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Guo Z, Peng Y, Shen Q, Li J, He P, Yuan P, Liu Y, Que Y, Guo W, Hu Y, Xu S. Reconstruction with 3D-printed prostheses after type I + II + III internal hemipelvectomy: Finite element analysis and preliminary outcomes. Front Bioeng Biotechnol 2023; 10:1036882. [PMID: 36698627 PMCID: PMC9868148 DOI: 10.3389/fbioe.2022.1036882] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/20/2022] [Indexed: 01/10/2023] Open
Abstract
Background: Prosthetic reconstruction after type I + II+ III internal hemipelvectomy remains challenging due to the lack of osseointegration and presence of giant shear force at the sacroiliac joint. The purpose of this study was to evaluate the biomechanical properties of the novel 3D-printed, custom-made prosthesis with pedicle screw-rod system and sacral tray using finite element analysis. Methods: Four models that included one intact pelvis were established for validation. Forces of 500 N and 2,000 N were applied, respectively, to simulate static bipedal standing and the most loaded condition during a gait cycle. Biomechanical analysis was performed, and the results were compared; the preliminary outcomes of four patients were recorded. Results: For the reconstructed hemipelvis, stress was mainly concentrated on the sacral screws, bone-prosthesis interface, and upper endplate of the L5 vertebra. The optimization of the design with the sacral tray structure could decrease the peak stress of the sacral screws by 18.6%, while the maximal stress of the prosthesis increased by 60.7%. The addition of the lumbosacral pedicle-rod system further alleviated stress of the sacral screws and prosthesis by 30.2% and 19.4%, respectively. The site of peak stress was contemporaneously transferred to the connecting rods within an elastic range. In the retrospective clinical study, four patients who had undergone prosthetic reconstruction were included. During a follow-up of 16.6 ± 7.5 months, the walking ability was found preserved in all patients who are still alive and no prosthesis-related complications had occurred except for one hip dislocation. The Musculoskeletal Tumor Society (MSTS) score was found to be 19.5 ± 2.9. Conclusion: The novel reconstructive system yielded favorable biomechanical characteristics and demonstrated promising preliminary outcomes. The method can be used as a reference for reconstruction after type I + II + III hemipelvectomy.
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Affiliation(s)
- Zehao Guo
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yongjun Peng
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Qiling Shen
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jian Li
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Peng He
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Peng Yuan
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yulei Liu
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yukang Que
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People’s Hospital, Beijing, China
| | - Yong Hu
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China,*Correspondence: Yong Hu, ; Shenglin Xu,
| | - Shenglin Xu
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China,*Correspondence: Yong Hu, ; Shenglin Xu,
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Zhu Y, Babazadeh-Naseri A, Dunbar NJ, Brake MRW, Zandiyeh P, Li G, Leardini A, Spazzoli B, Fregly BJ. Finite element analysis of screw fixation durability under multiple boundary and loading conditions for a custom pelvic implant. Med Eng Phys 2023; 111:103930. [PMID: 36792235 DOI: 10.1016/j.medengphy.2022.103930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 11/16/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022]
Abstract
Despite showing promising functional outcomes for pelvic reconstruction after sarcoma resection, custom-made pelvic implants continue to exhibit high complication rates due to fixation failures. Patient-specific finite element models have been utilized by researchers to evaluate implant durability. However, the effect of assumed boundary and loading conditions on failure analysis results of fixation screws remains unknown. In this study, the postoperative stress distributions in the fixation screws of a state-of-the-art custom-made pelvic implant were simulated, and the risk of failure was estimated under various combinations of two bone-implant interaction models (tied vs. frictional contact) and four load cases from level-ground walking and stair activities. The study found that the average weighted peak von Mises stress could increase by 22-fold when the bone-implant interactions were modeled with a frictional contact model instead of a tied model, and the likelihood of fatigue and pullout failure for each screw could change dramatically when different combinations of boundary and loading conditions were used. The inclusion of additional boundary and loading conditions led to a more reliable analysis of fixation durability. These findings demonstrated the importance of simulating multiple boundary conditions and load cases for comprehensive implant design evaluation using finite element analysis.
