YA. Weil, (Jeursalem)
Background:
Traumatic intra-articular fractures, whether open or closed, present major reconstructive challenges. The primary goal of surgical treatment is restoration of joint anatomy to achieve a stable, congruent articulation that allows painless motion. However, certain injuries are associated with substantial bone and cartilage loss that cannot be anatomically reconstructed. Salvage options—including arthrodesis, total joint arthroplasty, or osteochondral allograft transplantation—are limited and associated with significant morbidity, particularly in young and active patients. We present a novel reconstructive approach using three-dimensional (3D)–printed, patient-specific partial-resurfacing implants for localized joint defect reconstruction.
Methods:
High-resolution computed tomography (CT) scans of both the injured and contralateral healthy limbs were obtained. The unaffected joint was mirrored and used as an anatomical template. Semi-automatic segmentation was performed, and the missing joint segment was reconstructed by subtracting the injured area from the mirrored contralateral anatomy. A 3D model of the defect was created and printed. Based on this model, a custom titanium implant was manufactured, featuring a polished articular surface and a porous, plasma-sprayed trabecular interface with recesses for guided screw fixation. Surgical implantation was performed through an open arthrotomy with release of periarticular scar tissue. Fixation was achieved using titanium screws (2.7, 3.5, or 4.5 mm, as appropriate). Immediate postoperative range of motion was permitted, while weight bearing was restricted for 8–12 weeks.
Results:
Four procedures were successfully performed: one lateral talar defect following an open injury, one medial tibial condyle defect, one posterolateral distal femoral defect, and one lateral distal humeral defect. Three patients were young, active males (ages 21–31 years), and one patient was a healthy, active 55-year-old female with an elbow defect. All patients achieved painless, functional range of motion. At a minimum follow-up of one year, no implants demonstrated radiographic evidence of loosening, osteolysis, or mechanical failure.
Conclusion:
In selected patients with isolated, partial, stable joint defects following traumatic injury, patient-specific 3D-printed hemi-resurfacing implants may provide an effective reconstructive solution. This approach may restore joint kinematics, enable early motion, and potentially prevent or delay the need for more invasive salvage procedures such as total joint arthroplasty or arthrodesis. Larger patient series and longer-term follow-up are required to further assess the durability and clinical value of this technique.