a trauma patient. This is the first time a patient has been helped with a 3D printed trauma implant through a total talus replacement.

What’s more, the implant was patient specific. This also marks the first ever successful use of a patient-specific 3D printed talus implant in a trauma case. This his broad implications and could see patient-specific 3D printed implants to be used for a wide variety of orthopedic trauma cases.

3D Printing has been used extensively in orthopedics with tens of thousands of patients receiving orthopedic hip implants each year. For other surgeries such as CMF surgeries patient specific implants have been made. There have also been talus bone prostheses but no patient specific ones. In orthopedic trauma, however, we can now see that a unique titanium implant for one patient can be made to replace bone. This is a world first.

The 3D Printer used was an EOS M 280, a metal 3D printer that works on the powder bed fusion principle. The implant was 3D printed in titanium. A 32-year-old Gujarati man suffered a horrific accident that resulted in the loss of his talus bone. This left the man crippled. This was averted through Dr. Shah, and his team and the staff of Mumbai medical 3D printing startup 3D Post.

Anuj Nandu of 3D Post explains,

“Conventionally, such loss of talus bone was managed by fusing the ankle & subtalar joint leading to the loss of ankle-foot movements or amputation of the foot. Since these cases are relatively common in younger populations, it has not only a physical impact but also a psychological impact as a consequence of the disability. And so, the orthopedic surgeons have been on a quest to preserve movements & salvage the limb.”

After the accident

“The detached bone was bought to Dr. Shah. An index surgery wound clean-up & external fixation of broken bones was carried out immediately. Instead of throwing away the dead bone the Surgeon took a CT scan of this bone.”

The 3DPost team then,

“designed and 3D Printed a Titanium Talus prosthesis. The Implant was customized for the patient and had an ergonomic design for the ease of the surgeon. We had to ensure that the implant would stay in the right position and integrate like a natural structure. The entire process of designing and fabrication took around three weeks. The prosthesis was successfully implanted in the patient in the first week of July this year, saving his ankle joint and avoiding a traumatic amputation.”

3DPost also additionally,

“For the procedure to work, we designed some tools that helped the surgeon to place the implant ergonomically and also provisions to remove it. Currently, the patient is under observation and in the next couple of weeks, we will begin with rehabilitation and movement.”

The team believes that,

“There is practically no limit on the applications of this. A wide range of orthopedic trauma cases and also replacement of bone lost to cancer are on our radar.”

and

“It was a proud moment for Dr. Rajiv Shah and 3D POST to represent India for achieving such a feat at a global level.”

I would agree with them that the scope for this is vast indeed. The integrated approach whereby the supplier not only develops the implant but also created orthopedic guides and helps with surgical planning is one that I think would need to be replicated. In other prosthetics, we’re seeing the growth of the one stop shop in this area. The ability to widen the use of prostheses to many and various trauma cases would open up a lot of orthopedic trauma incidents to 3D printing. If we can then prove that surgery times could be shorter through use of the guides and less time fixing the standard implant to the patient, then we will be well on our way to proving better outcomes. Initial reports, funded by the companies that make prosthetic implants, indicate that patient specific implants could also shorten recovery times, cause less pain in patients and lead to less blood loss in patients. All of those advantages are caused in part by better preoperative planning and understanding and an implant that is easier to implant. If this could be substantiated in these orthopedic trauma cases, then we would be well on our way to seeing this be used widely indeed. If we can then also somehow establish that function is restored faster or more completely through such implants being patient specific then this could become a real breakthrough. In theory, a lot of these cases should have better outcomes because patient specific 3D printed implants would better approximate the original bone so would work better in load-bearing applications. Once much additional effort compounds this work we could see this as a procedure widely used for many thousands of unique cases per year.