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Affiliation(s)
- Yuhui Zhu
- Department of Mechanical Engineering, Rice University, Houston, Texas, USA
| | | | - Nicholas J Dunbar
- Department of Mechanical Engineering, Rice University, Houston, Texas, USA
| | - Matthew R W Brake
- Department of Mechanical Engineering, Rice University, Houston, Texas, USA
| | - Payam Zandiyeh
- Department of Orthopedic Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Geng Li
- Department of Mechanical Engineering, Rice University, Houston, Texas, USA
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Benedetta Spazzoli
- Clinica Ortopedica III, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Benjamin J Fregly
- Department of Mechanical Engineering, Rice University, Houston, Texas, USA.
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Wang M, Liu T, Xu C, Liu C, Li B, Lian Q, Chen T, Qiao S, Wang Z. 3D-printed hemipelvic prosthesis combined with a dual mobility bearing in patients with primary malignant neoplasm involving the acetabulum: clinical outcomes and finite element analysis. BMC Surg 2022; 22:357. [PMID: 36203147 DOI: 10.1186/s12893-022-01804-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 09/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Limb salvage reconstruction for pelvic tumors, especially periacetabular tumors, is challenging. We combined the use of dual mobility bearing and 3D-printed hemipelvic prosthesis to improve function and reduce the probability of complications after hemi-pelvic resection in patients with primary acetabular malignancy. The purpose of this study was to evaluate the efficacy and safety of this combination. METHODS Between October 2011 and May 2021, 11 patients with malignancies involving the acetabulum received hemipelvic replacement with a 3D-printed prosthesis and dual mobility bearing. Follow-up of postoperative survival, complications, and Musculoskeletal Tumor Society 93 (MSTS-93) lower limb functional scores were carried out. A finite element model of the postoperative pelvis was developed and input into the finite element analysis software. The Von Mises equivalent stress formula was used to analyze the stress distribution of each part of the pelvis under one gait cycle and the stress distribution at different angles of the hip joint. RESULTS By the last follow-up, 9 of the 11 patients (81.8%) were still alive, and 2 patients had local tumor recurrence. The complications including 1 deep infection and 1 dislocation of the artificial joint. Excluding 1 amputation patient, the average score of the remaining 8 patients at the last follow-up was 21.4/30 (71.3%) on the MSTS-93. In the reconstructed pelvis, stress distributions were concentrated on the junction between hemipelvic prosthesis and screw and iliac bone on the resected side, and between femoral prosthesis stem and femoral bulb, while the stress of polyethylene lining was small. Before impact, the polyethylene lining will rotate at a small angle, about 3°. The inner stress of polyethylene liner is greater than the outer stress in all conditions. The polyethylene liner has no tendency to slide out. CONCLUSION Pelvic tumor resection and reconstruction using 3D-printed hemipelvic prosthesis combined with dual mobility bearing was an effective treatment for pelvic tumors. Our patients achieved good early postoperative efficacy and functional recovery. The dual mobility bearing is beneficial to prevent dislocation, and the mechanical distribution and wear of the prosthesis are acceptable.
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Affiliation(s)
- Miao Wang
- Department of Orthopedics, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai, 200433, People's Republic of China.,Department of Orthopedics, The Third Affiliated Hospital, Naval Medical University (Second Military Medical University), 700 North Moyu Road, Jiading District, Shanghai, 201805, People's Republic of China
| | - Tianze Liu
- Department of Orthopedics, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai, 200433, People's Republic of China
| | - Changli Xu
- Department of Orthopedics, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai, 200433, People's Republic of China
| | - Chang Liu
- Department of Orthopedics, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai, 200433, People's Republic of China. .,Department of Orthopedics, The 900th Hospital of Joint Logistic Support Force, 156 North Xi-er Huan Road, Gulou District, Fuzhou, 350025, Fujian, People's Republic of China.
| | - Bo Li
- Department of Orthopedics, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai, 200433, People's Republic of China
| | - Qiujian Lian
- Department of Orthopedics, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai, 200433, People's Republic of China
| | - Tongjiang Chen
- Department of Orthopedics, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai, 200433, People's Republic of China
| | - Suchi Qiao
- Department of Orthopedics, The Third Affiliated Hospital, Naval Medical University (Second Military Medical University), 700 North Moyu Road, Jiading District, Shanghai, 201805, People's Republic of China.
| | - Zhiwei Wang
- Department of Orthopedics, The Third Affiliated Hospital, Naval Medical University (Second Military Medical University), 700 North Moyu Road, Jiading District, Shanghai, 201805, People's Republic of China.
