Total talus replacement has gained traction over the last few years and whether it is a viable alternative to a very serious problem is still to be debated. In the mean time, we quickly wanted to review the companies out there creating patient specific 3D printed technology expanding the armamentarium of foot and ankle surgeons across the world.

The advent of 3D printed implants in foot and ankle began in 2008 when 4 Web launched it’s proprietary truss implant platform. A few years later, 4 Web expanded their custom offering beyond cages and created 3D printed talar replacements to deal with AVN. This is done by taking a CT of the patient’s healthy ankle; then using computer engineering, the image is reversed and becomes a blueprint for creating the new talus. In addition to custom cages, they also offer an off the shelf portfolio of evans and cotton wedges along with a variety of spine cages.

Additive Orthopedics , based in New Jersey, is looking to take over as the dedicated Foot and Ankle customs provider. Their Instagram Page showcases a variety of cases from failed 1 st MTP arthroplasty implants to total talar replacements compatible with tibial replacement components from a variety of companies. They offer a variation of the TTC bone block cage deemed the “death star” spherical cage that can be used in combination with a nail or fusion plate to help provide stability and bone graft retention in an effort to span large deficits in fusion cases.

A new player is emerging in Restor3D , a spinoff from the Medshape group. Their website is under construction, so not much is info is currently available other than a few recent webinars displaying that they have the capabilities to create complex customs for similar disaster cases presented by the other companies.

A downside of customs is that they can be expensive and approvals for use at some institutions can be difficult. CPT codes are available and these implants are reimbursable. In some cases, patients pay out of pocket for the implants or sign documentation that they will pay for the implant if they cancel their case prior to surgery. Regardless of cost, all 3 of these companies are providing technology platforms that are providing options to surgeons to treat patients that may have otherwise ended up with a BKA.

When will the major players begin their own customs programs? Regulatory concerns have to be the barrier to entry at this point. At some point the rules will change, and patient specific implants for TAR and other unique cases will be the norm similar to what Conformis is doing with knees and hips currently. Would it surprise you to see a 3D printer in the core of your OR that creates On-Demand custom implants in 5 years?