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Hu X, Wen Y, Lu M, Luo Y, Zhou Y, Yang X, Tu C, Min L. 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. J Orthop Surg Res 2024; 19:258. [PMID: 38654343 DOI: 10.1186/s13018-024-04697-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/22/2024] [Indexed: 04/25/2024] Open
Abstract
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).
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Affiliation(s)
- Xin Hu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xang, Chengdu, 610041, Sichuan, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yang Wen
- Department of Orthopedics, Zigong Fourth People's Hospital, Zigong, 643000, People's Republic of China
| | - Minxun Lu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xang, Chengdu, 610041, Sichuan, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yi Luo
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xang, Chengdu, 610041, Sichuan, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yong Zhou
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xang, Chengdu, 610041, Sichuan, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xiao Yang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, 610064, Sichuan, People's Republic of China.
- Provincial Engineering Research Center for Biomaterials Genome of Sichuan, Sichuan University, Chengdu, 610064, People's Republic of China.
| | - Chongqi Tu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xang, Chengdu, 610041, Sichuan, People's Republic of China.
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Li Min
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xang, Chengdu, 610041, Sichuan, People's Republic of China.
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China.
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Nischal N, Kurisunkal V, Jeys L, Davies M, Botchu R. Incidence of avascular necrosis of native femur following hip transposition surgery for periacetabular malignancies: a single-centre experience. Hip Int 2024:11207000241241288. [PMID: 38566283 DOI: 10.1177/11207000241241288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Hip transposition surgery after surgical resection of large pelvic tumours is a well-established alternate to endoprosthetic reconstruction. The major goals of surgery are to ensure adequate resection margins with limb salvation, albeit with acceptable levels of morbidity. While surveillance is aimed at diagnosing local recurrence or distant metastasis primarily, other complications may occasionally be seen.The aim of this study was to assess incidence of avascular necrosis (AVN) in the preserved native femoral heads after hip transposition surgery for periacetabular malignancies, also known as hanging hip surgery. PATIENTS AND METHODS Patient records and follow-up imaging of 22 patients who had undergone hanging hip surgery from 1999 to 2020 were retrospectively analysed to assess for any probable causes of AVN. RESULTS Of the 22 patients, 5 (22.7%) had developed AVN on follow-up with a mean time of onset of about 10.5 months from surgery (5 months-2 years). A review of the patient demographics, surgical notes, preoperative management did not offer any clues as to the cause of AVN in these patients. Osteopenia was the most common radiological finding (59%) in most patients, but this also did not herald AVN onset. CONCLUSIONS The theory that loss of major vascular supply to the femoral head from capsular disruption during hip transposition surgery would lead to AVN in most patients did not hold true as AVN occurred in a small number of patients.
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Affiliation(s)
- Neha Nischal
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
- Holy Family Hospital, New Delhi, India
| | | | - Lee Jeys
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Mark Davies
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Rajesh Botchu
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
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Li Z, Luo Y, Lu M, Wang Y, Gong T, He X, Hu X, Long J, Zhou Y, Min L, Tu C. Biomimetic design and clinical application of Ti-6Al-4V lattice hemipelvis prosthesis for pelvic reconstruction. J Orthop Surg Res 2024; 19:210. [PMID: 38561755 PMCID: PMC10983619 DOI: 10.1186/s13018-024-04672-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/13/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE This study aims to biomimetic design a new 3D-printed lattice hemipelvis prosthesis and evaluate its clinical efficiency for pelvic reconstruction following tumor resection, focusing on feasibility, osseointegration, and patient outcomes. METHODS From May 2020 to October 2021, twelve patients with pelvic tumors underwent tumor resection and subsequently received 3D-printed lattice hemipelvis prostheses for pelvic reconstruction. The prosthesis was strategically incorporated with lattice structures and solid to optimize mechanical performance and osseointegration. The pore size and porosity were analyzed. Patient outcomes were assessed through a combination of clinical and radiological evaluations. RESULTS Multiple pore sizes were observed in irregular porous structures, with a wide distribution range (approximately 300-900 μm). The average follow-up of 34.7 months, ranging 26 from to 43 months. One patient with Ewing sarcoma died of pulmonary metastasis 33 months after surgery while others were alive at the last follow-up. Postoperative radiographs showed that the prosthesis's position was consistent with the preoperative planning. T-SMART images showed that the host bone was in close and tight contact with the prosthesis with no gaps at the interface. The average MSTS score was 21 at the last follow-up, ranging from 18 to 24. There was no complication requiring revision surgery or removal of the 3D-printed hemipelvis prosthesis, such as infection, screw breakage, and prosthesis loosening. CONCLUSION The newly designed 3D-printed lattice hemipelvis prosthesis created multiple pore sizes with a wide distribution range and resulted in good osteointegration and favorable limb function.