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Clinical Outcome and Fracture Risk Prediction of Benign Bone Tumors on the Acetabular Dome: 7-Year Clinical Experience and a Finite Element Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:5150474. [PMID: 35321500 PMCID: PMC8938047 DOI: 10.1155/2022/5150474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/05/2022] [Accepted: 02/17/2022] [Indexed: 02/05/2023]
Abstract
The treatment of benign pelvic lesions and tumors is still a challenge in clinical orthopedics. The surgical procedure was complicated and the postoperative complication was hard to avoid usually. The purpose of this study is to analyze the clinical outcome and predict the fracture risk of benign bone tumors on acetabular dome by finite element analysis. In our research, clinical data of 25 patients were collected from January 2010 to January 2017, including basic information of patients, reconstruction methods, complications, and postoperative MSTS function scores. Finite element analysis (FEA) was used to predict the fracture risk when a benign tumor involved an acetabular dome. 25 patients were followed up for 37.5 ± 5.6 (ranging from 24 to 78) months. Intraoperative bleeding was 100–3000 ml (mean 858.3 ml). The postoperative MSTS93 score was 19.61 ± 7.32 before operation and 26.28 ± 15.59 at the last follow-up. The results of finite element analysis suggest that there was a high risk for pathological fracture in the following: both columns were damaged by tumors; the anterior column and 50% of the posterior column were affected. Other cases were in the low fracture risk group. Based on this study, we believe that, according to the risk assessment results of tumor cavity fracture suggested by the FEA results, combined with the nature of tumor, it may become a useful tool which is a great significance to guide the operation plan, select the operation time, and guide the postoperative functional exercise.
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Complex Bone Tumors of the Trunk-The Role of 3D Printing and Navigation in Tumor Orthopedics: A Case Series and Review of the Literature. J Pers Med 2021; 11:jpm11060517. [PMID: 34200075 PMCID: PMC8228871 DOI: 10.3390/jpm11060517] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 02/07/2023] Open
Abstract
The combination of 3D printing and navigation promises improvements in surgical procedures and outcomes for complex bone tumor resection of the trunk, but its features have rarely been described in the literature. Five patients with trunk tumors were surgically treated in our institution using a combination of 3D printing and navigation. The main process includes segmentation, virtual modeling and build preparation, as well as quality assessment. Tumor resection was performed with navigated instruments. Preoperative planning supported clear margin multiplanar resections with intraoperatively adaptable real-time visualization of navigated instruments. The follow-up ranged from 2–15 months with a good functional result. The present results and the review of the current literature reflect the trend and the diverse applications of 3D printing in the medical field. 3D printing at hospital sites is often not standardized, but regulatory aspects may serve as disincentives. However, 3D printing has an increasing impact on precision medicine, and we are convinced that our process represents a valuable contribution in the context of patient-centered individual care.
