Pelvic-girdle reconstruction with three-dimensional-printed endoprostheses after limb-salvage surgery for pelvic sarcomas: current landscape

Clinical Application of 3D-Printed Custom Hemipelvic Prostheses With Negative Poisson's Ratio Porous Structures in Reconstruction After Resection of Pelvic Malignant Tumors

OBJECTIVES

Pelvic bone tumor resection and reconstruction present significant challenges due to complex anatomy and weight-bearing demands. 3D-printed hemipelvic prostheses, incorporating customized osteotomy guides and porous structures, offer a promising solution for enhancing osseointegration. This study evaluates the long-term outcomes of 3D-printed custom hemipelvic reconstruction with a focus on the integration of auxetic biomaterials with a negative Poisson's ratio to optimize mechanical properties.

METHODS

A retrospective analysis was conducted on 12 patients with primary pelvic malignancies who underwent reconstruction using 3D-printed hemipelvic prostheses between January 2018 and May 2023. Follow-up duration was 48 months (range, 29-64 months) Oncological, functional, surgical, pain control, and radiographic outcomes were assessed.

RESULTS

At the latest follow-up, 8 patients (66.7%) were disease-free, 3 (25%) had disease progression, and 1 (8.3%) died from metastatic complications. Functional outcomes improved significantly, with the MSTS-93 score increasing from 15 (range, 12-17) to 26 (range, 21-29). Pain scores decreased from 5 (range, 4-7) to 1 (range, 0-2). The median surgical duration was 270 min (range, 150-560 min), with intraoperative blood loss averaging 3200 mL (range, 1900-6300 mL). Complications included poor wound healing in 2 patients (16.7%), managed with VAC drainage. No mechanical failures, loosening, or fractures occurred. Accurate osteotomy, prosthesis implantation, and screw fixation were achieved. Successful osseointegration was observed in all cases, with no signs of bone absorption or osteolysis.

CONCLUSIONS

3D-printed custom hemipelvic prostheses with auxetic biomaterials offer an effective solution for pelvic reconstruction, providing promising oncological, functional, and radiographic outcomes. These findings support the use of 3D printing in complex pelvic defect reconstruction, optimizing both osteointegration and mechanical strength.

Causal effects of metabolites on malignant neoplasm of bone and articular cartilage: a mendelian randomization study

Objective

Previous research has demonstrated that metabolites play a significant role in modulating disease phenotypes; nevertheless, the causal association between metabolites and malignant malignancies of bones and joint cartilage (MNBAC)has not been fully elucidated.

Methods

This study used two-sample Mendelian randomization (MR) to explore the causal correlation between 1,400 metabolites and MNBAC. Data from recent genome-wide association studies (GWAS) involving 8,299 individuals were summarized. The GWAS summary data for metabolites were acquired from the IEU Open GWAS database, while those for MNBAC were contributed by the Finnish Consortium. We employed eight distinct MR methodologies: simple mode, maximum likelihood estimator, MR robust adjusted profile score, MR-Egger, weighted mode, weighted median, MR-PRESSO and inverse variance weighted to scrutinize the causal association between metabolites engendered by each gene and MNBAC. Consequently, we evaluated outliers, horizontal pleiotropy, heterogeneity, the impact of single nucleotide polymorphisms (SNPs), and adherence to the normal distribution assumption in the MR analysis.

Results

Our findings suggested a plausible causative relationship between N-Formylmethionine (FMet) levels, lignoceroylcarnitine (C24) levels, and MNBAC. We observed a nearly significant causal association between FMet levels and MNBAC within the cohort of 1,400 metabolites (P = 0.024, odds ratio (OR) = 3.22; 95% CI [1.16-8.92]). Moreover, we ascertained a significant causal link between levels of C24 and MNBAC (P = 0.0009; OR = 0.420; 95%CI [0.25-0.70]). These results indicate a potential causative relationship between FMet, C24 level and MNBAC.

Conclusion

The occurrence of MNBAC may be causally related to metabolites. This might unveil new possibilities for investigating early detection and treatment of MNBAC.

