Failed Ankle Replacement Treatment | 3D-Printed Implants

What can be done when an ankle replacement fails?

Most ankle replacements work well for many years. Some wear out, loosen or become infected, and around 1 in 10 needs further surgery within 10 years. As more replacements are done, more people will face this problem.

Taking out a failed replacement leaves a large gap in the bone. Filling that gap and getting the ankle to heal solidly is the hard part. The usual options are a new replacement, a fusion using bone graft, or, rarely, amputation.

Custom 3D-printed titanium implants

At Guy’s Hospital we use implants designed from each patient’s own CT scan. A titanium cage with an open lattice is 3D-printed to fill the exact shape of the gap. It is packed with bone graft and held with a nail through the heel, so the bone grows into and around it.

Surgery is usually done in two stages:

1. The old replacement is removed, samples are taken to check for infection and a temporary antibiotic spacer fills the gap.
2. Six to eight weeks later the custom cage is put in through the outside of the ankle.

What our study found

We followed six patients treated between 2018 and 2022 for an average of three years.

• All six fused, confirmed on CT scan at 12 months.
• Foot pain and function scores (MOXFQ) improved from 73 to 32, where lower is better.
• Quality of life scores roughly doubled.
• No patient needed the fusion redone or an amputation.
• Three patients had a complication: one wound problem, one broken screw and one infection two years later, which settled after the nail was removed.

This is a small group and longer follow-up is needed. The results support custom cages as a good option where there is a lot of bone loss. We also published a classification of bone loss after ankle replacement, the Guy’s Hospital classification, to help plan the shape of each implant.

Reference: Lewis TL, Walker R, Alkhalfan Y, Latif A, Abbasian A. Custom patient-specific 3D-printed titanium truss tibiotalocalcaneal arthrodesis implants for failed total ankle replacements. Foot & Ankle International 2024. doi:10.1177/10711007241255381

Mr Abbasian sees patients at Guy’s Hospital and in private practice in London. Book a consultation.