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Wang J, Min L, Lu M, Zhang Y, Lin J, Luo Y, Zhou Y, Tu C. Three-dimensional-printed custom-made hemipelvic endoprosthesis for the revision of the aseptic loosening and fracture of modular hemipelvic endoprosthesis: a pilot study. BMC Surg 2021; 21:262. [PMID: 34039325 PMCID: PMC8157625 DOI: 10.1186/s12893-021-01257-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 05/18/2021] [Indexed: 02/08/2023] Open
Abstract
Background The aims of this pilot study were (1) to assess the efficacy of 3D-printed custom-made hemipelvic endoprosthesis in restoring the natural location of acetabulum for normal bodyweight transmission; (2) to evaluate the short-term function of the revision with this endoprosthesis and (3) to identify short-term complications associated with the use of this endoprosthesis. Methods Between February 2017 and December 2017, seven patients received revision with 3D-printed custom-made hemipelvic endoprosthesis. The body weight moment arm (BWMA) and cup height discrepancy (CHD) after primary and revisional surgery were analyzed to assess acetabulum location with plain radiography. After a median follow-up duration of 29 months (range 24–34), the function was evaluated with the Musculoskeletal Tumor Society (MSTS-93) score and Harris hip score (HHS). Complications were recorded by chart review. Results The acetabulum locations were deemed reasonable, as evaluated by median BWMA (primary vs. revision, 10 cm vs. 10 cm) and median CHD (primary vs. revision, 10 mm vs. 8 mm). The median MSTS-93 score and HHS score were 21 (range 18–23) and 78 (range 75–82) after the revision. No short or mid-term complication was observed in the follow-up of this series. Conclusions Revision with 3D-printed custom-made hemipelvic endoprostheses benefited in reconstructing stable pelvic ring and natural bodyweight transmission for patients encountering the aseptic loosening and fracture of modular hemipelvic endoprosthesis. The revision surgery and appropriate rehabilitation program improved patients’ function to a median MSTS score of 22 and pain-free ambulation. The incidence of the complications was low via this individualized workflow.
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Affiliation(s)
- Jie Wang
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, People's Republic of China.,Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Li Min
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, People's Republic of China.,Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Minxun Lu
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, People's Republic of China.,Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yuqi Zhang
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, People's Republic of China.,Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jingqi Lin
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, People's Republic of China
| | - Yi Luo
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, People's Republic of China.,Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yong Zhou
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, People's Republic of China.,Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Chongqi Tu
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, People's Republic of China. .,Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
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Yu Z, Zhang W, Fang X, Tu C, Duan H. Pelvic Reconstruction With a Novel Three-Dimensional-Printed, Multimodality Imaging Based Endoprosthesis Following Enneking Type I + IV Resection. Front Oncol 2021; 11:629582. [PMID: 33928025 PMCID: PMC8078592 DOI: 10.3389/fonc.2021.629582] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 03/18/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND PURPOSE Pelvic tumor involving Type I + IV resections are technically challenging, along with various reconstructions methods presenting unsatisfactory outcomes and high complication rates. Since predominating studies preferred adopting pedicle screw-rod system (PRSS) to address this issue, we designed a novel three-dimensional-printed, multimodality imaging (3DMMI) based endoprosthesis with patient-specific instrument (PSI) assistance to facilitate the surgical reconstruction of pelvic tumor involving Enneking Type I + IV resection. We aimed to investigate the clinical effectiveness of this novel endoprosthesis and compare it with PRSS in Type I + IV reconstruction. METHODS We retrospective studied 28 patients for a median follow-up of 47 months (range, 10 to 128 months) in this study with either 3D-printed endoprosthesis reconstruction (n = 10) or PRSS reconstruction (n = 18) between January 2000 and December 2017. Preoperative 3DMMI technique was used for tumor evaluation, PSI design, virtual surgery, and endoprosthesis fabrication. Clinical, oncological outcomes, functional assessments, and complications were analyzed between the two groups. RESULTS Minor surgical trauma with mean operative duration of 251 ± 52.16 minutes (p = 0.034) and median intraoperative hemorrhage of 2000ml (range, 1600, 4000ml) (p = 0.032) was observed in endoprosthesis group. Wide margins were achieved in 9 patients of the endoprosthesis group compared with 10 in the PRSS group (p = 0.09). The 1993 version of the Musculoskeletal Tumor Society score (MSTS-93) was 23.9 ± 3.76 in endoprosthesis group, which was higher than PRSS group (p = 0.012). No statistical significance was found in relapse between two groups (p = 0.36). Complications were observed in two patients in endoprosthesis group compared with 12 patients in PRSS group (p = 0.046). CONCLUSION The novel design of this 3D-printed endoprosthesis, together with 3DMMI and PSI assisted, is technically accessible with favorable clinical outcomes compared with PRSS. Further study is essential to identify its long-term outcomes.