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Affiliation(s)
- Zhuangzhuang Li
- Department of Orthopedics and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, People's Republic of China
| | - Yi Luo
- Department of Orthopedics and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, People's Republic of China
| | - Minxun Lu
- Department of Orthopedics and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, People's Republic of China
| | - Yitian Wang
- Department of Orthopedics and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, People's Republic of China
| | - Taojun Gong
- Department of Orthopedics and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, People's Republic of China
| | - Xuanhong He
- Department of Orthopedics and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, People's Republic of China
| | - Xin Hu
- Department of Orthopedics and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, People's Republic of China
| | - Jingjunjiao Long
- Department of Orthopedics and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, People's Republic of China
| | - Yong Zhou
- Department of Orthopedics and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, People's Republic of China
| | - Li Min
- Department of Orthopedics and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China.
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, People's Republic of China.
| | - Chongqi Tu
- Department of Orthopedics and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China.
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, People's Republic of China.
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Zhu J, Hu J, Zhu K, Ma X, Wang Y, Xu E, Huang Z, Zhu Y, Zhang C. Design of 3D-printed prostheses for reconstruction of periacetabular bone tumors using topology optimization. Front Bioeng Biotechnol 2023; 11:1289363. [PMID: 38116196 PMCID: PMC10728281 DOI: 10.3389/fbioe.2023.1289363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/22/2023] [Indexed: 12/21/2023] Open
Abstract
Background: Prostheses for the reconstruction of periacetabular bone tumors are prone to instigate stress shielding. The purpose of this study is to design 3D-printed prostheses with topology optimization (TO) for the reconstruction of periacetabular bone tumors and to add porous structures to reduce stress shielding and facilitate integration between prostheses and host bone. Methods: Utilizing patient CT data, we constructed a finite element analysis (FEA) model. Subsequent phases encompassed carrying out TO on the designated area, utilizing the solid isotropic material penalization model (SIMP), and this optimized removal area was replaced with a porous structure. Further analyses included preoperative FEA simulations to comparatively evaluate parameters, including maximum stress, stress distribution, strain energy density (SED), and the relative micromotion of prostheses before and after TO. Furthermore, FEA based on patients' postoperative CT data was conducted again to assess the potential risk of stress shielding subsequent to implantation. Ultimately, preliminary follow-up findings from two patients were documented. Results: In both prostheses, the SED before and after TO increased by 143.61% (from 0.10322 to 0.25145 mJ/mm3) and 35.050% (from 0.30964 to 0.41817 mJ/mm3) respectively, showing significant differences (p < 0.001). The peak stress in the Type II prosthesis decreased by 10.494% (from 77.227 to 69.123 MPa), while there was no significant change in peak stress for the Type I prosthesis. There were no significant changes in stress distribution or the proportion of regions with micromotion less than 28 μm before and after TO for either prosthesis. Postoperative FEA verified results showed that the stress in the pelvis and prostheses remained at relatively low levels. The results of follow-up showed that the patients had successful osseointegration and their MSTS scores at the 12th month after surgery were both 100%. Conclusion: These two types of 3D-printed porous prostheses using TO for periacetabular bone tumor reconstruction offer advantages over traditional prostheses by reducing stress shielding and promoting osseointegration, while maintaining the original stiffness of the prosthesis. Furthermore, in vivo experiments show that these prostheses meet the requirements for daily activities of patients. This study provides a valuable reference for the design of future periacetabular bone tumor reconstruction prostheses.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Chunlin Zhang
