Midfoot arthrodesis is considered the standard of care for the surgical treatment of degenerative or post-traumatic arthritis, instability, and progressive deformity of the tarsometatarsal and naviculocuneiform joints once conservative measures fail. Symptomatic midfoot arthritis has been reported to affect 12–17% of adults that are 50 years of age or older. ^, Fixation constructs for midfoot arthrodesis mainly consist of dorsal plates, screws and staples. However, symptomatic hardware removal occurs in a significant portion of midfoot arthrodesis patients accounting for up to 15–25% of patients who undergo this procedure. ^, Historically, fusion of these joints has demonstrated favorable outcomes in terms of pain relief and deformity correction, with union rates frequently reported above 85–95%. ^,, However, these procedures are not without complications. Prominent hardware, soft tissue irritation, and the subsequent need for hardware removal continue to represent a significant source of morbidity and healthcare utilization. ^, Despite efforts in trying to mitigate hardware prominence, this is difficult to address given the limitation of soft tissue coverage over the dorsal midfoot which inevitably leads to prominent hardware. Secondary hardware removal is commonly required and exposes patients to additional operative risk, cost, and recovery time. In addition to the cost, which is something that is notable and efforts should be made to mitigate as hardware removals innately do not come without complications, a 7-year analysis by Saltzman et al., looked at over 13,000 hardware removals and reported a complication rate of 9.6%. Structural dowel constructs represent a novel alternative that functions both as a stabilizing device and as a structural scaffold with potential to mitigate prominent dorsal hardware. Unlike metallic implants, structural allograft participates in biologic incorporation through creeping substitution and progressive host-graft integration. The theoretical advantages include intrinsic load-sharing stability, elimination of prominent dorsal hardware, and potential reduction in secondary procedures. However, despite these anecdotal benefits, there is also very limited clinical data on allograft structural dowels. Furthermore, newer systems like the one we are presenting is a 3-D printed titanium fenestrated hollow dowel which incorporate techniques of dowel reaming that allow for biologic augmentation through hollow implant designs which maintain the structural integrity of the graft while allowing biologic ingrowth through the fenestrated portions and are packed with autologous cancellous bone graft. The purpose of this pilot study was to evaluate early radiographic union, complication rates, and hardware removal incidence in patients undergoing midfoot arthrodesis using a 3-D printed titanium fenestrated hollow dowel.

A retrospective review was conducted of five patients who underwent midfoot arthrodesis using the Auxano Intrepid ® 3-D printed titanium fenestrated hollow dowel (Intreped, Auxano Medical, Brecksville, OH) between October 2024 and April 2025. All procedures were performed by a single surgeon who is the senior author in this study. Patient demographics, including age, body mass index (BMI), comorbidities, and tobacco use, were recorded. Descriptive statistics were computed to summarize the study data and are presented in the following section. Postoperative outcomes assessed included radiographic union, complications, and need for secondary procedures, including hardware removal. Union was determined using standard radiographs that appeared over 50% of consolidation/trabeculation across the arthrodesis site, and, when indicated, confirmed with computed tomography.

Five patients met our inclusion criteria. The mean body mass index was 33.5 kg/m², and no patients were active tobacco users. One patient had well-controlled diabetes. Additional comorbidities included osteoporosis, cardiovascular disease, hypertension, hyperlipidemia, and depression. Midfoot procedures performed included isolated second tarsometatarsal arthrodesis in one case, combined second and third tarsometatarsal arthrodesis in two cases, first through third tarsometatarsal arthrodesis in one case, and combined second and third tarsometatarsal with naviculocuneiform arthrodesis in one case. Radiographic union was achieved in 100% of patients. Three patients demonstrated CT-confirmed fusion at a mean time of 88 days (12.5 weeks) postoperatively, while two patients demonstrated osseous bridging on plain radiographs consistent with union. The mean follow-up duration was 8.8 months (range 6–12). There were no nonunions, infections, wound complications, or revision surgeries. Importantly, no patients reported symptomatic hardware and required no hardware removals during the follow-up period.