{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T18:02:36Z","timestamp":1792519356051,"version":"4.5.0"},"reference-count":29,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,2,22]],"date-time":"2026-02-22T00:00:00Z","timestamp":1771718400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Foot &amp; Ankle Specialist"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Managing critically sized osseous defects of the hindfoot and ankle remains challenging, particularly in the setting of failed arthrodesis, trauma, Charcot, or failed total ankle arthroplasty. Custom 3D-printed titanium implants have emerged as a potential alternative to structural allografts, offering mechanical stability and biologic incorporation through patient-specific geometry and engineered porosity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. A search of major databases identified studies reporting outcomes of tibiotalocalcaneal (TTC) arthrodesis using 3D-printed titanium implants for critical-sized defects. Union rates, complications, and limb-salvage outcomes were extracted and synthesized. A random-effects model was used to calculate pooled rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Fifteen studies comprising 142 patients met the inclusion criteria. Indications included segmental bone loss (n = 32), failed total ankle replacement (n = 31), avascular necrosis (n = 21), and nonunion (n = 20). The pooled union rate was 88.2% (95% CI: 82.0%-94.5%), and the limb-salvage rate was 92.3% (95% CI: 87.3%-97.3%). The complication rate was 16.9%, with infection and nonunion being the most frequent types. Functional outcome scores improved significantly in multiple studies. Only 6.3% of patients required below-knee amputation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Custom 3D-printed titanium implants demonstrate high union and limb-salvage rates with acceptable complication profiles in the treatment of large osseous hindfoot and ankle defects. These implants may offer a favorable alternative to traditional grafting in complex salvage scenarios.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19386400261420376","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T02:18:12Z","timestamp":1771813092000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Tibiotalocalcaneal Arthrodesis With 3D-Titanium Implants for Management of Critical-Sized Osseous Defects of the Hindfoot and Ankle: A Systematic Review and Meta-Analysis"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5627-2580","authenticated-orcid":false,"given":"Zachary","family":"Hill","sequence":"first","affiliation":[{"name":"Indy Foot and Ankle Reconstructive Surgery Fellowship, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Regal","sequence":"additional","affiliation":[{"name":"Indy Foot and Ankle Reconstructive Surgery Fellowship, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghan","family":"Roby","sequence":"additional","affiliation":[{"name":"Indy Foot and Ankle Reconstructive Surgery Fellowship, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Griffin","family":"Van","sequence":"additional","affiliation":[{"name":"Indy Foot and Ankle Reconstructive Surgery Fellowship, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Elliott","sequence":"additional","affiliation":[{"name":"Indy Foot and Ankle Reconstructive Surgery Fellowship, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Blacklidge","sequence":"additional","affiliation":[{"name":"Indy Foot and Ankle Reconstructive Surgery Fellowship, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Michael","family":"Miller","sequence":"additional","affiliation":[{"name":"Indy Foot and Ankle Reconstructive Surgery Fellowship, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,2,22]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpm.2020.03.004"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2022.01.003"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/2473011420S00177"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/1938640015593079"},{"issue":"8","key":"e_1_3_2_6_2","first-page":"1786","article-title":"Critical bone loss in failed total ankle arthroplasties: when to consider custom metallic implants?","volume":"477","author":"Hutchison RL","year":"2019","unstructured":"Hutchison RL, DeCamp CE, Myerson MS. Critical bone loss in failed total ankle arthroplasties: when to consider custom metallic implants? Clin Orthop Relat Res. 2019;477(8):1786-1794.","journal-title":"Clin Orthop Relat Res"},{"key":"e_1_3_2_7_2","first-page":"1167","article-title":"Comparison of 3D-printed spherical implants vs. femoral head allografts for tibiotalocalcaneal arthrodesis","volume":"59","author":"Steel MW","year":"2020","unstructured":"Steel MW, Kadakia RJ, Cunningham DJ, Dekker TJ, Kildow BJ, Adams SB. Comparison of 3D-printed spherical implants vs. femoral head allografts for tibiotalocalcaneal arthrodesis. 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N Engl J Med. 2002;347(24):1924-1931.","journal-title":"N Engl J Med"},{"issue":"2","key":"e_1_3_2_27_2","first-page":"301","article-title":"Cost comparison of limb salvage versus amputation in diabetic foot infection","volume":"59","author":"Pinzur MS.","year":"2020","unstructured":"Pinzur MS. Cost comparison of limb salvage versus amputation in diabetic foot infection. J Foot Ankle Surg. 2020;59(2):301-304.","journal-title":"J Foot Ankle Surg"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.3390\/surgeries6020026"},{"issue":"1","key":"e_1_3_2_29_2","article-title":"Efficacy of 3D-printed customized titanium implants and its clinical validation in foot and ankle surgery","volume":"10","author":"Lin Y","year":"2024","unstructured":"Lin Y, He P, Yang G, et al. Efficacy of 3D-printed customized titanium implants and its clinical validation in foot and ankle surgery. 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