scholarly journals Custom-made 3D-printed prosthesis and free vascularised fibula for humeral reconstruction after osteosarcoma resection in a 13-year-old patient

2021 ◽  
Vol 14 (5) ◽  
pp. e240726
Author(s):  
Giovanni Beltrami ◽  
Anna Maria Nucci ◽  
Angela Tamburini ◽  
Marco Innocenti
Keyword(s):  
Three Dimensional ◽  
Surgical Reconstruction ◽  
Fibular Graft ◽  
Orthopaedic Oncology ◽  
Neoplastic Tissue ◽  
Limb Function ◽  
Custom Made ◽  
3D Printed ◽  
Novel Strategy

Surgical reconstruction after humeral resection represents a challenging issue in orthopaedic oncology. Particularly in paediatric patients, the main concerns are maintaining limb function and reconstruction longevity. We describe a novel strategy of humeral reconstruction based on the use of a three-dimensional-printed custom-made prosthesis in a 13-year-old patient diagnosed with osteosarcoma. The implant was specifically designed to sustain the native head, which was spared, as it was not involved by the neoplastic tissue. The mechanical support the prosthesis provided was associated with the biological stimulus of a free vascularised fibular graft to obtain an anatomic, functional and stable construct. This solution has had good longevity, and after 3 years of follow-up, the patient still shows excellent limb function and personal satisfaction.

scholarly journals Recurrent contracted sockets treated with personalized, three-dimensionally printed conformers and buccal grafts

2021 ◽  
pp. 112067212110000
Author(s):  
Annabel LW Groot ◽  
Jelmer S Remmers ◽  
Roel JHM Kloos ◽  
Peerooz Saeed ◽  
Dyonne T Hartong
Keyword(s):  
Three Dimensional ◽  
Case Series ◽  
Secondary Outcome ◽  
Retrospective Case ◽  
Upper Eyelid ◽  
Ocular Prosthesis ◽  
Buccal Mucosal Graft ◽  
Custom Made ◽  
3D Printed

Purpose: Recurrent contracted sockets are complex situations where previous surgeries have failed, disabling the wear of an ocular prosthesis. A combined method of surgery and long-term fixation using custom-made, three-dimensional (3D) printed conformers is evaluated. Methods: Retrospective case series of nine patients with recurrent excessive socket contraction and inability to wear a prosthesis, caused by chemical burns ( n = 3), fireworks ( n = 3), trauma ( n = 2) and enucleation and radiotherapy at childhood due to optic nerve glioma ( n = 1) with three average previous socket surgeries (range 2–6). Treatment consisted of a buccal mucosal graft and personalized 3D-printed conformer designed to be fixated to the periosteum and tarsal plates for minimal 2 months. Primary outcome was the retention of an ocular prosthesis. Secondary outcome was the need for additional surgeries. Results: Outcomes were measured at final follow-up between 7 and 36 months postoperatively (mean 20 months). Eight cases were able to wear an ocular prosthesis after 2 months. Three cases initially treated for only the upper or only the lower fornix needed subsequent surgery for the opposite fornix for functional reasons. Two cases had later surgery for cosmetic improvement of upper eyelid position. Despite pre-existing lid abnormalities (scar, entropion, lash deficiency), cosmetic outcome was judged highly acceptable in six cases because of symmetric contour and volume, and reasonably acceptable in the remaining two. Conclusions: Buccal mucosal transplant fixated with a personalized 3D-designed conformer enables retention of a well-fitted ocular prosthesis in previously failed socket surgeries. Initial treatment of both upper and lower fornices is recommended to avoid subsequent surgeries for functional reasons.

scholarly journals Custom-Made 3D-Printed Implants as Novel Approach to Reconstructive Surgery after Oncologic Resection in Pediatric Patients