Reconstruction of Internal Hemipelvectomy Defects After Oncologic Resection

Internal hemipelvectomy is preferred to hindquarter amputation for pelvic tumor resection if a functional lower extremity can be obtained without compromising oncologic principles; multidisciplinary advances in orthopaedic and plastic surgery reconstruction have made this possible. The goals of skeletal reconstruction are restoration of pelvic and spinopelvic skeletal continuity, maintenance of limb length, and creation of a functional hip joint. The goals of soft-tissue reconstruction are stable coverage of skeletal, prosthetic, and neurovascular structures, elimination of dead space, and prevention of herniation. Pelvic resections are divided into four types: type I (ilium), type II (acetabulum), type III (ischiopubic rami), and type IV (sacrum). Type I and IV resections resulting in pelvic discontinuity are often reconstructed with vascularized bone flaps and instrumentation. Type II resections, which traditionally result in the greatest functional morbidity, are often reconstructed with hip transposition, allograft, prosthesis, and allograft-prosthetic composites. Type III resections require soft-tissue repair, sometimes with flaps and mesh, but generally no skeletal reconstruction. Extension of resection into the sacrum can result in additional skeletal instability, neurologic deficit, and soft-tissue insufficiency, necessitating a robust reconstructive strategy. Internal hemipelvectomy creates complex deficits that often require advanced multidisciplinary reconstructions to optimize outcomes and minimize complications.

Exploring the optimal reconstruction strategy for Enneking III defects in pelvis bone tumors: a finite element analysis

BACKGROUND

Controversy exists regarding the reconstruction of bone defects in Enneking III. This study aimed to use the finite element analysis (FEA) method to clarify (1) the utility of reconstructing the pelvis Enneking III region and (2) the optimal approach for this reconstruction.

METHODS

FEA models were generated for three types of Enneking III defects in the pelvis, replacing all the defect areas in region III with a sizable solid box for topology optimization (TO). Based on the defect location and TO results, three reconstruction schemes were designed for each type of defect. We subsequently conducted simulations of static FEA under natural walking loads using ANSYS software (version 2022R1, Canonsburg, Pennsylvania, USA).

RESULTS

Compared with Scheme A, reconstruction of the Enneking III region (Schemes B and C) led to a more uniform stress distribution and lower peak stress in the pelvis. Moreover, prostheses and screws exhibit decreased peak stress and deformation, with complex reconstruction schemes (C) outperforming simpler ones (B).

CONCLUSIONS

The FEA results suggest that reconstructing Enneking Zone III defects improves stress distribution and reduces peak stress in the pelvis compared to non-reconstruction, potentially enhancing stability and reducing fracture risks. Complex reconstruction schemes involving more contralateral pelvis regions demonstrate superior biomechanical performance. However, clinical decisions should be individualized, integrating biomechanical insights with comprehensive patient-specific factors.

Three-Dimensional Printed Prosthesis Reconstructs Bilateral Type III Pelvic Defect After Malignant Tumors Resection

OBJECTIVE

Type III hemipelvectomy and reconstruction are challenging. Several reconstruction options, including autologous soft tissue, prosthesis patch, autologous, or allograft, were reported, but a variety of shortcomings limited their application. Three-dimensional (3D)-printed prosthesis was designed to reconstruct the unilateral Type III pelvic defect and had favorable clinical outcomes. However, the reconstruction method for bilateral Type III pelvic defect was few reported. This study aims to design a bilateral pubis prosthesis and evaluate the early clinical outcomes and complications.

METHODS

We retrospectively collected patients receiving 3D-printed bilateral pubis prosthesis reconstruction after malignant tumor resection between 2017 and 2021. Demographics, anatomic data, operation time, blood loss, and clinical outcomes of patients were analyzed. The Musculoskeletal Tumor Society-93 (MSTS-93) score was performed to evaluate the function and complications were recorded.

RESULTS

Four patients, including three for females and one for males, were enrolled in this study. Prosthesis was designed according to the pelvic anatomical data. The mean operation time and blood loss were 308.8 min (range, 240-400 min) and 655 mL (range, 400-1100 mL), respectively. The average follow-up was 15.5 months (range, 12-16 months). The mean MSTS was 28.5 (28-29). One patient had incision necrosis postoperatively. No hernia, prosthesis displacement, or implant failure occurred during follow-up. Four patients with 15 interfaces showed good osteointegration.

CONCLUSIONS

3D-printed bilateral pubis prosthesis could restore the integrity and stability of pelvic ring and improve limb function. Meanwhile, this reconstruction option provided a rigid bony-soft support to prevent the development of hernia. In all, 3D-printed bilateral pubis prosthesis is recommended to be a favorable selection for Type III pelvic defect reconstruction.

