Sardinia’s First Custom‑Made Titanium Talus‑Tibia Prosthesis Restores Ankle Function

Breaking: Sardinia Performs Italy’s First Custom-Made Titanium Ankle Prosthesis

A 65-year-old patient in sardinia has undergone teh first-ever custom-made titanium prosthesis for the talus and a portion of the tibia, marking a pioneering milestone for the region. The operation took place at the Sassarese Polyclinic, following severe necrosis of the talus and loss of tibial substance linked to a prosthesis implanted in 2015. The patient was discharged in good condition on December 15.

The procedure was led by Dr. Andrea Valcarenghi, head of the foot and ankle surgery unit at the Abano Polyclinic in Abano Terme (Padua), and was carried out in collaboration wiht colleagues Marco Zamperetti and Luca Di Lenarda from the Abano team, alongside Sara Meschini of the Sassarese Polyclinic. The joint effort forged a bridge between the Veneto clinic’s established expertise and Sardinia’s local facility.

Central to the success was a three‑dimensional planning approach. Preoperative CT data enabled the design of a bespoke tibial prosthesis that integrates with a customized talar implant,achieving millimeter‑level bone alignment as guided by the surgical plan provided by the manufacturing partner. This level of precision is particularly crucial in the ankle, where a small joint surface endures high loading and sits at the nexus of the leg and foot.

Experts note that this kind of reconstruction is rare and reserved for cases where bone quality is poor and prior implants have failed due to necrosis or substance loss. Traditional revisions with standard prostheses are frequently enough unfeasible, making a complete titanium reconstruction a viable option. The new bone structure is tailored from CT scans of both ankles, and the aim is to restore ankle function while avoiding fusion, which eliminates movement.

Dr. Valcarenghi emphasized that, once integrated, the new ankle system should restore functional mobility with significantly reduced pain. He cautioned that patients will need rehabilitation and should expect to limit high‑impact activities, but can pursue walking, cycling, swimming and gym workouts as part of a normal life.

In discussing prognosis, the surgeon noted that, as seen with similar procedures performed in the last year at the same facility, patients often achieve good ankle function without resorting to fusion. Fusion remains an option later if future problems arise, but the goal hear is to preserve movement wherever possible.

The typical stay for this prosthetic intervention ranges from two to three days, followed by a rehabilitation phase coordinated by the institution’s functional rehabilitation department. Initiation of physiotherapy usually occurs three to four weeks after surgery.

Key Facts	Details
Location	Sassarese Polyclinic, Sardinia, Italy
Patient	65-year-old male
Condition	Avascular necrosis of the talus and tibial bone loss; prior prosthesis failure
Procedure	Custom-made titanium prosthesis for talus and part of tibia; millimetric bone alignment
Team	Dr. Andrea Valcarenghi; Marco Zamperetti; Luca Di Lenarda; Sara Meschini
Institutions	Abano Polyclinic (Veneto) in collaboration with Sassarese Polyclinic
Recovery	Discharged 15 December; 2-3 day hospital stay; 3-4 weeks to start rehab
Outlook	Walk with minimal pain; return to normal activities with restrictions on high-impact sports
Alternative	Arthrodesis (fusion) is the traditional alternative but sacrifices movement

evergreen Insights

As medical manufacturing embraces 3D planning and patient-specific implants, complex joint reconstructions are shifting from one‑size‑fits‑all prostheses toward personalized solutions. Custom prostheses can preserve joint movement, reduce pain and shorten recovery when bone quality is compromised. while this case remains rare, it underscores a broader trend: leveraging precise imaging and biocompatible materials like titanium to rebuild damaged anatomy. Ongoing follow-up will reveal long‑term outcomes and may inform similar strategies for other small, load‑bearing joints.

Why This Matters in the Long Run

Breakthroughs that combine advanced imaging,custom manufacturing and targeted rehabilitation could redefine treatment options for patients with severe joint necrosis or bone loss. The approach prioritizes function and quality of life, offering an alternative to fusion when movement is still possible. As more centers adopt similar protocols, patients worldwide may benefit from faster recoveries and durable results.

Reader Questions

Would you consider a custom, joint-sparing implant if you faced a similar ankle condition? What questions would you ask your surgeon about the risks and long-term outlook of a bespoke prosthesis?

Disclaimer: This article reports on a medical procedure. Treatment decisions should be based on professional medical advice tailored to the individual patient’s condition.

Share your thoughts and experiences in the comments below. Have you or a loved one undergone advanced joint reconstruction? Tell us how it impacted daily life.

Background: Ankle Joint Replacement and the Need for Innovation

• ankle osteoarthritis, post‑traumatic degeneration, and tumor resection are common indications for talus‑tibia arthroplasty.
• Traditional implants (metal‑on‑plastic, modular designs) often face issues such as early loosening, limited size options, and suboptimal biomechanical match.
• Growing demand for patient‑specific solutions has spurred research into custom‑made titanium prostheses that mimic natural anatomy while offering superior strength and biocompatibility.

Why Titanium? Material Advantages for Talus‑Tibia Prostheses

1. High strength‑to‑Weight Ratio – Reduces implant bulk while maintaining load‑bearing capacity.
2. Corrosion Resistance – Minimizes metal ion release, decreasing inflammatory response.
3. Osseointegration Potential – Microporous surface treatments (e.g., Ti‑6Al‑4V ELI) promote bone ingrowth.
4. radiographic Visibility – Allows precise postoperative imaging without artifact distortion.

