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

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.

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3D-Printed Connector for Revision Limb Salvage Surgery in Long Bones Previously Using Customized Implants

Metals ◽

10.3390/met11050707 ◽

2021 ◽

Vol 11 (5) ◽

pp. 707

Author(s):

Jong-Woong Park ◽

Hyun-Guy Kang ◽

June-Hyuk Kim ◽

Han-Soo Kim

Keyword(s):

Limb Salvage ◽

Salvage Surgery ◽

Revisional Surgery ◽

Limb Salvage Surgery ◽

Musculoskeletal Tumor ◽

Musculoskeletal Tumor Society ◽

Proximal Ulna ◽

Custom Made ◽

Orthopedic Oncology ◽

3D Printed

In orthopedic oncology, revisional surgery due to mechanical failure or local recurrence is not uncommon following limb salvage surgery using an endoprosthesis. However, due to the lack of clinical experience in limb salvage surgery using 3D-printed custom-made implants, there have been no reports of revision limb salvage surgery using a 3D-printed implant. Herein, we present two cases of representative revision limb salvage surgeries that utilized another 3D-printed custom-made implant while retaining the previous 3D-printed custom-made implant. A 3D-printed connector implant was used to connect the previous 3D-printed implant to the proximal ulna of a 40-year-old man and to the femur of a 69-year-old woman. The connector bodies for the two junctions of the previous implant and the remaining host bone were designed for the most functional position or angle by twisting or tilting. Using the previous 3D-printed implant as a taper, the 3D-printed connector was used to encase the outside of the previous implant. The gap between the previous implant and the new one was subsequently filled with bone cement. For both the upper and lower extremities, the 3D-printed connector showed stable reconstruction and excellent functional outcomes (Musculoskeletal Tumor Society scores of 87% and 100%, respectively) in the short-term follow-up. To retain the previous 3D-printed implant during revision limb salvage surgery, an additional 3D-printed implant may be a feasible surgical option.

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Outcomes of Tumor Resection and Reconstruction by Megaprosthesis around Knee: Our Experience

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i06.2254 ◽

2021 ◽

Vol 11 (3) ◽

Author(s):

Bikram Kesari Kar ◽

Mukund Madhav Ojha ◽

Sandeep Kumar Yadav ◽

Alok Chandra Agrawal ◽

Harshal Sakale

Keyword(s):

Local Recurrence ◽

Limb Salvage ◽

Lower Limbs ◽

Implant Failure ◽

Limb Salvage Surgery ◽

Musculoskeletal Tumor ◽

Musculoskeletal Tumor Society ◽

Prosthetic Reconstruction ◽

Msts Score

Introduction: In this modern era, limb reconstructive surgeries have become a standardized procedure for malignant tumor of lower limbs. We performed limb salvage surgeries for tumor around the knee with en bloc resection and subsequent reconstruction with a megaprosthesis. Methods: A total of six cases of malignant and locally aggressive tumor around the knee were operated on from 2017 to 2018, with resection and mega prosthetic reconstruction. Interpretation of functional outcome after surgery was performed with musculoskeletal tumor society (MSTS) score. Complications such as infection, local recurrence of tumor, implant failure, and distant metastases were evaluated during each follow-up. Results: Postoperatively, one patient developed superficial infection; one local recurrence with metastasis and the rest cases were uneventful. Patients were regularly followed for atleast1 year, and none of them developed any sign of deep infection, implant failure,or loosening. At the beginning of treatment, the average MSTS score was 8.83, which showed a significant increment to 25.83 after 12 months of follow-up. Conclusion: Albeit few cases were operated on, we draw this inference from our short-term experience that mega prosthesis acts as a boon to orthopedic surgeons in musculoskeletal tumor management, thereby uplifting the quality of life of patients even during terminal care. Keywords: Limb salvage surgery, osteosarcoma, giant cell tumor, megaprosthesis.

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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?

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02355-7 ◽

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.

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Three-dimensional-printed custom-made hemipelvic endoprosthesis for the revision of the aseptic loosening and fracture of modular hemipelvic endoprosthesis: a pilot study

BMC Surgery ◽

10.1186/s12893-021-01257-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jie Wang ◽

Li Min ◽

Minxun Lu ◽

Yuqi Zhang ◽

Jingqi Lin ◽

...