Design, characterisation, and clinical evaluation of a novel porous Ti-6Al-4V hemipelvic prosthesis based on Voronoi diagram

Three-dimensional printed Ti-6Al-4V hemipelvic prosthesis has become a current popular method for pelvic defect reconstruction. This paper presents a novel biomimetic hemipelvic prosthesis design that utilises patient-specific anatomical data in conjunction with the Voronoi diagram algorithm. Unlike traditional design methods that rely on fixed, homogeneous unit cell, the Voronoi diagram enables to create imitation of trabecular structure (ITS). The proposed approach was conducted for six patients. The entire contour of the customised prosthesis matched well with the residual bone. The porosity and pore size of the ITS were evaluated. The distribution of the pore size ranged from 500 to 1400 μm. Porosity calculations indicated the average porosity was 63.13 ± 0.30%. Cubic ITS samples were fabricated for micrograph and mechanical analysis. Scanning electron microscopy images of the ITS samples exhibited rough surface morphology without obvious defects. The Young's modulus and compressive strength were 1.68 ± 0.05 GPa and 174 ± 8 MPa, respectively. Post-operative X-rays confirmed proper matching of the customised prostheses with the bone defect. Tomosynthesis-Shimadzu metal artifact reduction technology images indicated close contact between the implant and host bone, alongside favourable bone density and absence of resorption or osteolysis around the implant. At the last follow-up, the average Musculoskeletal Tumour Society score was 23.2 (range, 21-26). By leveraging additive manufacturing and Voronoi diagram algorithm, customised implants tailored to individual patient anatomy can be fabricated, offering wide distribution of the pore size, reasonable mechanical properties, favourable osseointegration, and satisfactory function.

Short-to-Mid-Term Outcomes of Ipsilateral Femoral Head Autograft Combined with Uncemented Total Hip Replacement for Partial Periacetabular Defects Following Tumor Resection

OBJECTIVE

Periacetabular tumors, especially in young to middle-aged patients with invasive benign tumors or low-grade malignant tumors involving type II or II + III, present significant challenges due to their rarity and the complexity of the anatomical and biomechanical structures involved. The primary difficulty lies in balancing the need to avoid unfavorable oncological outcomes while maintaining postoperative hip joint function during surgical resection. This study aimed to evaluate the effectiveness and reliability of a surgical method involving partial weight-bearing acetabular preservation combined with the use of an uncontaminated femoral head autograft to reconstruct the segmental bone defect after intra-articular resection of the tumorous joint, providing a solution that ensures both oncological safety and functional preservation of the hip joint in these patients.

METHODS

We conducted a retrospective study with a follow-up period of at least 36 months. From January 2010 to October 2020, we reviewed 20 cases of patients under 60 year of age with periacetabular invasive benign tumors or primary low-grade malignant tumors. All patients underwent reconstruction of the tumorous joint using autologous femoral head grafts. Data collected included patient age, gender, tumor type, preoperative and postoperative visual analog scale (VAS) scores, Musculoskeletal Tumor Society (MSTS) scores, Harris Hip Scores (HHS), patient survival rates, postoperative tumor recurrence, and surgical complications. To analyze the data, we utilized various statistical methods, including descriptive statistics to summarize patient demographics and clinical characteristics, and paired sample t-tests to compare preoperative and postoperative scores.

RESULTS

The study included 20 patients, and a total median follow-up was 83 months. Their pathologic diagnoses comprised 13 giant cell tumors (GCTs), 5 chondrosarcomas, one chondroblastoma, and 1 leiomyosarcoma. Postoperatively, the median differences in vertical and horizontal center of rotation (COR) were 3.8 and 4.0 mm. Median limb length discrepancy (LLD) postoperatively was 5.7 mm (range, 2.3-17.8 mm). Two patients (10%) experienced delayed wound healing, resolved with antibiotics and early surgical debridement. One patient experienced dislocation 3 months postoperatively, which was promptly addressed under general anesthesia without further dislocation.

CONCLUSION

Through multiplanar osteotomy with limited margins, femoral head autograft, and uncemented total hip replacement for pelvic segmental bone defects in selected patients in type II or II + III appears to be an encouraging limb-sparing surgery worthy of consideration for carefully selected patients.