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Affiliation(s)
| | | | | | | | - Hong Duan
- West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
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Wang B, Sun P, Yao H, Tu J, Xie X, Ouyang J, Shen J. Modular hemipelvic endoprosthesis with a sacral hook: a finite element study. J Orthop Surg Res 2019; 14:309. [PMID: 31511034 PMCID: PMC6739965 DOI: 10.1186/s13018-019-1338-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 08/19/2019] [Indexed: 12/02/2022] Open
Abstract
Background A novel hemipelvic endoprosthesis with a sacral hook was introduced previously, and its clinical outcome with midterm follow-up showed decreased prosthesis-related complications, especially decreased rate of aseptic loosening. The aim of present study was to evaluate the role of a sacral hook in prosthesis stability and the biomechanical properties of this hemipelvic endoprosthesis. Methods A three-dimensional model of the postoperative pelvis was developed using computed tomography (CT) images. A force of 500 N was applied, and the distribution of stress and displacement was evaluated. Comparisons were performed to explore the role of the sacral hook in prosthesis stability. Prosthesis improvement was simulated to reduce unexpected breakage of the pubic connection plate. Results In the reconstructed hemipelvis, stress distributions were concentrated on the superior area of the acetabulum, sacral connection component, and sacral hook. A maximum stress of 250 MPa was observed at the root of the sacral connection component. The sacral hook reduced the maximum stress and displacement by 14.1% and 32.5%, respectively, when the prosthesis was well fixed and by 10.0% and 42.1%, respectively, when aseptic loosening occurred. Increasing the thickness of the pubic connection plate from 2 to 3.5 mm reduced the maximum stress by 32.0% and 15.8%, respectively. Conclusion A hemipelvic endoprosthesis with a sacral hook fulfills the biomechanical demands of the hemipelvis and is safe under static conditions. The sacral hook is important for prosthesis stability. Increasing the thickness of the pubic connection plate can reduce the maximum stress and risk of fatigue breakage.
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Affiliation(s)
- Bo Wang
- Department of Musculoskeletal Oncology, The First Affiliated Hospital of Sun Yat-Sen University, 58#, Zhongshan Road II, Guangzhou, 510080, Guangdong, China
| | - Peidong Sun
- Medical Biomechanical Key Laboratory of Guangdong Province, Department of Anatomy, Southern Medical University, Tonghe, Guangzhou, 510515, Guangdong, China
| | - Hao Yao
- Department of Musculoskeletal Oncology, The First Affiliated Hospital of Sun Yat-Sen University, 58#, Zhongshan Road II, Guangzhou, 510080, Guangdong, China
| | - Jian Tu
- Department of Musculoskeletal Oncology, The First Affiliated Hospital of Sun Yat-Sen University, 58#, Zhongshan Road II, Guangzhou, 510080, Guangdong, China
| | - Xianbiao Xie
- Department of Musculoskeletal Oncology, The First Affiliated Hospital of Sun Yat-Sen University, 58#, Zhongshan Road II, Guangzhou, 510080, Guangdong, China
| | - Jun Ouyang
- Medical Biomechanical Key Laboratory of Guangdong Province, Department of Anatomy, Southern Medical University, Tonghe, Guangzhou, 510515, Guangdong, China.
| | - Jingnan Shen
- Department of Musculoskeletal Oncology, The First Affiliated Hospital of Sun Yat-Sen University, 58#, Zhongshan Road II, Guangzhou, 510080, Guangdong, China.
