Retrospective Cohort Study Comparing Digitally Customized 3D-Printed Partial Talus Replacement and Ankle Arthrodesis for Extensive Talus Necrosis: Early Clinical Outcomes.

BACKGROUND This retrospective study from a single center included 105 patients with avascular necrosis of the talus in our hospital from January 2021 to January 2024 and aimed to compare outcomes from management with customized 3-dimensional (3D) printed partial talus replacement with ankle arthrodesis. MATERIAL AND METHODS The replacement group (n=49) received digital customized 3D-printed partial talus replacement surgery, and the arthrodesis group (n=53) underwent ankle arthrodesis. Efficacy of the 2 surgical methods was evaluated by comparing the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, pain visual analog scale (VAS), ankle range of motion (ROM), SF-36 quality of life scale, and complication rate before surgery and at last follow-up. RESULTS At final follow-up, the observation group showed significantly better outcomes than the conventional group in AOFAS score (85.88±3.56 vs 78.51±4.12, P<0.001), ankle ROM (48.31°±4.95° vs 0.91°±1.13°, P<0.001), and the SF-36 Physical Component Summary (74.12±4.10 vs 55.83±4.96, P<0.001) and Mental Component Summary (81.26±5.12 vs 68.15±5.93, P<0.001). VAS scores were also significantly lower in the observation group (1.71±0.71 vs 2.57±0.87, P<0.001). Overall complication rates were similar (8.1% vs 11.3%, P=0.592); however, the reoperation rate was lower in the observation group (0% vs 3.7%). CONCLUSIONS In early follow-up, 3D-printed partial talus replacement for extensive talus necrosis demonstrates superior joint function, ROM, and quality of life compared with ankle arthrodesis, without increasing complications, suggesting it is a safe and effective joint-preserving alternative.