Three-dimensional (3D)-printing technology is revolutionizing orthopedic oncology by providing precise, customized solutions for complex bone defects following tumor resection. Traditional modular endoprostheses are prone to complications such as fretting corrosion and implant failure, underscoring the need for innovative approaches. This case series reports on three patients treated with 3D-printed, patient-specific prostheses and cutting guides. Preoperative CT and MRI data were used to design implants tailored to each patient’s anatomy, manufactured using electron beam melting technology with a titanium–aluminum–vanadium alloy. Functional outcomes showed significant improvements: in Case I, AOFAS improved from 71 to 96, and VAS decreased from 6 to 1; in Case II, AOFAS increased from 65 to 79, and VAS decreased from 5 to 3. Radiographic evaluations demonstrated stable prosthesis placement and early evidence of bone integration in Cases I and II, while in Case III, localized disease control was achieved before systemic progression. This case series highlights the transformative potential of 3D-printed prostheses in addressing the challenges of reconstructing anatomically complex defects. By enabling precise tumor resection and improving functional outcomes, this approach can advance current practices in orthopedic oncology. Further research should explore larger cohorts and use cost-effectiveness analyses to validate these findings and facilitate broader clinical adoption.

Background: Technological advancements have made three-dimensional printing prevalent in orthopedic surgery. It facilitates the production of customized implants and tailored patient instruments, enhancing surgical planning and results. This review focuses on the uses and effectiveness of patient-specific products manufactured using three-dimensional printing in ankle surgery. Methods: A search of databases—PubMed, Embase, Cochrane Library, and Google Scholar—yielded 41 articles for review. Results: Total talus replacement offers a viable alternative to standard treatments like arthrodesis and total ankle arthroplasty. Custom implants and patient-specific instrumentation in total ankle arthroplasty procedures guarantee a tailored fit and accurate alignment. For arthrodesis, three-dimensional printing enables the production of cages, effectively solving issues associated with conventional bone grafts, such as poor bone quality, significant defects, and nonunion. Additionally, patient-specific instrumentation facilitates the swift and accurate placement of Kirschner wires at the correct sites. When performing supramalleolar osteotomy, patient-specific instrumentation leads to shorter operation times, reduced blood loss, and less radiation exposure. Conclusions: Three-dimensional printing is increasingly employed in ankle surgeries, and as technology advances, it is anticipated to become critical for addressing complex ankle issues.

Background: Ankle arthritis is a common degenerative disease that progresses as cartilage damage in the lower tibia and upper talus progresses, resulting in loss of joint function. In addition to typical arthritis, there is also structural bone loss in the talus due to diseases such as talar avascular necrosis. Total talus replacement surgery is the procedure of choice in end-stage ankle arthritis and consists of a tibial, talar component and an insert. However, in cases of severe cartilage and bone damage to the talar bone with less damage to the tibial cartilage, a talar component hemiarthroplasty may be considered. Although the application of total talus replacement surgery using ceramics has been studied, reports on the application of metal 3D printing technology are limited. We aimed to investigate the feasibility of partial talar components using ceramic and titanium 3D printing technology in terms of biocompatibility and stability through animal experiments. Methods: Preoperative 3D CT was acquired and converted to STL files to fabricate a partial talus component for ankle hemiarthroplasty using ceramic and titanium. Six minipigs with an average age of 17 months were implanted with three ceramic (C-group) and three titanium talar components (T-group) in the hind limb ankle joint. The surgery was performed under anesthesia in a sterile operating room and was performed by two experienced foot and ankle specialist orthopedic surgeons. Blood analysis and CT were performed before surgery and every month for 3 months after surgery to assess the extent of inflammatory response and physical stability, sacrifices were performed 3 months after surgery, and H&E staining and micro-CT analysis were performed to compare histological biocompatibility. A grading score was calculated to semi-quantitative assess and compare the two groups. Results: In the postsurgical evaluation, blood analysis revealed that both groups had increased white blood cell counts on the postoperative day after surgery. The white blood cell count increased more in the titanium group (1.85-fold) than in the ceramic group (1.45-fold). After 3 months, all values normalized. During the study, CT analysis confirmed that all artificial samples were displaced from their initial positions. In micro-CT analysis, the adhesive tissue score of the ceramic artificial sample was better than that of the titanium sample (average threshold = 3027.18 ± 405.92). In histologic and grading scores for the inflammatory reactions, the average inflammation indices of the ceramic and titanium groups were 2.0 and 1.21, respectively. Also, the average grade score confirmed based on the results of fibrous tissue proliferation and new blood vessels was 18.4 in the ceramic application group and 12.3 in the titanium application group. Conclusions: In conclusion, both titanium and ceramics have excellent biocompatibility for artificial joints, and ceramic materials can be used as novel artificial joints. Further research on the strength and availability of these ceramics is required.