Duke Uses Custom-Printed Bones to Help People Walk After Trauma

3-D Printed Bone Replacements Save Limbs, Improve Quality of Life

By Larissa Biggers
October 29, 2020
Dr. Selene Parekh

What once might have seemed like science fiction is now a common procedure at Duke -- replacing damaged or diseased ankle bones with 3-D printed replicas. In the not-too-distant past, for most people with severe ankle injuries involving the talus (the bone between the shin and the heel) or a failed ankle replacement affecting the talus, the only choices were amputation or fusing the shin and heel bones. As one of the early adopters and innovators of 3-D talus replacement surgery, Duke Health offers a better option.

3-D Technology and a Doctor’s Imagination

When 23-year-old Bryana Riley learned her lower left leg needed to be amputated following a serious car accident in her hometown of Atlanta, her family sprang into action. After scouring the internet, Riley’s mother found what she was looking for -- Selene Parekh, MD, a foot and ankle surgeon at Duke who is well-known for innovative orthopaedic surgeries using 3-D printed bones.

Dr. Parekh had performed countless 3-D printed talus replacement surgeries, but Riley’s case was different. The damage to her ankle was serious -- some of the crucial supporting bones in her ankle were missing. Also, not only would the talus need replacing, but also the bone that stabilizes the ankle (the malleolus). “We’re one of the leading centers in the world for 3-D talus replacement, so the novelty for us in this case was to replace two bones at the same time,” Parekh said. Despite the challenges, he knew he could help.

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"It’s all about imagination. 3-D printing can do whatever you want. You just have to be able to imagine it and communicate it."  -- Selene Parekh, MD

Because he could not replicate her missing bones, Parekh designed 3-D replacements based on mirror images of her right ankle. “It’s all about imagination,” he said. “3-D printing can do whatever you want. You just have to be able to imagine it and communicate it.” In Riley’s case, he was able to imagine and recreate the missing talus and malleolus. The procedure could not have gone any better. “We executed the surgery just as we planned on the computer. It shows the power of 3-D printing and how it has allowed surgeons to save limbs and restore quality of life.” Today Riley is walking without a limp and getting back to the activities she enjoys.

X-rays before and after 3-D talus replacement

The Future of 3-D Bone Replacement

Duke orthopaedic surgeons completed their first 3-D printed talus replacement in 2016 and since then have performed hundreds of these procedures -- some of the highest numbers in the U.S. And they aren’t stopping there. Dr. Parekh explains, “We are now offering different iterations of that surgery at Duke. We can replace the fibula, the bones in the foot itself, and parts of the shin bone. We will continue to find new ways to implement 3-D printing to do limb salvage surgery, change treatment protocols, and provide treatment where there are currently none. That’s already happening. We are opening up new ways of treating these injuries that never existed before.”