Management of a total defect of the talus with a customized 3D-implant made of porous titanium for Charcot neuroosteoarthropathy in a patient with neurosyphilis: a case report

Introduction Neuropathic arthropathy, or Charcot arthropathy, is characterized by rapid progressive bone destruction due to impaired nociceptive and proprioceptive innervation of the affected limb. In recent years, there have been publications on the use of 3D modeling and 3D printing of porous titanium implants for filling large bone defects in the foot, but we found only two descriptions of clinical cases of 3D porous titanium implants in patients with Charcot arthropathy.

The aim of the work is to demonstrate and analyze the results of performing resection calcaneotibial arthrodesis with  defect plasty using a customized 3D implant made of porous titanium in a patient with manifestation of Charcot arthropathy as a complication of tertiary syphilis.

Materials and methods A 50-year-old woman, with a history of syphilis for 26 years, noted the signs of inflammation in the ankle joint during increased loading two months after total knee arthroplasty on the left joint. The examination revealed total destruction of the talus. The diagnosis was Charcot neuroosteoarthropathy of the foot, active stage. After 2.5 months of unloading, based on the results of a CT study of the left ankle joint and 3D modeling, a 3D porous titanium customized implant was fabricated; resection calcaneotibial arthrodesis with autograft harvesting from the tibial canal and plastic surgery of the defect with a 3D implant and fixation with the Ilizarov apparatus were performed. Five months after the operation, consolidation was determined based on the results of control radiographs, and the Ilizarov apparatus was dismantled.

Discussion The proposed method of surgical treatment for total destruction of the talus and the resulting defect-diastasis allows for reconstructive intervention with immediate compensation of shortening, regardless of the shape and size of the defect, to avoid secondary shortening of the limb while maintaining its ability to support, thereby preventing the occurrence of secondary overload changes in the adjacent joints.

Conclusion The initial results in this clinical case seem encouraging, but additional research is required to clarify the indications and patient selection criteria for this treatment method.

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