OrthoCarolina's first total talus replacement with a 3D-printed implant was completed by Kent Ellington, MD, who performed the procedure on a 69-year-old patient with long-term avascular necrosis.
Here, Dr. Ellington describes how he collaborated with the patient and implant developer and how he expects 3D printing to progress in spine and orthopedics.
Note: Responses are lightly edited for style and content.
Question: As a surgeon, what was the most challenging part of this new procedure?
Dr. Kent Ellington: First, clinical indications. The surgeon must perform due diligence on who is an appropriate candidate and who is not. Next, it takes attention to detail by working with restor3D's team to design, modify and perfect the implant for the patient. Surgically removing the talus can be quite challenging.
Q: Can you describe the development process of the 3D-printed implant? How did you work with restor3D and the patient?
KE: The development process was smooth and efficient. Restore3D's team is focused on providing the best service, product and care for the patient. Once contacted, there's some paperwork to complete and they review the images I sent. Then we work together designing the implant. The patient was aware of the rarity of the case and understood this is novel technology. They were excited to be a part of this, especially considering the alternative of a Tibio-talo-calcaneal arthrodesis.
Q: What advantages do cobalt chrome implants have over implants designed from other materials?
KE: Cobalt chrome is the gold standard for load bearing articulating surfaces and is used in total hip and knee arthroplasty components due to the low coefficient of friction, leading to reduced wear. In the case of a total talus replacement, cobalt chrome is advantageous as it reduces wear with the adjacent bones of the foot that we want to keep intact to preserve motion in the joint.
Q: How do you see 3D printing developing in the field? What orthopedic area can 3D printing have the most impact on in the future?
KE: I think there will be significant advancements in 3D printing. Things that sound impossible will become possible. Clinical scenarios, once without a solution, will now have one. The next several years are going to be exciting. Point-of-care trauma applications will likely be a major advancement in the future. The field will expand from concentration in combined magnetic field, spine, and foot and ankle into new areas such as osteosarcoma, upper extremity, small joint arthroplasty and point-of-care solutions for trauma.
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