2021 ◽  
Vol 10 (5) ◽  
pp. 1056
Author(s):  
Giovanni Beltrami ◽  
Gabriele Ristori ◽  
Anna Maria Nucci ◽  
Alberto Galeotti ◽  
Angela Tamburini ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Soft Tissues ◽  
Lower Limbs ◽  
Host Bone ◽  
Limb Salvage Surgery ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Custom Made ◽  
3D Printed

Recently, custom-made 3D-printed prostheses have been introduced for limb salvage surgery in adult patients, but their use has not been described in pediatric patients. A series of 11 pediatric patients (mean age 10.8 years; range 2–13) with skeletal tumors treated with custom-made implants for the reconstruction of bony defects is described. Patients were followed up every 3 months. Functional results were evaluated by the Musculoskeletal Tumor Society Score (MSTS) for upper and lower limbs. The mean follow-up was 25.7 months (range 14–44). Three patients died after a mean of 19.3 months postoperatively—two because of disease progression and the other from a previous malignancy. Three patients experienced complications related to soft tissues. One patient required device removal, debridement, and antibiotic pearls for postoperative infection. Partial osseointegration between grafts and host bone was observed within a mean of 4 months. At the final follow-up, mean MSTS score was 75%. 3D prostheses may yield biological advantages due to possible integration with the host bone and also through the use of vascularized flaps. Further research is warranted.

What we have achieved in the design of 3D printed metal implants for application in orthopedics? Personal experience and review

2018 ◽  
Vol 24 (8) ◽  
pp. 1365-1379 ◽  
Author(s):  
Zuhao Li ◽  
Chenyu Wang ◽  
Chen Li ◽  
Zhonghan Wang ◽  
Fan Yang ◽  
...  
Keyword(s):  
Personal Experience ◽  
Three Dimensional ◽  
High Patient Satisfaction ◽  
Functional Rehabilitation ◽  
Content Type ◽  
Metal Implants ◽  
Potential Development ◽  
3D Printed ◽  
Future Potential

PurposeThis paper aims to review the latest applications in terms of three-dimensional printed (3DP) metal implants in orthopedics, and, importantly, the design of 3DP metal implants through a series of cases operated at The Second Hospital of Jilin University were presented.Design/methodology/approachThis paper is available to practitioners who are use 3DP implants in orthopedics. This review began with the deficiency of traditional prostheses and basic concepts of 3DP implants. Then, representative 3DP clinical cases were summarized and compared, and the experiences using customized prostheses and directions for future potential development are also shown.FindingsThe results obtained from the follow-up of clinical applications of 3DP implants show that the 3D designed and printed metal implants could exhibit good bone defect matching, quick and safe joint functional rehabilitation as well as saving time in surgery, which achieved high patient satisfaction collectively.Originality/valueSingle center experiences of 3DP metal implants design were shared and the detailed technical points between various regions were compared and analyzed. In conclusion, the 3DP technology is infusive and will present huge potential to reform future orthopedic practice.

scholarly journals Is three-dimensional–printed custom-made ultra-short stem with a porous structure an acceptable reconstructive alternative in peri-knee metaphysis for the tumorous bone defect?

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Jie Wang ◽  
Jingjing An ◽  
Minxun Lu ◽  
Yuqi Zhang ◽  
Jingqi Lin ◽  
...  
Keyword(s):  
Porous Structure ◽  
Aseptic Loosening ◽  
Bone Defect ◽  
Short Stem ◽  
Leg Length ◽  
Musculoskeletal Tumor Society ◽  
Custom Made ◽  
Orthopedic Oncology ◽  
3D Printed

