Utilization of Custom Stemmed Tibial Tray for Revision Total Ankle Arthroplasty: A Case Series

Research Type: Level 4 – Case series Introduction/Purpose: Total ankle arthroplasty (TAA) is quickly becoming a viable option for end-stage ankle arthritis management, owing to rapid improvement of implant quality and surgical technique. However, in the rare cases of failure, viable modalities of revision are necessary. Thus, this study aimed to examine the safety and efficacy of custom stemmed tibial tray in a series of patients who experienced failure of their primary TAA. Methods: 7 unique patients (8 ankles) who underwent revision TAA with a single surgeon at a tertiary care center from May 2023-March 2024 following primary TAA failure were retrospectively identified. All patients had a custom short-stem 3D printed tibial tray inserted. Data on age at surgery, time to most recent follow up, time to weightbearing, utilization of postoperative physical therapy (PT), pain and radiographic changes at most recent follow up, and requirement of reoperation/revision surgery were collected. Results: Patients were 61 years old on average (range 36-80 years old) with an average follow up of 255.38 days (range 98-468). Patients were cleared to weightbear at an average of 69.14 days after surgery (range 36-80 days), and all patients initiated and were adherent to physical therapy. Pain at final follow up was 4.17 out of 10 on average (range 3-6). Medial distal tibial angle (MDTA) and sagittal distal tibial angle (SDTA) were comparable between immediately postoperative and most recent radiographs. Implant survivorship was 100%, with no patients requiring reoperation or revision. Conclusion: As demonstrated by the findings from this case series, custom short stemmed tibial tray can be a viable option in the armamentarium of a foot and ankle surgeon when weighing implant choices for a revision TAA. While further and higher evidence research is necessary to provide additional support, it can be utilized without concerns of serious complications in the short term.