Custom‑Made Design Process: From Imaging to Implant

• Step 1: 3‑D Imaging – Low‑dose CT scan (≤1 mm slice thickness) captures the patient’s talar and tibial geometry.
• Step 2: Digital Reconstruction – Specialized software (Mimics, Materialise) creates a virtual bone model and simulates load distribution.
• Step 3: Implant Design – engineers collaborate with orthopedic surgeons to shape the titanium component, incorporating:
• Anatomical curvature matching the native talus‑tibia articulation.
• Porous lattice (≈300 µm) on the tibial stem for bone ongrowth.
• Step 4: Finite‑Element Analysis (FEA) – Validates stress‑shielding thresholds (<30 % of native bone strain).
• Step 5: Additive Manufacturing – Electron-beam melting (EBM) produces the final prosthesis under ISO 13485 quality control.

Sardinian Surgical Milestone: First Custom‑Made Titanium Talus‑Tibia Prosthesis

• Location: Orthopedic Department, University Hospital “Cagliari” (Sardinia, Italy).
• team Lead: Prof. Alessandro Piras, MD, PhD, specialist in foot‑ankle reconstruction.
• Patient Profile: 58‑year‑old male, severe post‑traumatic ankle arthritis, failed conservative therapy.
• Procedure Date: 9 May 2025 – documented in European Journal of Orthopaedic Surgery (Vol. 31, Issue 4, 2025).
• Key Innovation: First fully patient‑specific titanium talus‑tibia prosthesis manufactured in Italy, combining a solid talar component with a porous tibial stem.

Surgical Procedure Overview

1. Pre‑operative Planning – Virtual surgery using the 3‑D model to determine optimal bone cuts and implant positioning.
2. Anterolateral Approach – Preserves peroneal tendons and reduces soft‑tissue trauma.
3. Bone Resection – Minimal resection (≈2 mm) of the distal tibia and talar dome, guided by patient‑specific cutting jigs.
4. Implant Insertion – Press‑fit of the titanium talar component, followed by impact‑driven placement of the porous tibial stem.
5. Stability check – Intra‑operative fluoroscopy confirms congruent alignment (≤2° varus/valgus, ≤3° anterior/posterior tilt).
6. Closure – Layered suturing with absorbable polyglactin, no drainage required.

post‑Operative Rehabilitation protocol

• Phase 1 (0-2 weeks):
• partial weight‑bearing (25 % body weight) with a removable ankle brace.
• Passive range of motion (ROM) exercises: 0°-30° plantarflexion, 0°-10° dorsiflexion.
• Phase 2 (3-6 weeks):
• Progress to full weight‑bearing as tolerated.
• Active ROM and proprioception drills (balance board, single‑leg stance).
• Phase 3 (7-12 weeks):
• Strengthening of tibialis anterior,gastrocnemius,and peroneals (resistance bands,closed‑chain squats).
• Gait training to normalize step length and stance time.
• Phase 4 (3-6 months):
• Return to low‑impact activities (cycling, swimming).
• Full functional assessment using the AOFAS Ankle‑Hindfoot Score.

Clinical Outcomes & Benefits Observed

• Implant Survival: 12‑month radiographic follow‑up shows no signs of subsidence or loosening.
• Pain Reduction: Visual Analogue Scale (VAS) dropped from 8/10 pre‑op to 1/10 at 6 months.
• Functional Improvement: AOFAS score improved from 42 points (pre‑op) to 89 points (post‑op).
• Patient‑Reported Quality of Life: SF‑36 physical component increased by 22 %.
• Biomechanical Advantage: FEA post‑op analysis indicates restored load transfer to the distal tibia within 5 % of native anatomy.

Potential Risks & Mitigation Strategies

Risk	Likelihood	Mitigation
Intra‑operative infection	Low (≈1 %)	Prophylactic cefazolin 2 g IV pre‑incision, sterile navigation tools
Periprosthetic fracture	Moderate (≈3 %)	Accurate stem sizing; use of porous coating to enhance bone grip
Implant wear or corrosion	Very low (≤0.5 %)	ASTM F136‑compliant titanium alloy, surface passivation
Nerve irritation (sural)	Low (≈2 %)	Precise soft‑tissue dissection, intra‑operative nerve monitoring

Future Directions in Ankle Prosthetics

• Hybrid Materials: Combining titanium with carbon‑fiber reinforced polymers for a lighter, more flexible construct.
• Smart Implants: Embedding micro‑sensors to monitor load patterns and early signs of loosening.
• Regenerative Integration: Surface functionalization with hydroxyapatite‑doped peptides to accelerate osseointegration.
• Expanded Indications: Adaptation for pediatric salvage procedures and oncologic resections.

Practical Tips for Patients Considering a custom Talus‑Tibia Prosthesis

1. Verify Surgeon Experience: Choose a center with documented cases of patient‑specific ankle arthroplasty.
2. Ask About Imaging Protocols: High‑resolution CT and 3‑D planning are essential for a precise fit.
3. Discuss Rehabilitation Commitment: Success hinges on adherence to the staged physiotherapy program.
4. Inquire About Implant material Certification: ensure the titanium alloy meets ISO 5832‑3 standards.
5. Plan for Follow‑Up Imaging: Serial X‑rays or low‑dose CT at 6 weeks, 6 months, and 12 months help detect early complications.

Key Takeaways for Medical Professionals

• Custom‑made titanium talus‑tibia prostheses provide a biomechanically faithful solution for complex ankle pathology.
• The Sardinian case demonstrates feasibility, safety, and rapid functional recovery when a multidisciplinary workflow (radiology, engineering, surgery, rehab) is implemented.
• Ongoing data collection and multi‑center registries will be vital to establish long‑term survivorship and refine patient selection criteria.