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World Journal of Surgical Oncology

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Open Access 01-12-2015 | Research

Implantation of customized 3-D printed titanium prosthesis in limb salvage surgery: a case series and review of the literature

Authors: Hongbin Fan, Jun Fu, Xiangdong Li, Yanjun Pei, Xiaokang Li, Guoxian Pei, Zheng Guo

Published in: World Journal of Surgical Oncology | Issue 1/2015

Abstract

Background

Although modular prosthesis is commercially available to meet requirements in most limb salvage surgeries, customized prosthesis is still needed. In contrast to traditional complicated procedures, rapid prototyping (RP) technique can directly manufacture customized titanium prosthesis. The objectives of this study were to describe the workflow of this technique and show the follow-up results of patients.

Methods

Three patients with clavicle Ewing’s sarcoma (ES), scapular ES, and pelvic chondrosarcoma (CS) were scanned by computer tomography (CT). The images were segmented and reconstructed for preoperative planning and prosthesis design. Then, the data of prosthesis were imported into an electron beam melting system to manufacture implants. These three patients received prosthesis implantation after tumor excision. They were followed up to evaluate survival rate, functional outcome, and complications.

Results

All patients were alive with no evidence of disease. The Musculoskeletal Tumor Society (MSTS) scores were 93, 73, and 90 % for patients with clavicle ES, scapular ES, and pelvic CS, respectively. No surgical complications including limb length discrepancy, screw loosening, and implant breakage were observed in current study.

Conclusions

Electron beam melting (EBM) is a useful method to directly manufacture customized titanium prostheses. It might improve the effectiveness of limb salvage surgery for sarcomas in unusual sites.

Lietman SA, Joyce MJ. Bone sarcomas: overview of management, with a focus on surgical treatment considerations. Cleve Clin J Med. 2010;77 Suppl 1:S8–12.CrossRefPubMed

Schuh R, Panotopoulos J, Puchner SE, Willegger M, Hobusch GM, Windhager R, et al. Vascularised or non-vascularised autologous fibular grafting for the reconstruction of a diaphyseal bone defect after resection of a musculoskeletal tumour. Bone Joint J. 2014;96-B(9):1258–63.CrossRefPubMed

Fan H, Guo Z, Wang Z, Li J, Li X. Surgical technique: unicondylar osteoallograft prosthesis composite in tumor limb salvage surgery. Clin Orthop Relat Res. 2012;470:3577–86.PubMedCentralCrossRefPubMed

Pala E, Henderson ER, Calabrò T, Angelini A, Abati CN, Trovarelli G, et al. Survival of current production tumor endoprostheses: complications, functional results, and a comparative statistical analysis. J Surg Oncol. 2013;108:403–8.CrossRefPubMed

Ji T, Guo W, Yang RL, Tang XD, Wang YF. Modular hemipelvic endoprosthesis reconstruction—experience in 100 patients with mid-term follow-up results. Eur J Surg Oncol. 2013;39:53–60.CrossRefPubMed

Guo W, Li D, Tang X, Yang Y, Ji T. Reconstruction with modular hemipelvic prostheses for periacetabular tumor. Clin Orthop Relat Res. 2007;461:180–8.PubMed

Witte D, Bernd L, Bruns J, Gosheger G, Hardes J, Hartwig E, et al. Limb-salvage reconstruction with MUTARS hemipelvic endoprosthesis: a prospective multicenter study. Eur J Surg Oncol. 2009;35:1318–25.CrossRefPubMed

Jaiswal PK, Aston WJ, Grimer RJ, Abudu A, Carter S, Blunn G, et al. Peri-acetabular resection and endoprosthetic reconstruction for tumours of the acetabulum. J Bone Joint Surg Br. 2008;90:1222–7.CrossRefPubMed

Chandrasekar CR, Grimer RJ, Carter SR, Tillman RM, Abudu A, Buckley L. Modular endoprosthetic replacement for tumours of the proximal femur. J Bone Joint Surg Br. 2009;91:108–12.CrossRefPubMed

10.

Kabukcuoglu Y, Grimer RJ, Tillman RM, Carter SR. Endoprosthetic replacementfor primary malignant tumors of the proximal femur. Clin Orthop Relat Res. 1999;358:8–14.CrossRefPubMed

11.

Guo Z, Wang Z, Wang Z, Zhang Y. Allograft of clavicle for reconstruction of bone defect after tumor resection. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2008;22:102–5.PubMed

12.

Mnaymneh WA, Temple HT, Malinin TI. Allograft reconstruction after resection of malignant tumors of the scapula. Clin Orthop Relat Res. 2002;405:223–9.CrossRefPubMed

13.

