When modern engineering combines with surgery, the results may offer a futuristic personalized option not available until now. In Ohio - The future began in Bellevue.
In January, The Bellevue Hospital (TBH) and NOMS Healthcare podiatric surgeon Peter Highlander, DPM, MS performed Ohio’s first successful total talus, or ankle, replacement using 3D printing. His patient, a 31-year-old Bellevue woman, had been living with a deformed ankle after an automobile accident severely fractured and damaged bone tissue due to insufficient blood supply, also known as avascular necrosis. The woman said other surgeons told her amputation was inevitable, but Highlander’s recent knowledge and involvement of 3D printing offered a more positive option.
“Timing was everything with this patient. If she had come to see me even a year before, I would’ve agreed with the other surgeons about amputation or major bone fusion being her only options. But, nine months ago I became aware and involved in surgical 3D printing,” Highlander said. “After discussing her options, we decided to try something ‘outside-of-the-box.’ Since the bone tissue was dead and wouldn’t support a traditional implant, the only option was to surgically remove the dead bone and replace it with a one-of-a- kind custom device.”
Highlander sent X-ray and CT images of both ankles to Additive Orthopaedics, a New Jersey based biologics company. The company then used 3D imagery of her healthy ankle to create a mirror-reverse-prosthetic talus made out of cobalt chromium.
Until 3D printing, talus replacements were all the same with only “small,” “medium,” and “large” sizing options: Obtaining a perfect fit was nearly impossible. With 3D printing, a customized implant device tailored specifically to the patient’s anatomy offers a near perfect fit, longevity and ability to regain function.
To date, only 30 custom ankle replacements have been done in the U.S. by three surgeons including Highlander, and only ten surgeons world-wide have reported performing the procedure.
Highlander is also the first surgeon in the U.S. to perform a custom first-metatarsal (big toe) replacement. His patient was a 58-year-old man who suffered a partial foot amputation in a motorcycle accident.
“Using a custom implant for this patient allowed a re-balance of the foot and reduced painful pressure areas created from the initial amputation,” Highlander said.
“My overall goal is to let people know there may be options in podiatric surgery after being told that amputation is imminent, there’s nothing left to do, or having suffered a previously failed replacement,” said Highlander. “I hope surgical 3D printing becomes a niche practice in our four-county area. People are surprised when they find out I’m offering this advanced surgery in rural North Central Ohio. But to me it makes perfect sense,” said the Castalia native. “First, I get to help people return to the quality of life they deserve, and then, I’m able to offer this to the communities where I grew up. It’s a win-win for me.”
Highlander is also the Medical Director for The Bellevue Hospital’s Wound Reconstruction Center, offering comprehensive wound treatment options for chronic, non-healing wounds related to diabetes, bone infections, venous insufficiency and pressure ulcers.
“Wound care is extremely important for someone with diabetes. Patients may develop pressure ulcers on their feet leading to bone infections. Unfortunately, those bone infections have a tendency to reoccur. We now have the option of cutting out the affected portion of bone and using the 3D printing technology, to replace that section,” said Highlander.
The Bellevue Hospital has been named a “Center of Excellence” by the American Orthopaedic Society of 3D Printing (AOS3DP) because of Dr. Highlander’s recent accomplishments using custom, patient specific implants for complex foot and ankle pathologies.
“The Society provides a platform for orthopaedic thought leaders to share ideas and experiences with one another and the industry. The society looks to maximize the integration of 3D printing into clinical practice to help treat difficult cases and to provide novel treatment options,” said Dr. Selene Parekh, founding member and chairman of the AOS3DP. “The concept of a Center of Excellence allows patients to identify those clinical practices and surgeons who have a deep understanding of the benefits and limitations of 3D printed implants,” continued Parekh.
For more information, or to contact Dr. Highlander: