Health Care

UM surgeons implant ‘Terminator-style’ 3D-printed chrome ankle bone in novel surgery

Surgeons at the University of Miami ordered three versions of a 3D-printed ankle bone implant made out of cobalt chrome by Restor3D, a company in Durham, North Carolina. The implants came in three sizes in case the estimated fit was off. The surgeons successfully implanted the true-size fit during a novel surgery.
Surgeons at the University of Miami ordered three versions of a 3D-printed ankle bone implant made out of cobalt chrome by Restor3D, a company in Durham, North Carolina. The implants came in three sizes in case the estimated fit was off. The surgeons successfully implanted the true-size fit during a novel surgery. University of Miami

For the first 15 or so hours after Gracia Sylla woke up from surgery, she couldn’t feel her legs. She was scared and uncertain if the risk she had taken by having an unusual surgery involving a 3D-printed bone would work.

Sylla, 24, had just undergone an operation that had only been performed about 100 or so times in the country. It was one of the first in Florida. Surgeons from the University of Miami had ordered three sizes of a 3D-printed ankle bone — the talus, a small bone that sits between the heel and the two bones of the lower leg — from a North Carolina company that manufactures implants.

Then they took the best fit, a hunk of cobalt chrome, and reconstructed Sylla’s ankle.

The alternative would have been a lifetime of stiffness and limited movement. Instead, Sylla is now focusing on learning to walk with a new joint. That started the moment she woke up after the surgery in July.

“I’d been getting tired of crutches,” Sylla said.

Before the surgery, blood flow to Sylla’s talus had been reduced because of a sickle cell disease. That led to a “dead bone,” known as avascular necrosis.

Amiethab Aiyer, a UM orthopedic surgeon, initially saw Sylla at Jackson Memorial Hospital. They had tried bracing the ankle, physical therapy, and other treatments, but nothing was helping her pain.

The more common procedure would have involved removing the dead bone and fusing Sylla’s shin bone, essentially gluing it to her heel, which would have shortened her leg and required surgery on both ankles to make up for the height discrepancy.

“There are ways to make up that limb length discrepancy that can arise, but regardless of what you do to make up for that, it leaves the patient stiff,” Aiyer said. “Someone as young as her ... I thought, ‘Hey, is there another option?’”

Aiyer consulted with colleague Steve Quinnan, a UM orthopedic trauma surgeon. They began considered a 3D-printed talus bone, having seen reports of successful transplants from Japan and Australia.

Sylla was skeptical at first. How did the surgeons know it would work? What if her body rejected the implant? Could she stomach a second surgery if the high-tech bone replacement didn’t work? Eventually, she began to warm up to the idea.

“I would still have mobility in my ankles, I could still walk,” Sylla said. “There’s a chance my body won’t reject it.”

Aiyer and Quinnan performed X-rays and CT scans to measure and gauge Sylla’s talus bone. Then they sent the scans off to Durham, N.C., to a company called Restor3D. The company sent back three shiny metal talus bones, one true to size, and another two that were 5% and 10% smaller.

The true-size talus bone fit perfectly. It was Aiyer’s first time performing the surgery, and he said he didn’t anticipate it being as seamless as it ended up being.

“You can read all the case histories you want. You can think about it all you want. But it’s never quite the same until you actually do it,” he said.

Fitted with what Aiyer described as a “Terminator-style” ankle bone — a reference to the science fiction movie about a cyborg — Sylla woke up unable to feel her legs from the nerve-block for the surgery. But within days, she was attempting to walk. She said it was incredibly painful at first, and the new bone felt heavy in her ankle.

Now, though, Sylla is walking with an ankle brace, and much of the pain has retreated. She said it’s a relief to think she will eventually get back to how she was before her ankle bone died.

“I stopped going to school. I stopped working because of it,” she said. “For me to have it back, it was like I can finally go back to normal activities.”

Aiyer said he made it clear to Sylla that her doctors would have to keep an eye on how the implant is doing because so few of the surgeries have been performed.

“Yes, it’s a very cool thing. It’s very novel,” Aiyer said. “It’s very futuristic, if you will. We don’t know everything there is to know about how these joints are going to do.”

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