Keyword(s):

Pilot Study ◽

Aseptic Loosening ◽

Pelvic Ring ◽

The Body ◽

Harris Hip Score ◽

Short Term ◽

Musculoskeletal Tumor Society ◽

Custom Made ◽

3D Printed

Abstract Background The aims of this pilot study were (1) to assess the efficacy of 3D-printed custom-made hemipelvic endoprosthesis in restoring the natural location of acetabulum for normal bodyweight transmission; (2) to evaluate the short-term function of the revision with this endoprosthesis and (3) to identify short-term complications associated with the use of this endoprosthesis. Methods Between February 2017 and December 2017, seven patients received revision with 3D-printed custom-made hemipelvic endoprosthesis. The body weight moment arm (BWMA) and cup height discrepancy (CHD) after primary and revisional surgery were analyzed to assess acetabulum location with plain radiography. After a median follow-up duration of 29 months (range 24–34), the function was evaluated with the Musculoskeletal Tumor Society (MSTS-93) score and Harris hip score (HHS). Complications were recorded by chart review. Results The acetabulum locations were deemed reasonable, as evaluated by median BWMA (primary vs. revision, 10 cm vs. 10 cm) and median CHD (primary vs. revision, 10 mm vs. 8 mm). The median MSTS-93 score and HHS score were 21 (range 18–23) and 78 (range 75–82) after the revision. No short or mid-term complication was observed in the follow-up of this series. Conclusions Revision with 3D-printed custom-made hemipelvic endoprostheses benefited in reconstructing stable pelvic ring and natural bodyweight transmission for patients encountering the aseptic loosening and fracture of modular hemipelvic endoprosthesis. The revision surgery and appropriate rehabilitation program improved patients’ function to a median MSTS score of 22 and pain-free ambulation. The incidence of the complications was low via this individualized workflow.

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Case Report of a Posterior Malleolus Metastasis: A Very Rare Metastasis Localization

Journal of the American Podiatric Medical Association ◽

10.7547/20-142 ◽

2021 ◽

Vol 111 (2) ◽

Author(s):

Koray Başdelioğlu ◽

Gonca Civi

Keyword(s):

Salvage Surgery ◽

Distal Tibia ◽

Metastatic Lesion ◽

Limb Salvage Surgery ◽

Ankle Pain ◽

Musculoskeletal Tumor ◽

Musculoskeletal Tumor Society ◽

Medial Side ◽

Posterior Malleolus

Metastasis of the distal tibia is quite rare. In this article, we present the case of a 58-year-old woman with distal tibial metastasis located in the posterior malleous caused by breast cancer. She had left ankle pain and nonweightbearing status that had been ongoing for 2 months and showed progression. The patient's Mirels score was 10. Limb salvage surgery was performed by removing the metastatic lesion by posterior ankle incision followed by applying a double plate from the posterior and the medial side of the distal tibia, and the defect was reconstructed with methylmethacrylate. Consequently, good stability was achieved. Radiotherapy consisting of 10 fractions (2000 cGy total) was applied to the distal tibia at postoperative week 3. There were no complications after surgery. No recurrence was observed at the 18-month follow-up of the patient. The Musculoskeletal Tumor Society Score at the 18-month control of the patient was 86%. Use of curettage of the metastatic mass, double-plate application, and defect reconstruction with methylmethacrylate is an effective method for distal tibia metastases located in the posterior malleolus.

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The Neoadjuvant Chemotherapy and Expandable Prosthesis Reconstruction to Treat Osteosarcoma Around the Knee in Child

10.21203/rs.3.rs-120042/v1 ◽

2020 ◽

Author(s):

Jiajia Cheng ◽

Junqi Huang ◽

Wenzhi Bi ◽

Gang Han ◽

Jinpeng Jia ◽

...

Keyword(s):