Abstract Background Long-lasting reconstruction after extensive resection involving peri-knee metaphysis is a challenging problem in orthopedic oncology. Various reconstruction methods have been proposed, but they are characterized by a high complication rate. The purposes of this study were to (1) assess osseointegration at the bone implant interface and correlated incidence of aseptic loosening; (2) identify complications including infection, endoprosthesis fracture, periprosthetic fracture, leg length discrepancy, and wound healing problem in this case series; and (3) evaluate the short-term function of the patient who received this personalized reconstruction system. Methods Between September 2016 and June 2018, our center treated 15 patients with malignancies arising in the femur or tibia shaft using endoprosthesis with a 3D-printed custom-made stem. Osseointegration and aseptic loosening were assessed with digital tomosynthesis. Complications were recorded by reviewing the patients’ records. The function was evaluated with the 1993 version of the Musculoskeletal Tumor Society (MSTS-93) score at a median of 42 (range, 34 to 54) months after reconstruction. Results One patient who experienced early aseptic loosening was managed with immobilization and bisphosphonates infusion. All implants were well osseointegrated at the final follow-up examination. There are two periprosthetic fractures intraoperatively. The wire was applied to assist fixation, and the fracture healed at the latest follow-up. Two patients experienced significant leg length discrepancies. The median MSTS-93 score was 26 (range, 23 to 30). Conclusions A 3D-printed custom-made ultra-short stem with a porous structure provides acceptable early outcomes in patients who received peri-knee metaphyseal reconstruction. With detailed preoperative design and precise intraoperative techniques, the reasonable initial stability benefits osseointegration to osteoconductive porous titanium, and therefore ensures short- and possibly long-term durability. Personalized adaptive endoprosthesis, careful intraoperative operation, and strict follow-up management enable effective prevention and treatment of complications. The functional results in our series were acceptable thanks to reliable fixation in the bone-endoprosthesis interface and an individualized rehabilitation program. These positive results indicate this device series can be a feasible alternative for critical bone defect reconstruction. Nevertheless, longer follow-up is required to determine whether this technique is superior to other forms of fixation.

Rapid prototyping to design a customized locking plate for pancarpal arthrodesis in a giant breed dog

2014 ◽  
Vol 27 (01) ◽  
pp. 85-89 ◽  
Author(s):  
T. Nicetto ◽  
M. Petazzoni
Keyword(s):  
Rapid Prototyping ◽  
Locking Plate ◽  
Three Dimensional ◽  
Radiographic Examination ◽  
Implant Position ◽  
Plastic Model ◽  
Computed Tomography Images ◽  
Custom Made ◽  
Osseous Union

SummaryThis report describes the treatment of traumatic carpal hyperextension in a giant breed dog by pancarpal arthrodesis using a custom- made Fixin locking plate, created with the aid of a three-dimensional plastic model of the bones of the antebrachium produced by rapid prototyping technology.A three-year-old 104 kg male Mastiff dog was admitted for treatment of carpal hyperextension injury. After diagnosis of carpal instability, surgery was recommended. Computed tomography images were used to create a life-size three-dimensional plastic model of the forelimb. The model was used as the basis for constructing a customized 12-hole Fixin locking plate. The plate was used to attain successful pancarpal arthrodesis in the animal.Radiographic examination after 74 and 140 days revealed signs of osseous union of the arthrodesis. Further clinical and radiographic follow-up examination three years later did not reveal any changes in implant position or complications.

scholarly journals Reconstruction for Massive Proximal Tibial Bone Defects Using Patient-customized Three-dimensional-printed Metaphyseal Cones in Revision Total Knee Arthroplasty

2020 ◽  
Author(s):  
Yang Li ◽  
Xinguang Wang ◽  
Hua Tian
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Three Dimensional ◽  
Bone Defects ◽  
Revision Total Knee Arthroplasty ◽  
3D Printed ◽  
Total Knee ◽  
The Mean ◽  
Highly Porous