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Wang B, Zou C, Hu X, Tu J, Yao H, Yin J, Huang G, Xie X, Shen J. Reconstruction with a novel combined hemipelvic endoprosthesis after resection of periacetabular tumors involving the sacroiliac joint: a report of 25 consecutive cases. BMC Cancer 2019; 19:861. [PMID: 31470808 PMCID: PMC6716888 DOI: 10.1186/s12885-019-6049-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 08/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Our purpose was to examine the outcomes of patients who underwent extensive resection of periacetabular tumors involving the sacroiliac joint and joint reconstruction with a hemipelvic endoprosthesis. METHODS The records of 25 consecutive patients diagnosed with Enneking type I/II/IV pelvic tumors from 2010 to 2016 who received resection and hemipelvic endoprosthesis reconstruction were retrospectively reviewed. RESULTS The median follow-up period was 48 months. At the most recent follow-up, 11 patients were alive, with estimated 3- and 5-year survival rates of 45.6 and 38.0%, respectively. Fourteen patients died, with a mean survival of 20.8 months, and 8 patients had local recurrence at an average of 9.3 months after surgery. Distal metastases were detected in 11 patients at an average of 11.0 months after surgery. The total complication rate was 56.0%, and the most common complications were wound healing disturbances (28.0%) and deep infections (16.0%). The prosthesis-related complication rate was 24.0%; periprosthetic infections and aseptic loosening were most common. The estimated 1- and 3-year prosthesis survival rates were 81.2 and 63.2%, respectively. The mean Musculoskeletal Tumor Society score was 48.0%. Function and prosthesis-related complications did not differ significantly after adding an extra screw fixation to the first sacral vertebra. CONCLUSIONS Reconstruction with the hemipelvic endoprosthesis described herein provides satisfactory function with a relatively low complication rate. Adding an extra screw fixation to the first sacral vertebra was not associated with any improvement in the clinical results after short-term follow-up. Improvement and further studies of this endoprosthesis are needed.
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Affiliation(s)
- Bo Wang
- Department of Musculoskeletal Oncology, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Second Road, Guangzhou, Guangdong, China
| | - Changye Zou
- Department of Musculoskeletal Oncology, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Second Road, Guangzhou, Guangdong, China
| | - Xiaokun Hu
- Reproductive Medicine Center, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Second Road, Guangzhou, Guangdong, China
| | - Jian Tu
- Department of Musculoskeletal Oncology, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Second Road, Guangzhou, Guangdong, China
| | - Hao Yao
- Department of Musculoskeletal Oncology, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Second Road, Guangzhou, Guangdong, China
| | - Junqiang Yin
- Department of Musculoskeletal Oncology, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Second Road, Guangzhou, Guangdong, China
| | - Gang Huang
- Department of Musculoskeletal Oncology, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Second Road, Guangzhou, Guangdong, China
| | - Xianbiao Xie
- Department of Musculoskeletal Oncology, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Second Road, Guangzhou, Guangdong, China.
| | - Jingnan Shen
- Department of Musculoskeletal Oncology, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Second Road, Guangzhou, Guangdong, China.
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Abstract
Tumour endoprostheses have facilitated limb-salvage procedures in primary bone and soft tissue sarcomas, and are increasingly being used in symptomatic metastases of the long bones. The objective of the present review was to analyse articles published over the last three years on tumour endoprostheses and to summarize current knowledge on this topic. The NCBI PubMed webpage was used to identify original articles published between January 2015 and April 2018 in journals with an impact factor in the top 25.9% of the respective category (orthopaedics, multidisciplinary sciences). The following search-terms were used: tumour endoprosthesis, advances tumour endoprosthesis, tumour megaprosthesis, prosthetic reconstruction AND tumour. We identified 347 original articles, of which 53 complied with the abovementioned criteria. Articles were categorized into (1) tumour endoprostheses in the shoulder girdle, (2) tumour endoprostheses in the proximal femur, (3) tumour endoprostheses of the knee region, (4) tumour endoprostheses in the pelvis, (5) (expandable) prostheses in children and (6) long-term results of tumour endoprostheses. The topics of interest covered by the selected studies largely matched with the main research questions stated at a consensus meeting, with survival outcome of orthopaedic implants being the most commonly raised research question. As many studies reported on the risk of deep infections, research in the future should also focus on potential preventive methods in endoprosthetic tumour reconstruction.