Neoadjuvant Chemotherapy ◽

Limb Salvage ◽

Growth Period ◽

Functional Results ◽

Limb Salvage Surgery ◽

High Survival ◽

Level Of Evidence ◽

Musculoskeletal Tumor ◽

Musculoskeletal Tumor Society

Abstract Background: To investigate: (1) what are the prognosis in patients treated with this chemotherapy scheme and limb salvage; (2) what are the clinical outcomes of expandable endoprosthesis reconstruction in child?Methods: From January 2009 to December 2014, we retropected 29 skeletally immature kids ( mean age, 10.5 years; range, 6-15 years) with osteosarcoma around knee. Of the 29 patients who underwent neoadjuvant chemotherapy and limb salvage surgery, this expandable prosthesis was implanted to reconstruct. These 29 patients were included in our retrospection. No patients were missed during follow-up. The evaluation index involved follow-up time, complication, functional results, lengthening procedures. The survivorship and recurrence were assessed by SPSS software. The function was assessed by Musculoskeletal Tumor Society (MSTS) scoring system.Results: A mean of follow-up time was 8.9 years (range, 6-12years). The overall 5-year survival was 89.1% based on Kaplan-Meier. Relapse suffered in three patients and one underwent amputation. Lung metastasis developed in one patient. At six months after operation, patients had a mean MSTS score of 27 points (range, 24-29). Two patients underwent revision surgery--one for implant infection and one for aseptic loosening.Conclusions: Chemotherapy scheme and limb salvage could achieved high survival rate. Use of this expandable prosthesis was associated with good function and low complication. The character of expandability could be a method to overcome discrepancy in the growth period.Level of Evidence Level IV, therapeutic study.

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One-Stage Soft Tissue Reconstruction Following Sarcoma Excision: A Personalized Multidisciplinary Approach Called “Orthoplasty”

Journal of Personalized Medicine ◽

10.3390/jpm10040278 ◽

2020 ◽

Vol 10 (4) ◽

pp. 278

Author(s):

Andrea Angelini ◽

Cesare Tiengo ◽

Regina Sonda ◽

Antonio Berizzi ◽

Franco Bassetto ◽

...

Keyword(s):

Surgical Resection ◽

Lower Limbs ◽

Surgical Approaches ◽

Soft Tissue Reconstruction ◽

Musculoskeletal Tumor ◽

Musculoskeletal Tumor Society ◽

One Stage ◽

Unplanned Excision ◽

Increased Risk ◽

Toronto Extremity Salvage Score

Background and Objectives. Wide surgical resection is a relevant factor for local control in sarcomas. Plastic surgery is mandatory in demanding reconstructions. We analyzed patients treated by a multidisciplinary team to evaluate indications and surgical approaches, complications and therapeutic/functional outcomes. Methods. We analyzed 161 patients (86 males (53%), mean age 56 years) from 2006 to 2017. Patients were treated for their primary tumor (120, 75.5%) or after unplanned excision/recurrence (41, 25.5%). Sites included lower limbs (36.6%), upper limbs (19.2%), head/neck (21.1%), trunk (14.9%) and pelvis (8.1%). Orthoplasty has been considered for flaps (54), skin grafts (42), wide excisions (40) and other procedures (25). Results. At a mean follow-up of 5.3 years (range 2–10.5), patients continuously showed no evidence of disease (NED) in 130 cases (80.7%), were alive with disease (AWD) in 10 cases (6.2%) and were dead with disease (DWD) in 21 cases (13.0%). Overall, 62 patients (38.5%) developed a complication (56 minor (90.3%) and 6 major (9.7%)). Flap loss occurred in 5/48 patients (10.4%). The mean Musculoskeletal Tumor Society (MSTS) and Toronto Extremity Salvage Score (TESS) was 74.8 ± 14 and 79.1 ± 13, respectively. Conclusions. Orthoplasty is a combined approach effective in management of sarcoma patients, maximizing adequate surgical resection, limb salvaging and functional recovery. One-stage reconstructions are technically feasible and are not associated with increased risk of complications.

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A Protocol for the Use of a Combined Microvascular Free Flap with Custom-Made 3D-Printed Total Temporomandibular Joint (TMJ) Prosthesis for Mandible Reconstruction in Children

Applied Sciences ◽

10.3390/app11052176 ◽

2021 ◽

Vol 11 (5) ◽

pp. 2176

Author(s):

Krzysztof Dowgierd ◽

Rafal Pokrowiecki ◽

Maciej Borowiec ◽

Marcin Kozakiewicz ◽

Dominika Smyczek ◽

...