- Department of Orthopedic Surgery, Institute of Bone Tumor, Shanghai 10th People’s Hospital Affiliated to Tongji University, Tongji University School of Medicine, Shanghai, China
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Broekhuis D, Boyle R, Karunaratne S, Chua A, Stalley P. Custom designed and 3D-printed titanium pelvic implants for acetabular reconstruction after tumour resection. Hip Int 2023; 33:905-915. [PMID: 36408844 PMCID: PMC10486168 DOI: 10.1177/11207000221135068] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 07/26/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Reconstructive procedure following resection of large pelvic tumours around the hip joint remains a complex challenge. METHODS This study presents a retrospective case series of patients presenting with benign or malignant pelvic tumour for which an internal hemipelvectomy including the hip joint and subsequent reconstruction with a custom designed 3-dimensional printed titanium pelvic implant (3DPPI) has been performed between August 2013 and January 2018. RESULTS 15 consecutive patients with a median age of 33.9 years (IQR 26.4-72.2) and a median BMI of 20.7 kg/m2 (IQR 19.0-33.3) were reviewed after median follow-up of 33.8 months (IQR 24.0-78.1). The majority of patients presented with a malignant tumour as their principal diagnosis (n = 13, 86.7%). The median surgical time was 5.5 hours (IQR 4.5-8.5) and median peri-operative blood loss was 5000 ml (IQR 2000-10000). The median MSTS score at follow-up was 63.3% (IQR 51.7-86.7%). The median NRS in rest was 0.0 (IQR 0.0-5.0), the median NRS during activity was 2.0 (IQR 0.5-7.0) and the median HOOS-PS was 76.6% (IQR 67.9-91.0). 4 patients had implant-specific complications (n = 4, 26.6%); 1 hip dislocation (Henderson type 1a), 3 structural complications (type 3a), 1 deep infection (type 4a) and 1 local tumour recurrence (type 5b). At follow-up, 4 out of 15 implants were classified as a failure, resulting in an implant survival rate of 73.3%. CONCLUSIONS Acceptable peri-operative outcomes, functional results, complication rates and short-term implant survival can be achieved in a cohort of complex patients undergoing 3DPPI reconstruction after hemipelvectomy including the acetabulum.
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Affiliation(s)
| | - Richard Boyle
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Sascha Karunaratne
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Alfred Chua
- Department of Anaesthetics, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Paul Stalley
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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Hinckley NB, Beauchamp CP, Christopher ZK, Schwartz AJ, Ogunleye T, Goulding KA. What are the 2-year survivorship outcomes of custom hemipelvis reconstruction after hemipelvectomy and revision arthroplasty? The evolution of a custom ilium "monoflange". J Surg Oncol 2023; 127:480-489. [PMID: 36255157 DOI: 10.1002/jso.27124] [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: 06/01/2022] [Revised: 09/06/2022] [Accepted: 10/03/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Innovations in machined and three-dimensionally (3D) printed implant technology have allowed for customized complex pelvic reconstructions. We sought to determine the survivorship of custom hemipelvis reconstruction using ilium-only fixation at a minimum 2-year follow-up, their modes of failure, and the postoperative complications resulting from the procedure. METHODS A retrospective review identified 12 consecutive patients treated with custom hemipelvis reconstruction. Indications for surgery were bone tumor requiring internal hemipelvectomy (four patients) or multiply revised, failed hip arthroplasty with massive bone loss (eight patients). All patients had a minimum of 2-year follow-up with a mean of 60.5 months. Kaplan-Meier survivorship analysis was determined for all patients. Postoperative complications and reoperations were categorized for all patients. RESULTS At a mean of 60.5 months, 11 of 12 patients had retained their custom implant (92% survivorship). One implant was removed as a result of an acute periprosthetic joint infection (PJI). There were no cases of aseptic loosening. Seven of 12 patients required reoperation (three PJI; two dislocations; two superficial wound complications), with five patients going on to reoperation-free survival. CONCLUSIONS Custom hemipelvis reconstruction utilizing an ilium monoflange provides durable short-term fixation at a minimum 2-year follow-up. Reoperation for infection and dislocation is common.