Cite this article: EFORT Open Rev 2019;4:445-459. DOI: 10.1302/2058-5241.4.180081
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Affiliation(s)
- Maria A Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Austria
| | - Dimosthenis Andreou
- Department of General Orthopaedics and Tumour Orthopaedics, University Hospital Muenster, Germany
| | - Per-Ulf Tunn
- Tumour Orthopaedics, HELIOS Klinikum Berlin-Buch, Germany
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Austria
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11
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Lin P, Shao Y, Lu H, Zhang Z, Lin H, Wang S, Li B, Li H, Wang Z, Lin N, Ye Z. Pelvic reconstruction with different rod-screw systems following Enneking type I/I + IV resection: a clinical study. Oncotarget 2018; 8:38978-38989. [PMID: 28465495 PMCID: PMC5503588 DOI: 10.18632/oncotarget.17164] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 04/03/2017] [Indexed: 11/29/2022] Open
Abstract
The mechanical outcomes of patients with pelvic bone tumors involving zone I or zone I + IV who received resection and different reconstructions are not clear. Therefore, the purpose of this study was to compare the outcomes of different rod-screw systems in reconstruction for these patients, and evaluate the relative risk of mechanical failure for them. We reviewed 30 patients for a mean duration of 40.4 months of follow-up (range, 13.1–162.2 months), five patients had mechanical complications. The mechanical survival rate of two-rod and four-screw (TRFS) group was significantly higher than one-rod and two-screw (ORTS) group (p = 0.000). The implant survival rate was correlated with ages (p = 0.010), younger people are more likely to fail. Thus, TRFS fixation for pelvic reconstruction after Enneking type I/I + IV resection can provide better short to long-term mechanical stability compared with ORTS fixation, the strength of ORTS fixation is not enough. In addition, biological reconstruction such as autologous bone graft is recommended for the patients who are younger or suffered from benign tumor. As for the patients who are older, with malignant tumors, underwent adjuvant radiotherapy or chemotherapy, functional reconstruction with bone cement is a good choice.
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Affiliation(s)
- Peng Lin
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine/Orthopedics Research Institute of Zhejiang University, Hangzhou 310009, China.,Department of Orthopaedics, Taizhou Hospital of Zhejiang Province, Linhai 317000, China
| | - Youyou Shao
- Department of Pediatric Pulmonology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Huigen Lu
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine/Orthopedics Research Institute of Zhejiang University, Hangzhou 310009, China.,Department of Orthopaedics, The Second Hospital of Jiaxing, Jiaxing 314000, China
| | - Zhengliang Zhang
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine/Orthopedics Research Institute of Zhejiang University, Hangzhou 310009, China.,Department of Orthopaedics, Dongyang People's Hospital, Jinhua 322100, China
| | - Haiqing Lin
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine/Orthopedics Research Institute of Zhejiang University, Hangzhou 310009, China.,Department of Orthopaedics, The Second Hospital of Jiaxing, Jiaxing 314000, China
| | - Shengdong Wang
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine/Orthopedics Research Institute of Zhejiang University, Hangzhou 310009, China
| | - Binghao Li
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine/Orthopedics Research Institute of Zhejiang University, Hangzhou 310009, China
| | - Hengyuan Li
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine/Orthopedics Research Institute of Zhejiang University, Hangzhou 310009, China
| | - Zhan Wang
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine/Orthopedics Research Institute of Zhejiang University, Hangzhou 310009, China
| | - Nong Lin
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine/Orthopedics Research Institute of Zhejiang University, Hangzhou 310009, China
| | - Zhaoming Ye
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine/Orthopedics Research Institute of Zhejiang University, Hangzhou 310009, China
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12
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Iqbal T, Shi L, Wang L, Liu Y, Li D, Qin M, Jin Z. Development of finite element model for customized prostheses design for patient with pelvic bone tumor. Proc Inst Mech Eng H 2018. [PMID: 28639517 DOI: 10.1177/0954411917692009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to design a hemi-pelvic prosthesis for a patient affected by pelvic sarcoma. To investigate the biomechanical functionality of the pelvis reconstructed with designed custom-made prosthesis, a patient-specific finite element model of whole pelvis with primary ligaments inclusive was constructed based on the computed tomography images of the patient. Then, a finite element analysis was performed to calculate and compare the stress distribution between the normal and implanted pelvis models when undergoing three different static conditions-both-leg standing, single-leg standing for the healthy and the affected one. No significant differences were observed in the stresses between the normal and reconstructed pelvis for both-leg standing, but 20%-40% larger stresses were predicted for the peak stress of the single-leg standing (affected side). Moreover, two- to threefold of peak stresses were predicted within the prostheses compared to that of the normal pelvis especially for single-leg standing case, however, still below the allowable fatigue limitation. The study on the load transmission functionality of prosthesis indicated that it is crucial to carry out finite element analysis for functional evaluation of the designed customized prostheses before three-dimensional printing manufacturing, allowing better understanding of the possible peak stresses within the bone as well as the implants for safety precaution. The finite element model can be equally applicable to other bone tumor model for biomechanical studying.