Abstract Background: The reconstruction of massive bone defects is one of the main challenges in revision total knee arthroplasty (RTKA). Although several methods are available, each of them has its prominent shortcomings. The purpose of this study is to review the clinical outcomes of RTKA with massive proximal tibial bone defects using patient-customized three-dimensional (3D)-printed highly porous metaphyseal cones.Methods: We retrospectively reviewed seven RTKAs with Anderson Orthopaedic Research Institute (AORI) type III tibial defects using patient-customized 3D-printed highly porous metaphyseal cones, which have been performed at a single institution between 2016 and 2018. Results: The mean age at diagnosis of the patients was 68 years old (61-77). The mean length of follow-up was 25.3 months (19-36). At the latest follow-up, no aseptic loosening or prosthetic joint infection has been determined. The mean HSS increased from 49 (39-63) to 78 (70-83) (P<0.01); the mean WOMAC increased from 59 (46-73) to 26 (12-38) (P<0.01). All patients obtained the range of motion and mechanical alignment improvement postoperatively.Conclusion: The patient-customized 3D-printed metaphyseal cone could be a promising technique in addressing severe tibial defects in RTKA. Our study shows encouraging short-term clinical and radiological outcomes with no aseptic loosening, periprosthetic infection, or fracture. Nevertheless, further follow-up and the expansion of sample size are needed to demonstrate the advantage of this innovative technique fully.

scholarly journals Application of Personalized Three-Dimensional Printing for Shoulder Joint Prosthesis in the Treatment of Shoulder Joint Tuberculosis: A Case Report

2020 ◽  
Author(s):  
Yanlong Han ◽  
Habaxi Kaken ◽  
Wei Zhao ◽  
Ainiwaerjiang Damaola ◽  
Li Wang
Keyword(s):  
Shoulder Joint ◽  
Total Shoulder Arthroplasty ◽  
Three Dimensional ◽  
Shoulder Prosthesis ◽  
Left Shoulder ◽  
Joint Prosthesis ◽  
Imaging Results ◽  
Post Operation ◽  
3D Printed

Abstract Background: This article presents an application of the use of a personalized three-dimensional (3D)-printed reverse shoulder prosthesis to be used in a reverse total shoulder arthroplasty (RTSA) for a patient with tuberculosis of the shoulder joint. Background: Patient concerns: A 37-year-old female, who suffered a trauma on her left shoulder 17 years ago, reported significant worsening pain and limited physical activity within the last 6 months. The left shoulder joint activity was clearly restricted. Diagnosis: Her clinical manifestations, bone changes in shoulder joint, and imaging results were all consistent with extended exposure to tuberculosis of the shoulder joint. Interventions: For this patient, a personalized 3D-printed titanium alloy shoulder joint prosthesis was used in the RTSA. The patient’s stability was regularly monitored and followed up after operation. During pre-operation, post-operation, and follow-up, the scores of ASES, Neer Shoulder score, and Constant-Murley Shoulder were evaluated. Results: 3D shoulder prosthesis was successfully implanted into the patient and complete anatomic reconstruction was performed intraoperatively. ASES, Neer, and Constant-Murley scores were gradually improved on follow-up. The X-ray image showed good bone healing and no changes in the position of the prosthesis seven and a half years post-operation. The functionality of the shoulder joint was well restored and no restrictions were found in activities of daily living. Conclusion: Personalized 3D-printed shoulder joint prosthesis is very effective in the treatment of advanced tuberculosis of the shoulder joint. 3D-printed technology may be a novel and efficient method for similar arthroplasties and severe bone defects.

Reconstruction of Paprosky type III Acetabular Defects by the Three-dimensional Printed Porous Augment: Techniques and Clinical Outcomes of 18 Consecutive Cases

2020 ◽  
Author(s):  
Jun Fu ◽  
Ming Ni ◽  
Xiang Li ◽  
Wei Chai ◽  
Libo Hao ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Bone Defect ◽  
Three Dimensional ◽  
Acetabular Bone ◽  
Type Iii ◽  
Acetabular Bone Defect ◽  
3D Printed ◽  
The Mean ◽  
Acetabular Defects

