Hi, my name is William Mack Malarkey. I'm a third year resident at Geisler Medical Center. I'll be presenting a case series on Sherco Arthropathy limb salvage with 3D custom cage and dynamic hind foot fusion nail combination fixation. Dr. Jared Cush was the PI for the project. Disclosures, Dr. Cush is a consultant for Restore3D and MedShape. Meanwhile, the FDA has approved all pharmaceuticals and medical devices that were used in this presentation. Patients with a Sherco Arthropathy with hind foot collapse present an incredibly difficult challenge for foot and ankle surgeons. These are images of a 48-year-old patient of ours who had two weeks of increasing atraumatic ankle pain, showing significant loss of the joint, distinguishing features of Sherco Arthropathy. While traditional limb salvage options included a tibio-talo-calcaneo-arthrodesis with accepted shortening, thin wire external fixation, or a TTC-arthrodesis with bulk femoral allograft, new custom 3D patient-specific implants offer a whole new treatment modality for limb salvage for this difficult issue. The purpose of this case series is to offer one surgeon's experience with the new treatment technique for limb salvage. Previous series looking at 3D custom cage nail fusion constructs looked at trauma patients as well as the acute shortening associated with the TTC, but no specific series has looked at these implants in patients with Sherco Arthropathy. These are pre-op films and post-op showing the construct. So all patients, the methods of the project, all patients undergoing limb salvage procedures from 2018 to 2021 with a custom 3D hind foot cage with the TTC hind foot fusion IM nail were included. It was a telephone survey. Along with patient demographics and length of follow-up, patients were asked a series of questions in order to measure patient-reported outcomes, including current ambulatory status and whether they would have elected to undergo the same treatment modality again. Complications were also tracked. Finally, radiographs were analyzed to evaluate the degree of deformity correction on both coronal and sagittal planes, as well as the degree of deformity correction maintenance at last radiographic follow-up. In total, there were 13 patients, 10 of which had Sherco Arthropathy, one with a prior TAA, one with a prior ankle fusion, and three without Sherco. Average follow-up was 323 days. Here is a table of our patient demographics. As you can see, most patients were above the age of 45. Complications. So two patients actually had deep infections that ultimately required below-the-knee amputation. One other patient had a superficial wound debridement along with a broken screw that eventually required chronic antibiotic suppression. Another patient had hardware hallucinating. Interestingly enough, both patients who failed the limb salvage and required a below-the-knee amputation reported that they would prefer to have undergone the same attempt at limb salvage even with the resulting amputation. Eleven out of the 13 patients had successful limb salvage as defined by the maintenance of a functional limb without the need for an amputation. Other interesting results were that five patients actually improved their ambulatory status going from using a cane or walker to completely unassisted. Radiographically, the average amount of coronal plane deformity correction was 25 degrees, while the average amount of sagittal plane deformity correction was 6 degrees. The average amount of deformity correction maintenance seen at the last radiographic follow-up was high with a loss of only 0.5 degrees in the coronal plane deformity correction loss throughout the time period and an average of 2 degrees of sagittal plane deformity correction loss. Here's the custom cage program getting a CT3D recon, repositioning your anatomy, and then allowing to see your proposed resection. Here's an example of the custom cage implant that was being used. Here's postoperative imaging of a patient who underwent this treatment. Here are the outcomes of our patients with four complications in total, two of which were below the knee amputations. So, in conclusions, while our Charcot is a challenging pathology to treat, custom patient-specific 3D implants combined with a TTC hindfoot fusion nail is a viable construct for patients with Charcot orthopathy who are undergoing limb salvage for hindfoot collapse. Thank you very much.

limb salvage

Sherco Arthropathy

3D custom cage

dynamic hindfoot fusion nail fixation

treatment modality