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Affiliation(s)
| | | | | | - Adam J Schwartz
- Mayo Clinic Arizona, Department of Orthopedic Surgery, Phoenix, Arizona, USA
| | - Temi Ogunleye
- Burrell College of Osteopathic Medicine, Las Cruces, New Mexico, USA
| | - Krista A Goulding
- Mayo Clinic Arizona, Department of Orthopedic Surgery, Phoenix, Arizona, USA
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Acetabular reconstruction in oncological surgery: A systematic review and meta-analysis of implant survivorship and patient outcomes. Surg Oncol 2021; 38:101635. [PMID: 34365178 DOI: 10.1016/j.suronc.2021.101635] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/15/2021] [Accepted: 07/18/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Reconstruction of the hip for peri-acetabular oncological disease remains a challenge. The objective of this study was to summarize the evidence and identify techniques utilized for primary and metastatic tumors of the acetabulum and hemipelvis. METHODS A systematic review of the published literature was carried out in accordance with PRISMA guidelines. MEDLINE, EMBASE and Cochrane databases identified relevant articles. Quality was assessed using the Newcastle-Ottawa Scale. The study was registered on PROSPERO. RESULTS 53 papers were included, 16 were suitable for meta-analysis. 909 patients had primary and 1140 metastatic disease. 1094 patients underwent reconstruction with conventional total hip arthroplasty (with or without cup-cage or cement augmentation) or modifications of the Harrington procedure, collectively termed 'non-complex'. 928 patients underwent 'complex' reconstructions with either a modular hemipelvic, saddle, reverse snow-cone, custom-made or 3D-printed endoprosthesis. The most common complication was deep infection (11%) followed by dislocation (5%). Mean MSTS scores were 61.9% for 'non-complex' versus 63.2% for 'complex' reconstruction. Meta-analysis suggested increased mortality for primary (OR 3.14; 95% CI 1.15-8.54) and trends toward reduced mortality for metastatic disease (OR 0.93; 95% CI 0.26-3.29) following 'complex' versus 'non-complex' reconstruction. Reoperation rates were higher following 'complex' reconstruction for metastatic disease (OR 1.90; 95% CI 0.66-5.46) and similar for primary disease (OR 0.98; 95% CI 0.45-2.14). CONCLUSIONS Peri-acetabular tumors are associated with high rates of morbidity and mortality. Decisions regarding implant selection are multi-factorial with recent increase in the use of custom-made and 3D-printing technologies. Multiple factors contribute to the oncological outcome and patient function. Further research is required in order to guide optimal practice.
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Reconstruction of Bony Defects after Tumor Resection with 3D-Printed Anatomically Conforming Pelvic Prostheses through a Novel Treatment Strategy. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8513070. [PMID: 33335928 PMCID: PMC7723494 DOI: 10.1155/2020/8513070] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/09/2020] [Accepted: 11/11/2020] [Indexed: 01/07/2023]
Abstract
There has been an increasing interest and enormous applications in three-dimensional (3D) printing technology and its prosthesis, driving many orthopaedic surgeons to solve the difficult problem of bony defects and explore new ways in surgery approach. However, the most urgent problem is without an effective prosthesis and standard treatment strategy. In order to resolve these problems, this study was performed to explore the use of a 3D-printed anatomically conforming pelvic prosthesis for bony defect reconstruction following tumor resection and to describe a detailed treatment flowchart and the selection of a surgical approach. Six patients aged 48-69 years who had undergone pelvic tumor resection underwent reconstruction using 3D-printed anatomically conforming pelvic prostheses according to individualized bony defects between March 2016 and June 2018. According to the Enneking and Dunham classification, two patients with region I+II tumor involvement underwent reconstruction using the pubic tubercle-anterior superior iliac spine approach and the lateral auxiliary approach and one patient with region II+III and three patients with region I+II+III tumor involvement underwent reconstruction using the pubic tubercle-posterior superior iliac spine approach. The diagnoses were chondrosarcoma and massive osteolysis. After a mean follow-up duration of 30.33 ± 9.89 months (range, 18-42), all patients were alive, without evidence of local recurrence or distant metastases. The average blood loss and blood transfusion volumes during surgery were 2500.00 ± 1461.51 ml (range, 1200-5000) and 2220.00 ± 1277.62 ml (range, 800-4080), respectively. During follow-up, the mean visual analogue scale (VAS) score decreased, and the mean Harris hip score increased. There were no signs of hip dislocation, prosthetic loosening, delayed wound healing, or periprosthetic infection. This preliminary study suggests the clinical effectiveness of 3D-printed anatomically conforming pelvic prostheses to reconstruct bony defects and provide anatomical support for pelvic organs. A new surgical approach that can be used to expose and facilitate the installation of 3D-printed prostheses and a new treatment strategy are presented. Further studies with a longer follow-up duration and larger sample size are needed to confirm these encouraging results.
