Tibiotalocalcaneal Arthrodesis With 3D-Titanium Implants for Management of Critical-Sized Osseous Defects of the Hindfoot and Ankle: A Systematic Review and Meta-Analysis

Background Managing critically sized osseous defects of the hindfoot and ankle remains challenging, particularly in the setting of failed arthrodesis, trauma, Charcot, or failed total ankle arthroplasty. Custom 3D-printed titanium implants have emerged as a potential alternative to structural allografts, offering mechanical stability and biologic incorporation through patient-specific geometry and engineered porosity. Methods A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. A search of major databases identified studies reporting outcomes of tibiotalocalcaneal (TTC) arthrodesis using 3D-printed titanium implants for critical-sized defects. Union rates, complications, and limb-salvage outcomes were extracted and synthesized. A random-effects model was used to calculate pooled rates. Results Fifteen studies comprising 142 patients met the inclusion criteria. Indications included segmental bone loss (n = 32), failed total ankle replacement (n = 31), avascular necrosis (n = 21), and nonunion (n = 20). The pooled union rate was 88.2% (95% CI: 82.0%-94.5%), and the limb-salvage rate was 92.3% (95% CI: 87.3%-97.3%). The complication rate was 16.9%, with infection and nonunion being the most frequent types. Functional outcome scores improved significantly in multiple studies. Only 6.3% of patients required below-knee amputation. Conclusion Custom 3D-printed titanium implants demonstrate high union and limb-salvage rates with acceptable complication profiles in the treatment of large osseous hindfoot and ankle defects. These implants may offer a favorable alternative to traditional grafting in complex salvage scenarios.