Case report: Individualized 3D-printed uncemented distal fibular prosthesis preserving the lateral malleolus for repair of distal fibular defects

Background

Involvement of the distal fibula by alveolar soft-part sarcoma is rare. Extensive resection or amputation may be needed; however, distal fibula resection can disrupt foot and ankle biomechanics, leading to ankle joint instability. Reports on joint preservation for maintaining optimal ankle joint function are scarce. Computer-aided design and individualized three-dimensional (3D)-printed uncemented implants represent an evolving solution for reconstructing the distal fibula.

Case presentation

A 34-year-old woman was diagnosed with alveolar soft-part sarcoma in the right lower leg involving the cortical bone of the fibula. After anlotinib treatment, the tumor size decreased, and the tumor response rate was a partial response (PR); however, the patient continued to experience adverse reactions. With multiple disciplinary team discussions, surgical resection was deemed appropriate. Due to the extensive defect and ankle joint instability after resection, a custom-made 3D-printed prosthesis was designed and fabricated to reconstruct the defect, preserving the lateral malleolus. During the follow-up, the patient achieved favorable ankle function, and no prosthesis-related complications were observed.

Conclusion

3D-printed personalized uncemented implants constitute a novel approach and method for addressing the reconstruction issues of the distal fibula and ankle joint. Through the personalized design of 3D-printed prostheses, the lateral malleolus can be preserved, ensuring the normal anatomical structure of the ankle joint. They achieve a well-integrated interface between the prosthesis and bone, ensuring satisfactory postoperative function. Additionally, they offer valuable insights for reconstructing distal bone defects near joints in the extremities. However, confirming these findings requires extensive cohort studies.

Advanced Pelvic Girdle Reconstruction with three dimensional-printed Custom Hemipelvic Endoprostheses following Pelvic Tumour Resection

PURPOSE

Resection of pelvic bone tumours and subsequent pelvic girdle reconstruction pose formidable challenges due to the intricate anatomy, weight-bearing demands, and significant defects. 3D-printed implants have improved pelvic girdle reconstruction by enabling precise resections with customized guides, offering tailored solutions for diverse bone defect morphology, and integrating porous surface structures to promote osseointegration. Our study aims to evaluate the long-term efficacy and feasibility of 3D-printed hemipelvic reconstruction following resection of malignant pelvic tumours.

METHODS

A retrospective review was conducted on 96 patients with primary pelvic malignancies who underwent pelvic girdle reconstruction using 3D-printed custom hemipelvic endoprostheses between January 2017 and May 2022. Follow-up duration was median 48.1 ± 17.9 months (range, 6 to 76 months). Demographic data, imaging examinations, surgical outcomes, and oncological evaluations were extracted and analyzed. The primary endpoints included oncological outcomes and functional status assessed by the Musculoskeletal Tumor Society (MSTS-93) score. Secondary endpoints comprised surgical duration, intraoperative bleeding, pain control and complications.

RESULTS

In 96 patients, 70 patients (72.9%) remained disease-free, 15 (15.6%) had local recurrence, and 11 (11.4%) succumbed to metastatic disease. Postoperatively, function improved with MSTS-93 score increasing from 12.2 ± 2.0 to 23.8 ± 3.8. The mean operating time was 275.1 ± 94.0 min, and the mean intraoperative blood loss was 1896.9 ± 801.1 ml. Pain was well-managed, resulting in substantial improvements in VAS score (5.3 ± 1.8 to 1.4 ± 1.1). Complications occurred in 13 patients (13.5%), including poor wound healing (6.3%), deep prosthesis infection (4.2%), hip dislocation (2.1%), screw fracture (1.0%), and interface loosening (1.0%). Additionally, all patients achieved precise implantation of customized prosthetics according to preoperative plans. T-SMART revealed excellent integration at the prosthesis-bone interface for all patients.

CONCLUSION

The use of a 3D-printed custom hemipelvic endoprosthesis, characterized by anatomically designed contours and a porous biomimetic surface structure, offers a potential option for pelvic girdle reconstruction following internal hemipelvectomy in primary pelvic tumor treatment. Initial results demonstrate stable fixation and satisfactory mid-term functional and radiographic outcomes.