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What are the Complications of Three-dimensionally Printed, Custom-made, Integrative Hemipelvic Endoprostheses in Patients with Primary Malignancies Involving the Acetabulum, and What is the Function of These Patients? Clin Orthop Relat Res 2020; 478:2487-2501. [PMID: 32420722 PMCID: PMC7594920 DOI: 10.1097/corr.0000000000001297] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Functional reconstruction after resection of pelvic malignancies involving the acetabulum remains challenging. Numerous reconstruction methods have been proposed, but they are generally associated with mechanical and nonmechanical complications. To improve the function of patients with primary malignancies of the acetabulum after internal hemipelvectomy and reduce the complication rate after this procedure, we designed a series of three-dimensionally (3D) printed, custom-made, integrative hemipelvic endoprostheses with a porous structure and wanted to present the early results of using this construct to determine whether it could be considered a reasonable reconstruction option. QUESTIONS/PURPOSES We performed this study to (1) evaluate, in a small group of patients, whether the new endoprosthesis restores short-term lower-limb function; (2) identify short-term complications associated with the use of this endoprosthesis; and (3) assess osseointegration between the host bone and the 3D-printed integrative hemipelvic endoprosthesis with a porous structure. METHODS Between October 2016 and May 2017, our center treated 26 patients with malignancies involving the acetabulum. Thirteen of these patients received hemipelvic replacement with a 3D-printed, custom-made, integrative endoprosthesis, six received hemipelvic replacement with a modular endoprosthesis, four received radiotherapy, and three received external hemipelvectomy. Resection and reconstruction with a 3D-printed, custom-made, integrative endoprosthesis were indicated if the resection margin was the same as that achieved in hemipelvectomy, if reconstruction would preserve reasonable function after resection, if the patient had a good physical status and life expectancy longer than 6 months, and if the patient was willing to accept the potential risk of a 3D-printed, custom-made, endoprosthesis. The exclusion criteria were an inability to achieve a satisfactory surgical margin with limb salvage, inability to preserve the function of the limb because of tumor involvement of the sacral nerve or sciatic nerve, and unresectable and/or widely metastatic disease on presentation. Pain and function were evaluated with the 10-cm VAS score (range 0 to 10; a lower score is desirable), the 1993 version of the Musculoskeletal Tumor Society (MSTS-93) score (range 0 to 30; a higher score is desirable), and the Harris hip score ([HHS]; range 0 to 100; a higher score is desirable) were evaluated preoperatively and at a median of 27 months after reconstruction (range 24 to 31 months). The functional scores and complications were recorded after reviewing the patients' records. Osseointegration was assessed with digital tomosynthesis by two senior surgeons. We observed the trabecular structures connected to the implant surface to assess whether there was good osseointegration. RESULTS The median preoperative VAS score, MSTS-93 score, and HHS were 5 (range 2 to 8), 14 (range 3 to 18), and 64 (range 20 to 76) points, respectively. At the latest follow-up interval, the median VAS score, MSTS-93 score, and HHS were 2 (range 0 to 6), 23 (range 15 to 27), and 82 (range 44 to 93) points, respectively. No deep infection, dislocation, endoprosthetic breakage, aseptic loosening, or local recurrence occurred. Two patients experienced delayed wound healing; the wounds healed after débridement. Using digital tomography, we found that all implants were well-osseointegrated at the final follow-up examination. CONCLUSIONS A 3D-printed, custom-made, integrative hemipelvic endoprosthesis provides acceptable early outcomes in patients undergoing pelvic reconstruction. Osseointegration is possible, and we anticipate this will lead to biologic stability with a longer follow-up interval. The custom-made integrative design ensured precise implantation. Although a few patients in this study had only a short follow-up duration, the functional results were reasonable. We have observed no major complications so far, but this was a very small series and we caution that these are large reconstructions that will certainly result in complications for some patients. Our method uses a precise preoperative simulation and endoprosthesis design to aid the surgeon in performing challenging operations. If our early results are confirmed with more patients and longer follow-up and are replicated at other centers, this may be a reconstruction option for patients with periacetabular malignancies. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Wang J, Min L, Lu M, Zhang Y, Wang Y, Luo Y, Zhou Y, Duan H, Tu C. Three-dimensional-printed custom-made hemipelvic endoprosthesis for primary malignancies involving acetabulum: the design solution and surgical techniques. J Orthop Surg Res 2019; 14:389. [PMID: 31775805 PMCID: PMC6882053 DOI: 10.1186/s13018-019-1455-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 11/05/2019] [Indexed: 02/05/2023] Open
Abstract