Keyword(s):

Temporomandibular Joint ◽

Soft Tissues ◽

Total Joint Replacement ◽

Speech Development ◽

Functional Requirements ◽

Immediate Reconstruction ◽

Congenital Deformities ◽

Custom Made ◽

Masticatory System

Extended postoperative mandibular reconstructions due to orofacial disease involving the temporomandibular joint (TMJ) in immature patients remain a challenge as a result of ongoing growth, which is usually affected by the disease and treatment. Current reconstructive techniques based fully on alloplastic total joint replacement fail to meet fully the anatomical and functional requirements for the masticatory system and speech development. Fourteen children aged 12.6 ± 2.6 with tumors or congenital deformities affecting the mandible and TMJ were included in the study. Radical surgical treatment according to our own protocol was performed through microvascular anastomotic flap reconstruction of the soft tissues and bones, together with total TMJ custom replacements. Follow-up lasted 2–6 years. During the follow-up, increases in the mandible body (13% growth) and ramus (12% growth) were observed, both of which were related (p < 0.001). This is the first report concerning the immediate reconstruction of the mandible with ramus and total TMJ in children and adolescents that combines a free vascularized graft and total individual prosthesis of the TMJ. The presented technique enabled optimal function of the TMJ, growth of the mandible, and further rehabilitation of the patients. The technique was demonstrated to be safe, reliable, and provide good functional and cosmetic outcomes.

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Clinical outcome of operative treatment in 18 cases of giant cell tumors of bones

Journal of Chitwan Medical College ◽

10.3126/jcmc.v10i2.29677 ◽

2020 ◽

Vol 10 (2) ◽

pp. 67-71

Author(s):

Suresh Pandey

Keyword(s):

Clinical Outcome ◽

Giant Cell ◽

De Novo ◽

Excellent Result ◽

Giant Cell Tumors ◽

Musculoskeletal Tumor ◽

Musculoskeletal Tumor Society ◽

Non Union ◽

Proximal Fibula

Background: Giant Cell Tumor of the bone (GCTB) has got variable outcome after the different methods of surgical treatment depending upon the site and grade of lesion and extent of tumor removal. This retrospective prospective analysis of operatively treated cases of GCTB of different sites aimed to highlight the clinical outcome. Methods: This was a prospective observational study of 18 cases of GCTB; proximal tibia (n=6), distal femur (n=5), distal radius (n=4), proximal femur (n=1), proximal fibula (n=1) and anterior arc of first rib (n=1) treated with different operative management with mean follow up of 53.61 months. Functional outcome with Musculoskeletal Tumor Society Score (MSTS), recurrence and complications were analyzed with at least 24 months of follow up. Results: There were 10 females and 8 males with average age at presentation 27.3 years (range 15-38). Average duration of symptom was 4.72 months. 2 were cases of recurrence previously operated and 16 were de novo cases. Mean MSTS was 84.27% with good to excellent result in 88%. There were no non-union, graft failure, metastasis, prosthetic failure or wound infection till at least 24 months of follow up in any of the cases. Conclusions: Extended curettage or reconstruction with auto graft in grade I and II tumor or endoprosthesis in higher grade or recurrence of GCTB can give good to excellent functional result in majority of the cases.

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Reconstruction with Custom Unicondylar Hemiarthroplasty following Tumor Resection: A Case Series and Review of the Literature

The Journal of Knee Surgery ◽

10.1055/s-0039-1688556 ◽

2019 ◽

Vol 33 (08) ◽

pp. 818-824

Author(s):

Joseph A. Ippolito ◽

Megan L. Campbell ◽

Brianna L. Siracuse ◽

Joseph Benevenia

Keyword(s):

Distal Femur ◽

Weight Bearing ◽

Tumor Resection ◽

Case Series ◽

Full Weight Bearing ◽

Musculoskeletal Tumor ◽

Musculoskeletal Tumor Society ◽

Optimal Function ◽

Tumor Involvement

AbstractFor patients with tumors of the distal femur, options for limb salvage include tumor resection followed by reconstruction. While reconstruction commonly involves a distal femoral replacement, careful selection of patients with tumor involvement limited to a single condyle may be candidates for reconstruction with distal femur hemiarthroplasty. In these procedures, resection spares considerably more native anatomy. Three consecutive patients who underwent resection and reconstruction at the distal femur with custom unicondylar hemiarthroplasty are presented in this case series at a mean follow-up of 45 months (range, 26–78). In two cases, prostheses were utilized as a secondary procedure after failure of initial reconstruction. In one case, the custom prosthesis was utilized as the primary method of reconstruction. Mean Musculoskeletal Tumor Society disease-specific scores were 26.7 (range, 25–28). All patients achieved a return to full weight bearing, activities of daily living, and functional range of motion. In appropriately selected patients with tumors of the distal femur, reconstruction with custom unicondylar hemiarthroplasty provides benefits including optimal function postoperatively via preservation of tumor-free bone and ligamentous structures. Additionally, maintenance of greater bone stock may confer benefits to patients with pathology at a high likelihood for recurrence and need for subsequent procedures.

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