title: Custom-Made Total Talonavicular Replacement in a Professional Rock Climber.
abstract: Professional athletes are often eager to resume sporting activities at preinjury levels. When facing the challenge of restoring joint function after a complex articular fracture, innovative solutions must be explored. We describe the results of what we believe to be the first custom-made talonavicular prosthesis implanted in a professional rock climber who had developed post-traumatic ankle and talonavicular arthritis as sequelae of a complex talar and navicular fracture. Using computed tomography scan reconstruction of the contralateral healthy ankle and direct metal laser sintering, a custom-made talonavicular prosthesis was obtained and implanted using an anteromedial approach. The patient was clinically and radiographically evaluated every 6 months after surgery for 30 months. A 3-dimensional videofluoroscopic analysis was performed to assess the range of motion about the prosthesis. At the last follow-up visit, the functional scores were excellent (Tegner activity scale score of 9 of 10), and he had completely resumed his sporting activity. The American Orthopaedic Foot and Ankle Society score had increased from 36 to 81 points, and no signs of radiolucency were observed on the radiographs. The 3-dimensional videofluoroscopic analysis showed 15° of dorsiflexion and 4° of plantar flexion at the ankle. A customized solution is an option when the patient's expectations are not likely to be met by standard treatment, such as arthrodesis. A custom-made talonavicular prosthesis can be an effective solution for complex ankle injury sequelae in patients demanding high functionality.
authors.affiliation: Professor, I Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Giannini
authors.affiliation: Surgeon, I Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Cadossi
authors.affiliation: Medical Doctor, I Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy. Electronic address: antonio.mazzotti2@studio.unibo.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Mazzotti
authors.affiliation: Medical Doctor, I Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Ramponi
authors.affiliation: Engineer, Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Belvedere
authors.affiliation: Engineer, Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Leardini
mesh_terms: D000328:Adult; D016512:Ankle Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D001168:Arthritis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001265:Athletic Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007595:Joint Prosthesis; D008297:Male
keywords: custom prosthesis; gait study; osteonecrosis; sports; trauma