Comparison of the efficacy of three-dimensional printing-assisted strategy and traditional total ankle arthroplasty in the treatment of end-stage ankle arthritis.

OBJECTIVE

To compare perioperative parameters, early functional outcomes, and complication profiles between 3D printing-assisted total ankle arthroplasty strategy incorporating preoperative virtual planning, patient-specific osteotomy guides, and a customized talar component and conventional total ankle arthroplasty (TAA) in the treatment of end-stage ankle arthritis.

METHODS

A retrospective analysis was conducted on data from 44 patients diagnosed with end-stage ankle arthritis who were admitted to our hospital between January 2021 and December 2023. Among them, 20 patients (observation group) underwent total ankle arthroplasty (TAA) using a 3D-printed patient-specific TAA strategy, while 24 patients (control group) received conventional TAA using the same tibial component and polyethylene liner but a standard off-the-shelf talar component, together with standard instrumentation. The following parameters were recorded and evaluated: operative duration, intraoperative blood loss, length of postoperative hospital stay, intraoperative fluoroscopy time, preoperative and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores, visual analogue scale (VAS) scores, and ankle range of motion (ROM). Additionally, the occurrence of soft tissue-related complications was monitored.

RESULTS

The AOFAS score, VAS score, and ankle range of motion (ROM) in both groups showed significant improvement postoperatively compared to preoperative values (P < 0.05). However, no statistically significant differences were observed between the two groups (P > 0.05). With regard to surgical outcomes, including operative time, intraoperative blood loss, postoperative hospitalization duration, and the intraoperative fluoroscopy time, the observation group demonstrated significantly better results than the control group (P < 0.001). Concerning postoperative complications, the observation group experienced only one case of superficial infection, whereas the control group had two cases of superficial infection and one case of wound edge necrosis. Although the total complication rate was slightly lower in the observation group, the difference between the two groups was not statistically significant (P = 0.389). Postoperative radiographic analysis confirmed significantly improved alignment accuracy of the tibial component in the observation group compared to the control group (P < 0.05).

CONCLUSION

The 3D printing-assisted TAA strategy appears to improve perioperative efficiency and short-term radiographic alignment accuracy compared with conventional TAA, whereas short-term functional outcomes and wound-related complication rates remain comparable between groups. Given the additional preoperative preparation time and cost, its theoretical promise for patients with complex deformities and its potential effect on long-term implant survival require further confirmation through prospective, randomized studies with long-term follow-up.