Written informed consent was obtained from the patient for their anonymized information to be published in this article. Our institution does not require ethical approval for reporting individual cases. No permission was needed to reproduce any figures in this case report. A 43-year-old male patient presented with a talar AVN associated with progressive pain as a result of a traumatic open ankle dislocation 20 years earlier. The wound was laterally based and moderately contaminated. The patient initially underwent deep debridement and continuous irrigation of the open wound. Finally, he was stabilized with plaster and completed treatment with intravenous antibiotic for 2 weeks. The patient presented an AVN Irwin grade I (Chart 1): segmental articular deficit isolated to either a talar portion; subtype B: AVN deep to the articular segment (Figures 1 and 2). A percutaneous bone biopsy was made in order to confirm the AVN diagnosis (Figure 3). Conservative treatment (12-month period) prior to surgery failed. It consisted of physiokinetic treatment, insoles, and analgesic medication. A diagnostic injection was done in the ankle (Result positive 3/3) and subtalar joint (Result positive 2/3) to recognize origin of pain.
The use of patient-specific 3D printed Ti6Al4V ELI PER ASTM F3001 prosthesis with standard screws was deliberated with the patient. A computed tomography (CT) scan slices of 1 mm in all planes of the left ankle were collected and sent to medical application for processing and producing the implant. The manufacturer was Biotrom SA (Argentina); 3D printing vendor: Protolabs (Munich, Germany). The cost of the prosthesis was US$2498. The information was saved into a software (Mimics 11; Materialize , Belgium) that allowed for 3D handling of the bones and articulations (Figure 4).
Then, fibular and tibial plafond osteotomy was made to allow correct visualization (not done to correct ankle malalignment) of the lateral region of the talus. When lateral portion of the talus was resected, it showed macroscopic signs of AVN (Figure 5). The Ti6Al4V prosthesis was implanted with a matching less than 1 mm (Figures 6 and 7) and subtalar arthrodesis (evident subtalar chondral lesion was seen under direct vision) was added to correct varus hindfoot.
Postoperatively, the patient continued non-weightbearing with a plaster for 8 weeks followed by 2 weeks of controlled weightbearing in a walker boot. He then changed to full weightbearing for 2 weeks. Weightbearing was allowed prior to full CT consolidation. By 4 months, CT showed complete bone integration. X-rays and CT scan showed successful bone integration (Figure 8).
At final follow-up (18 months), the patient showed improvement in different scores: foot and ankle ability measure (FAAM) activities of daily living (AVD) improved as 22.62 points (range: 38.09-60.71), FAMM sports enhanced as 35.71 points (range: 28.57-64.28), and the visual analogue scale (VAS) improved 6 points (range: 9-3).