Abstract
OBJECTIVE: To evaluate the early effectiveness of total talar replacement (TTR) with personalized three-dimensional (3D)-printed titanium talus prostheses in the treatment of steroid-induced talar avascular necrosis (TAN). METHODS: The clinical data of 11 patients with steroid-induced TAN who met the selection criteria between June 2022 and June 2024 were retrospectively analyzed. There were 8 males and 3 females with an average age of 51 years ranging from 26 to 67 years. The duration of hormone use ranged from 12 to 36 months, with an average of 19.6 months. The TTR treatment was performed with the personalized 3D-printed titanium alloy talus prosthesis. Radiographic evaluation was performed preoperatively and at last follow-up to assess prosthesis-related conditions, including loosening, subsidence, and adjacent joint degeneration. Clinical outcomes were assessed using the visual analogue scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Ankle Osteoarthritis Scale (AOS), 36-Item Short Form Survey (SF-36) [including physical health score (PCS) and mental health score (MCS)], and ankle range of motion (ROM) to assess functional recovery. RESULTS: All surgeries were completed successfully. The operation time was 40-60 minutes (mean, 51 minutes), and intraoperative blood loss was 5-20 mL (mean, 10 mL). All incisions healed by first intention without early complications such as infection, skin necrosis, hematoma, neurovascular injury, or deep vein thrombosis. All 11 patients were followed 15-33 months (mean, 22.8 months). One superficial wound infection occurred at 2 weeks postoperatively and resolved after conservative treatment. No prosthetic joint infection, loosening, subsidence, adjacent joint degeneration, or reoperation was observed. At last follow-up, the VAS score, AOFAS ankle-hindfoot score, AOS score, PCS score, and MCS score improved significantly when compared with preoperative ones ( P<0.05), whereas ankle ROM showed no significant difference ( P>0.05). CONCLUSION: Personalized 3D-printed titanium talus prostheses effectively relieve pain and improve ankle function and quality of life in patients with steroid-induced TAN, providing a viable joint-preserving treatment option.