Background This study is to describe the detailed design and surgical techniques of three-dimensional (3D)-printed custom-made endoprosthesis for hemipelvic tumorous bone defect. Methods According to the pelvic tumor resection classification by Enneking and Dunham, the hemipelvis is divided into three zones including the ilium (P1), acetabulum (P2), and pubis and ischium (P3). Thirteen patients were included in this study. Of these, P1 and P2 were involved in three cases, while P1, P2, and P3 were involved in 10. Based on radiography data, 3D pelvic model was rebuilt, and virtual surgery was simulated. Different fixation methods were applied according to residual bone volume. Parameters of the first sacral (S1) vestibule, second sacral (S2) vestibule, the narrowest zone of superior pubic medullary cavity (NPSPMC), and the resected surface of superior pubic medullary cavity (RSSPMC) were selectively measured in various fixation methods. Model overlapping, feature simplifying, and size controlling were three basic steps during design procedure. Volume proportion of porous structure was determined according to estimated weight of resected specimen. Acetabular location, anteversion, and inclination were modulated. Screw diameter, direction, and combination were considered. The osteotomy guides and plastic models were used during surgery. Results Of 13 cases, after P1 resection, endoprostheses were fixed to sacra (8; 61.5%), ilia (3; 23.1%), and both (2; 15.4%). After P3 resection, endoprostheses were fixed to residual acetabulum (3; 23.1%), and residual pubis by stem (8; 61.5%) or “cap-like” structure (2; 15.4%). Mean area of the S1 vestibule, S2 vestibule, RSSPMC, and PSPMC were 327.9 (222.2 to 400), 131.7 (102.6 to 163.6), 200.5 (103.8 to 333.2), and 79.8 mm2 (40.4 to 126.2), respectively. Porous structure with 600 μm pore size and 70% porosity accounted for 68.8% (53.0 to 86.0) of the whole endoprosthesis on average. Mean acetabular anteversion and inclination were designed as 23.2° (20 to 25) and 42.4° (40 to 45). Median numbers of screws designed in the S1 vestibule was 5 (IQR, 4 to 6), in the S2 vestibule was 1 (IQR, 1 to 2), in the ilium was 5 (IQR, 2 to 6), and in the pubis was 1 (IQR, 1 to 1), while screws designed in the ischium was all 2. Median number of screws inserted in the S1 vestibule was 4 (IQR, 3 to 4), in the S2 vestibule was 1 (IQR, 1 to 1), in the ilium was 3 (IQR, 1 to 5), in the pubis was 1 (IQR, 0 to 1), and in the ischium was 1 (IQR, 1 to 1). Conclusions This study firstly presents detailed design and related surgical techniques of 3D-printed custom-made hemipelvic endoprosthesis reconstruction. Osseointegration is critical for long-term outcome and requires three design elements including interface connection, porous structure, and initial stability achieved by precise matching and proper fixation methods.
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Affiliation(s)
- Jie Wang
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Li Min
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Minxun Lu
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yuqi Zhang
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yitian Wang
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yi Luo
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yong Zhou
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Hong Duan
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Chongqi Tu
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China. .,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.
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Sun W, Zan P, Ma X, Hua Y, Shen J, Cai Z. Surgical resection and reconstructive techniques using autologous femoral head bone-grafting in treating partial acetabular defects arising from primary pelvic malignant tumors. BMC Cancer 2019; 19:969. [PMID: 31627719 PMCID: PMC6800503 DOI: 10.1186/s12885-019-6196-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 09/24/2019] [Indexed: 01/02/2023] Open
Abstract
Background The aim of this study is to present and evaluate surgical resection and reconstructive techniques using autologous femoral head bone-grafting in treating partial acetabular defects arising from primary pelvic malignant tumors. Methods From January 2009 until January 2015, a total of 20 primary pelvic malignancy cases involving the acetabulum were retrospectively investigated. Surgical resections and reconstructions were conducted based on the type of the tumor with custom osteotomy guides and autologous femoral head bone-grafting. In all cases, prosthesis survival period, complication occurrence, and clinical outcomes data were collected and analyzed. Results Thirteen male and 7 female patients with an average age of 48 years old (range 23-69 years old) were followed for a median of 69 months (range 48-112 months). Of these cases, 17 included chondrosarcomas and 3 additional patients with a malignant giant cell tumor of bone (MBGCT) as proven by pathology. During follow-up, 3 cases of chondrosarcoma recurred (15%), of which two cases received hemi-pelvic amputation, 1 case of MBGCT relapsed and developed pulmonary metastases. Two cases of acetabular prosthesis with an impending dislocation received closed reduction followed by 6 weeks of hip abduction brace fixation. One case of prosthesis loosening was revised. In another case a deep infection occurred with debridement and prosthesis removal. Musculoskeletal Tumor Society 1993 (MSTS-93) score was utilized to conduct functional evaluation: 13 cases were good, 6 were average and one was poor. Conclusion The precision of the osteotomies performed is likely crucial for this type of reconstructive strategy to be successful. The use of custom guides for acetabular osteotomies and femoral head reconstruction can improve functional outcomes with relatively low complications at the intermediate length of follow-up.
