Clinical Outcomes of 3D-Printed Patient-Specific Instrumentation for Total Ankle Arthroplasty versus Retrograde Intramedullary Nailing for Ankle Arthrodesis

Objective To explore the Clinical Outcomes between Total Ankle Arthroplasty with 3D-Printed Patient-Specific Instrumentation and Ankle Arthrodesis with Retrograde Intramedullary Nailing for End-Stage Ankle Arthritis.The study included 50 patients with end-stage ankle arthritis, randomly assigned to two groups: the 3D-printed group (n = 25) and the arthrodesis group (n = 25). Comparisons were made between the two groups regarding age, body mass index, duration of surgery, intraoperative blood loss, number of intraoperative fluoroscopy sessions, AOFAS score, VAS score, and SF-36 score (PCS and MCS scores).Compared to the arthrodesis group, the 3D-printed group exhibited a significant reduction in operative time, intraoperative blood loss, and the number of fluoroscopic exposures, as well as significantly lower postoperative VAS scores (p < 0.05).The two groups were comparable at baseline, with no significant differences in body mass index, age, or duration of follow-up (p > 0.05).The preoperative Physical Component Summary (PCS) scores were marginally superior in the arthrodesis group compared to the 3D-printed group, whilst the Mental Component Summary (MCS) scores were marginally superior in the 3D-printed group. Postoperatively, both groups demonstrated improved scores, with the 3D-printed group exhibiting greater relative improvements in both PCS and MCS scores than the arthrodesis group. However, the differences between groups did not reach statistical significance (P > 0.05).Moreover, the 3D-printed group demonstrated superior AOFAS scores at the final follow-up compared to the arthrodesis group (p < 0.05). The application of 3D-printed patient-specific instrumentation to provide bespoke surgical solutions for end-stage ankle osteoarthritis not only significantly reduced operative time, minimised intraoperative haemorrhage and radiation exposure, thereby enhancing surgical efficiency and safety, but also yielded superior outcomes in long-term functional recovery and pain relief.Consequently, this approach achieved more satisfactory and safer surgical outcomes. Methods A retrospective analysis was conducted on 50 patients with end-stage ankle arthritis who underwent inpatient surgery at the 940th Hospital of the PLA Joint Logistics Support Force between June 2019 and June 2025. Patients were divided into two groups based on the surgical procedure received: a 3D-printed implant group (n = 25) and an arthrodesis group (n = 25). This study aimed to compare the efficacy of 3D-printed implants by assessing preoperative baseline data; intraoperative parameters (number of fluoroscopies, blood loss, and operation time); and postoperative outcomes at the final follow-up, including AOFAS, VAS, and SF-36 scores. Results Compared with the arthrodesis group, the 3D-printed group demonstrated shorter operative times, lower intraoperative blood loss, and fewer fluoroscopic examinations: (118.0 ± 14.5) minutes versus (141.2 ± 25.3) minutes; Intraoperative blood loss was (97.3 ± 12.4) millilitres vs (163.2 ± 26.8) millilitres; fluoroscopy use was (6.0 ± 1.7) times vs (10.4 ± 2.2) times; all differences were statistically significant (P < 0.05). Furthermore, both groups underwent follow-up for 1.5 ± 0.5 years (range 1–2 years), with prostheses demonstrating good alignment and no displacement (Fig. 3). The 3D-printed group demonstrated superior AOFAS and VAS scores compared to the arthrodesis group: AOFAS score (82.5 ± 9.6) vs (77.1 ± 6.1); VAS score (2.3 ± 1.2) vs (2.6 ± 1.8). All differences were statistically significant (P < 0.05). At final follow-up, the 3D-printed group exhibited a marginally lower preoperative PCS score on the SF-36 questionnaire compared to the arthrodesis group, whilst the postoperative difference was marginally higher. MCS scores showed marginally greater preoperative and postoperative differences than the arthrodesis group, though neither difference was statistically significant. Conclusion Within the 3D printing group, patient-specific osteotomy guides manufactured via 3D printing technology enabled precise preoperative planning of osteotomy planes and prosthesis positioning, whilst providing intraoperative guidance. This enhanced surgical accuracy and minimised the need for repeated adjustments and manipulations during the procedure. This approach reduces operative time, intraoperative blood loss, and the number of fluoroscopic exposures. Furthermore, at the final follow-up, the AOFAS Ankle-Hindfoot Score and Visual Analogue Scale (VAS) scores demonstrated superior outcomes compared to the arthrodesis group.