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Affiliation(s)
- Taimoor Iqbal
- 1 State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Lei Shi
- 2 Department of Orthopedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Ling Wang
- 1 State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Yaxiong Liu
- 1 State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Dichen Li
- 1 State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Mian Qin
- 1 State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Zhongmin Jin
- 1 State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China.,3 Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
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13
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Baimagambetov SA, Balgazarov SS, Ramazanov ZK, Belan YA, Abilov RS, Dolgov AA, Balgazarov AS. Paraprosthetic Complications After Endoprosthesis Replacement of Pelvis Joint with Implants. J Natl Med Assoc 2017; 110:231-241. [PMID: 29778124 DOI: 10.1016/j.jnma.2017.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 04/17/2017] [Accepted: 05/12/2017] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of the paper is shaping of ideas about possible ways of decreasing complications of the analyzed types of operations and identification of opportunities of the impact on the socio-economic environment among the Afro-American population of USA. The paper demonstrates that the issue of coxofemoral prosthesis is not only a purely medical but also a social problem. In particular, availability of timely aid, as well as insurance in the form of surgery, refer to relevance of the range of problems. METHODOLOGY The experimental method was used in the study. Patients were implanted different types of endoprostheses. 90 patients were implanted customized endoprostheses, 27 patients were implanted foreign module endoprostheses. The research subject is prediction of complications after endoprosthesis replacement surgeries depending on methods, types and forms. RESULTS As a result, we can see that available health insurance is more acceptable understanding of the need for endoprosthesis replacement. Post-operative care issues fall into the range of social policy problems. A comparative aspect of a country with general insurance and differentiated coverage among the Afro-America population appears innovative. CONCLUSIONS In the context of the current situation it can be concluded that surgery is the last stage for already established support system of the population. For this reason, it's worth mentioning that state bodies of the U.S. should put a greater emphasis on the health care of the Afro-American population.
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Affiliation(s)
| | - Serik S Balgazarov
- Research Institute of Traumatology and Orthopedics, Ablay khan Street 15A, 010000, Astana, Kazakhstan
| | - Zhanatay K Ramazanov
- Research Institute of Traumatology and Orthopedics, Ablay khan Street 15A, 010000, Astana, Kazakhstan
| | - Yelena A Belan
- Research Institute of Traumatology and Orthopedics, Ablay khan Street 15A, 010000, Astana, Kazakhstan
| | - Ruslan S Abilov
- Research Institute of Traumatology and Orthopedics, Ablay khan Street 15A, 010000, Astana, Kazakhstan
| | - Alexey A Dolgov
- Research Institute of Traumatology and Orthopedics, Ablay khan Street 15A, 010000, Astana, Kazakhstan
| | - Amangol S Balgazarov
- Research Institute of Traumatology and Orthopedics, Ablay khan Street 15A, 010000, Astana, Kazakhstan
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14
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Liang H, Li D, Guo W, Yang R, Tang X. Lateral lumbar vertebral body screw predisposes to neuralgia after limb-salvage surgery for pelvic tumors: a single-center, retrospective study of 349 cases. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:4094-4102. [DOI: 10.1007/s00586-016-4685-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 06/20/2016] [Accepted: 06/28/2016] [Indexed: 11/28/2022]
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