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Affiliation(s)
- Wei Sun
- Department of Orthopedic Surgery, Shanghai general hospital affiliated to Jiaotong University, No.100 Haining Road, Hongkou District, Shanghai, 200080, China
| | - Pengfei Zan
- Department of Orthopedic Surgery, Second affiliated hospital of Zhejiang University, Hangzhou, China
| | - Xiaojun Ma
- Department of Orthopedic Surgery, Shanghai general hospital affiliated to Jiaotong University, No.100 Haining Road, Hongkou District, Shanghai, 200080, China
| | - Yingqi Hua
- Department of Orthopedic Surgery, Shanghai general hospital affiliated to Jiaotong University, No.100 Haining Road, Hongkou District, Shanghai, 200080, China
| | - Jiakang Shen
- Department of Orthopedic Surgery, Shanghai general hospital affiliated to Jiaotong University, No.100 Haining Road, Hongkou District, Shanghai, 200080, China
| | - Zhengdong Cai
- Department of Orthopedic Surgery, Shanghai general hospital affiliated to Jiaotong University, No.100 Haining Road, Hongkou District, Shanghai, 200080, China.
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Han Q, Zhang K, Zhang Y, Wang C, Yang K, Zou Y, Chen B, Wang J. Individual resection and reconstruction of pelvic tumor with three-dimensional printed customized hemi-pelvic prosthesis: A case report. Medicine (Baltimore) 2019; 98:e16658. [PMID: 31490360 PMCID: PMC6738983 DOI: 10.1097/md.0000000000016658] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RATIONALE Pelvic tumor had great impact on patients' quality of life. After tumor resection, how to accurately fill bone defect remained challenging for orthopedic surgeons. Due to lack of individual design, high incidence of prosthetic mismatching, and loosening were reported in pelvic reconstruction surgery with conventional modular prostheses. Nowadays, with rapid development of three-dimensional (3D) print technology, pelvic prostheses could be designed according to patients' own anatomy. The objective of this study was to describe the application of 3D printed customized hemi-pelvic prosthesis for patients with pelvic tumor. PATIENT CONCERNS A 62-year-old female had developed severe right joint pain without obvious inducement from 5 months before she sought medical advice. Pain, swelling, and limited range of motion of right joint were founded during physical examination. DIAGNOSIS The patients were diagnosed as "right acetabulum metastatic carcinoma" INTERVENTION:: 3D printed titanium alloy hemi-pelvic prosthesis was designed according the morphology of unaffected side hemi-pelvis and subsequently implanted in surgery to reconstruct the pelvis. 3D printed osteotomy guide and pelvic model were also manufactured and applied to improve accuracy of osteotomy and reduce operation time. X-Ray of pelvis, Harris score, musculoskeletal tumor society score (MSTS) and The MOS item short from health survey (SF-36) were recorded during the period of preoperation, 1, 3, 6, 12 months follow-up after operation. OUTCOMES 3D printed hemi-pelvic prosthesis matched precisely with pelvis and implanted successfully. There was no sign of prosthetic loosening within 12 months' follow-up. No sign of peri-prosthetic infection from laboratory examination. Harris score, MSTS, and SF-36 were gradually increasing during follow-up period. LESSONS Satisfactory effect of pelvic reconstruction could be achieved by 3D printed hemi-pelvic prostheses. It also provided a promising way to the treatment of pelvic tumor in similar cases.
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Affiliation(s)
| | | | - Yong Zhang
- Clinical Laboratories, Second Hospital of Jilin University, Changchun, Jilin Province, China
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