3D-Printed custom-made hemipelvic endoprosthetic reconstruction following periacetabular tumor resection: utilizing a novel classification system

BACKGROUND

Customized 3D-printed pelvic implants with a porous structure have revolutionized periacetabular pelvic defect reconstruction after tumor resection, offering improved osteointegration, long-term stability, and anatomical fit. However, the lack of an established classification system hampers implementation and progress.

METHODS

We formulated a novel classification system based on pelvic defect morphology and 3D-printed hemipelvis endoprostheses. It integrates surgical approach, osteotomy guide plate and prosthesis design, postoperative rehabilitation plans, and perioperative processes.

RESULTS

Retrospectively analyzing 60 patients (31 males, 29 females), we classified them into Type A (15 patients: Aa = 6, Ab = 9), Type B (27 patients: Ba = 15, Bb = 12), Type C (17 patients). All underwent customized osteotomy guide plate-assisted tumor resection and 3D-printed hemipelvic endoprosthesis reconstruction. Follow-up duration was median 36.5 ± 15.0 months (range, 6 to 74 months). The mean operating time was 430.0 ± 106.7 min, intraoperative blood loss 2018.3 ± 1305.6 ml, transfusion volume 2510.0 ± 1778.1 ml. Complications occurred in 13 patients (21.7%), including poor wound healing (10.0%), deep prosthesis infection (6.7%), hip dislocation (3.3%), screw fracture (1.7%), and interface loosening (1.7%). VAS score improved from 5.5 ± 1.4 to 1.7 ± 1.3, MSTS-93 score from 14.8 ± 2.5 to 23.0 ± 5.6. Implant osseointegration success rate was 98.5% (128/130), with one Type Ba patient experiencing distal prosthesis loosening.

CONCLUSION

The West China classification may supplement the Enneking and Dunham classification, enhancing interdisciplinary communication and surgical outcomes. However, further validation and wider adoption are required to confirm clinical effectiveness.

Biomechanical and clinical outcomes of 3D-printed versus modular hemipelvic prostheses for limb-salvage reconstruction following periacetabular tumor resection: a mid-term retrospective cohort study

BACKGROUND

Debates persist over optimal pelvic girdle reconstruction after acetabular tumor resection, with surgeons grappling between modular and 3D-printed hemipelvic endoprostheses. We hypothesize superior outcomes with 3D-printed versions, yet scarce comparative research exists. This study fills the gap, examining biomechanics and clinical results retrospectively.

METHODS

From February 2017 to June 2021, we retrospectively assessed 32 patients undergoing en bloc resection for malignant periacetabular tumors at a single institution.

PRIMARY OUTCOME

limb function.

SECONDARY OUTCOMES

implant precision, hip joint rotation center restoration, prosthesis-bone osteointegration, and complications. Biomechanical characteristics were evaluated through finite element analysis on pelvic defect models.

RESULTS

In the 3D-printed group, stress distribution mirrored a normal pelvis, contrasting the modular group with elevated overall stress, unstable transitions, and higher stress peaks. The 3D-printed group exhibited superior functional scores (MSTS: 24.3 ± 1.8 vs. 21.8 ± 2.0, p < 0.05; HHS: 79.8 ± 5.2 vs. 75.3 ± 3.5, p < 0.05). Prosthetic-bone interface osteointegration, measured by T-SMART, favored 3D-printed prostheses, but surgery time (426.2 ± 67.0 vs. 301.7 ± 48.6 min, p < 0.05) and blood loss (2121.1 ± 686.8 vs. 1600.0 ± 505.0 ml, p < 0.05) were higher.

CONCLUSIONS

The 3D-printed hemipelvic endoprosthesis offers precise pelvic ring defect matching, superior stress transmission, and function compared to modular endoprostheses. However, complexity, fabrication expertise, and challenging surgical implantation result in prolonged operation times and increased blood loss. A nuanced consideration of functional outcomes, complexity, and patient conditions is crucial for informed treatment decisions.

LEVEL OF EVIDENCE

Level III, therapeutic study (Retrospective comparative study).

Clinical outcomes in patients with neurological disorders following periacetabular tumor removal and endoprosthetic reconstruction of the hemipelvis

Background

Surgical treatment of musculoskeletal tumors in the periacetabular region present extremely difficult due to the complex anatomy and need for reconstruction. Orthopedic surgeons face more difficulties in patients with neurological conditions, which can cause increased muscle tone, an elevated risk of fractures, and compromised bone quality. There is limited evidence regarding endoprosthetic reconstruction for periacetabular tumors in individuals with neurological disorders.