Abstract Background and Purpose: A major challenge posed by primary and revision total hip arthroplasty (THA) is the management of severe acetabular bone defect. Previous surgical techniques have certain limitations in the anatomical reconstruction and accurate match of severe acetabular defects. Until now, reports are scanty on the clinical outcomes of acetabular reconstruction by the three-dimensional (3D) printed porous augments in bone defect patients. This study reported the clinical outcomes of reconstruction of Paprosky type III acetabular defects by 3D printed porous augments.Methods: 18 patients with Paprosky type III acetabular defects receiving reconstructive surgery by 3D printed porous augments were included in current study. Their data, including general information, intra-operative findings, imaging results, functional scores and complications were retrospectively analyzed.Results: The mean follow-up time lasted 33.3 ± 2.0 (24-56) months. The average limb-length discrepancy (LLD) was 31.7 ± 4.2 (3-59) mm preoperatively, 7.7 ± 1.4 (1-21) mm postoperatively (p<0.0001) and 7.5 ± 1.2 (0-18) mm at the latest follow-up. The mean vertical position of hip center of rotation (HCOR) from the inter teardrop line changed from preoperative 50.7 ± 3.9 (23.3-75.3) mm to postoperative 22.9 ± 1.9 (10.1-40.3) mm (p<0.0001), with the latest follow-up revealing an HCOR of 22.3 ± 1.7 (11.0-40.5) mm. Follow-up study showed that no hip had radiolucencies and radiological loosening of the acetabular components and augment. The average HHS improved from 40.3 ± 4.5 (10.5-71) before operation to 88.4 ± 1.9 (75-97) at the last follow-up (p<0.0001). Moreover, follow-up exhibited that no periprosthetic joint infection, hip dislocation, fracture and re-revision occurred. Conclusion: Surgical treatment of Paprosky type III acetabular defect with 3D printed porous augment was simple, achieved good match between porous augment and the defect bone surface and the acetabular component, ideally restored LLD and HCOR after operation, significantly improved HHS score and attained good early clinical outcomes. It is a promising personalized solution for patients with severe acetabular bone defect.

Fast production of customized three-dimensional-printed hand splints

2020 ◽  
Vol 26 (1) ◽  
pp. 134-144 ◽  
Author(s):  
Diana Popescu ◽  
Aurelian Zapciu ◽  
Cristian Tarba ◽  
Dan Laptoiu
Keyword(s):  
3D Printing ◽  
Three Dimensional ◽  
Online Application ◽  
Content Type ◽  
3D Cad ◽  
Aesthetic Appearance ◽  
3D Printed ◽  
Manufacturing Time ◽  
Practical Implications

Purpose This paper aims to propose a new solution for producing customized three-dimensional (3D)-printed flat-shaped splints, which are then thermoformed to fit the patient’s hand. The splint design process is automated and is available to clinicians through an online application. Design/methodology/approach Patient anthropometric data measured by clinicians are associated with variables of parametric 3D splint models. Once these variables are input by clinicians in the online app, customized stereo lithography (STL) files for both splint and half mold, in the case of the bi-material splint, are automatically generated and become available for download. Bi-materials splints are produced by a hybrid manufacturing process involving 3D printing and overmolding. Findings This approach eliminates the need for 3D CAD-proficient clinicians, allows fast generation of customized splints, generates two-dimensional (2D) drawings of splints for verifying shape and dimensions before 3D printing and generates the STL files. Automation reduces splint design time and cost, while manufacturing time is diminished by 3D printing the splint in a flat position. Practical implications The app could be used in clinical practice. It meets the demands of mass customization using 3D printing in a field where individualization is mandatory. The solution is scalable – it can be extended to other splint designs or to other limbs. 3D-printed tailored splints can offer improved wearing comfort and aesthetic appearance, while maintaining hand immobilization, allowing visually controlled follow-up for edema and rapidly observing the need for revision if necessary. Originality/value An online application was developed for uploading patient measurements and downloading 2D drawings and STL files of customized splints. Different models of splints can be designed and included in the database as alternative variants. A method for producing bi-materials flat splints combining soft and rigid polymers represents another novelty of the research.

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