Methods

We conducted a single-center retrospective study to examine the outcomes of patients with preexisting neurological conditions who underwent surgery to remove periacetabular tumors and who underwent endoprosthesis reconstruction. Clinical presentation, detailed neurological conditions, complications, and functional outcomes were studied.

Results

Sixteen out of the 838 patients were identified (1.91%), with a mean follow-up time of 33 months. The primary neurological conditions encompassed Parkinson's disease, Alzheimer's disease, dementia, and cerebral ischemic stroke. Every patient was diagnosed with periacetabular lesions that were either primary or oligometastatic. They underwent tumor resection and subsequently received endoprosthetic reconstruction of the hemipelvis. Three patients developed metastasis lesions later, and two patients experienced tumor recurrence. Five cases experienced hip dislocation-one with periprosthetic fracture and one with surgical site infection. The position of the prosthetic rotating center was not correlated with dislocation. The reoperation rate was 31.25%. The cohort of patients all presented with more extended hospital stays and rehabilitation. In 3 patients, the general functional score was good, while in 6 patients, it was fair; in 7 patients, it was regarded as poor. The average MSTS93 score was 49.71%.

Conclusion

Endoprosthetic reconstruction after periacetabular tumor resection is an effective way to eliminate tumors and salvage limbs. However, this group of patients has an increased likelihood of secondary surgery, complications, extended hospital stay, and no significant improvement in functional outcomes. Despite the diverse nature of the cohort, it is recommended to consider enhanced soft tissue reconstruction, supervised functional recovery and rehabilitation training.

Three-Dimensional Multimodality Image Reconstruction as Teaching Tool for Case-based learning among medical postgraduates: a focus on primary pelvic bone Tumour Education

BACKGROUND

Postgraduate medical education in oncology orthopedics confronts obstacles when instructing on pelvic tumors, primarily due to their intricate anatomy and the limitations of conventional teaching techniques. The employment of Three-dimensional multimodality imaging (3DMMI) can be considered a valuable teaching tool, as it gracefully elucidates the intricacies of pelvic anatomical structures and the interactions between tumors and surrounding tissues through three-dimensional imaging, thereby providing a comprehensive and nuanced perspective. This study aimed to assess the feasibility and effectiveness of incorporating 3DMMI in combination with a Case-Based Learning (CBL) approach for postgraduate education.

METHODS

The study encompassed a 10-week course involving 90 surgical postgraduates, focusing on common pelvic tumor diseases. Students were assigned representative clinical cases, and each group created a PowerPoint presentation based on these cases. The core educational content included fundamental knowledge of pelvic anatomy, as well as clinical presentations, radiological features, and treatment principles of common pelvic tumor diseases. The research compared two groups: a traditional CBL group (n = 45) and a 3DMMI-CBL group (n = 45). The 3DMMI-CBL group had access to advanced imaging technology for better visualization. Various evaluations, including image interpretation, theoretical knowledge, and questionnaires, were used to assess the learning outcomes.

RESULTS

The 3DMMI-CBL group outperformed the CBL group not only in the imaging diagnosis of common pelvic diseases but also in their mastery of the related theoretical knowledge. Student questionnaires indicated higher scores for the 3DMMI-CBL group in basic pelvic anatomy knowledge (8.08 vs. 6.62, p < 0.01), image interpretation (8.15 vs. 6.69, p < 0.01), learning efficiency (8.07 vs. 7.00, p < 0.01), clinical reasoning (7.57 vs. 6.77, p < 0.01), and learning interest (8.46 vs. 7.00, p < 0.01). Teacher questionnaires revealed that 3DMMI technology enhanced teachers' clinical knowledge, facilitated instruction, and increased overall satisfaction and interest in teaching.

CONCLUSION

Our study introduced an enhancement to the conventional Case-Based Learning (CBL) model by incorporating 3DMMI technology for visualizing pelvic anatomy. In contrast to pure CBL, this adaptation improved teacher instruction, substantially heightened student engagement, ignited greater interest in learning, and boosted overall efficiency, ultimately leading to positive learning outcomes. Consequently, our study demonstrated the potential feasibility and acceptability of the 3DMMI-CBL teaching method for postgraduates in pelvic bone tumor education.