Puchner SE, Panotopoulos J, Puchner R, Schuh R, Windhager R, Funovics PT. Primary malignant tumours of the scapula—a review of 29 cases. Int Orthop. 2014;38:2155–62.CrossRefPubMed

14.

Shinjo K. Reconstruction of a segmental clavicular defect with a Marlex mesh-enveloped composite graft consisting of a hydroxyapatite prosthesis and autogenous bone: a case report. Jpn J Clin Oncol. 1992;22:221–4.PubMed

15.

Rengier F, Mehndiratta A, von Tengg-Kobligk H, Zechmann CM, Unterhinninghofen R, Kauczor HU, et al. 3D printing based on imaging data: review of medical applications. Int J Comput Assist Radiol Surg. 2010;5:335–41.CrossRefPubMed

16.

Ponader S, von Wilmowsky C, Widenmayer M, Lutz R, Heinl P, Körner C, et al. In vivo performance of selective electron beam-melted Ti-6Al-4V structures. J Biomed Mater Res A. 2010;92:56–62.CrossRefPubMed

17.

Li J, Li P, Lu H, Shen L, Tian W, Long J, et al. Digital design and individually fabricated titanium implants for the reconstruction of traumatic zygomatico-orbital defects. J Craniofac Surg. 2013;24:363–8.CrossRefPubMed

18.

Dewidar M, Mohamed HF, Lim JK. A new approach for manufacturing a high porosity Ti-6Al-4V scaffolds for biomedical applications. J Mater Sci Technol. 2008;24:931–5.

19.

Enneking WF, Dunham W, Gebhardt MC. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993;286:241–6.PubMed

20.

Malawer MM. Tumors of the shoulder girdle. Technique of resection and description of a surgical classification. Orthop Clin North Am. 1991;22:7–35.PubMed

21.

Singare S, Liu Y, Li D, Lu B, Wang J, He S. Individually prefabricated prosthesis for maxilla reconstuction. J Prosthodont. 2008;17:135–40.PubMed

22.

D'Urso PS, Earwaker WJ, Barker TM, Redmond MJ, Thompson RG, Effeney DJ, et al. Custom cranioplasty using stereolithography and acrylic. Br J Plast Surg. 2000;53:200–4.CrossRefPubMed

23.

Cho SH, Chang WG. Mirror-image anterior crown fabrication with computer-aided design and rapid prototyping technology: a clinical report. J Prosthet Dent. 2013;109:75–8.CrossRefPubMed

24.

Wang Z, Teng Y, Li D. Fabrication of custom-made artificial semi-knee joint based on rapid prototyping technique: computer-assisted design and manufacturing. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2014;18:347–51.

25.

Li Z, Xu SF, Li DC, Sun Z, Zhang T, Lu JX, et al. Composite artificial semi-knee joint system. Eur Rev Med Pharmacol Sci. 2014;18:1229–40.PubMed

26.

Dai KR, Yan MN, Zhu ZA, Sun YH. Computer-aided custom-made hemipelvic prosthesis used in extensive pelvic lesions. J Arthroplasty. 2007;22:981–6.CrossRefPubMed

27.

Horn TJ, Harrysson OL. Overview of current additive manufacturing technologies and selected applications. Sci Prog. 2012;95(Pt 3):255–82.CrossRefPubMed

28.

Harrysson O, Cansizoglu O, Marcellin-Little DJ, Cormier DR, West II HA. Direct metal fabrication of titanium implants with tailored materials and mechanical properties using electron beam melting technology. Mat Sci Eng C. 2008;28:366–73.CrossRef

29.

Rodriguez Martin J, Pretell Mazzini J, Viña Fernandez R, Marti Ciruelos R. Curto de la Mano A. Ewing sarcoma of clavicle in children: report of 5 cases. J Pediatr Hematol Oncol. 2009;31:820–4.CrossRefPubMed

30.

Tang X, Guo W, Yang R, Ji T, Sun X. Reconstruction with constrained prosthesis after total scapulectomy. J Shoulder Elbow Surg. 2011;20:1163–9.CrossRefPubMed

Title: Implantation of customized 3-D printed titanium prosthesis in limb salvage surgery: a case series and review of the literature
Authors: Hongbin Fan
Jun Fu
Xiangdong Li
Yanjun Pei
Xiaokang Li
Guoxian Pei
Zheng Guo
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: World Journal of Surgical Oncology / Issue 1/2015
Electronic ISSN: 1477-7819
DOI: https://doi.org/10.1186/s12957-015-0723-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Implantation of customized 3-D printed titanium prosthesis in limb salvage surgery: a case series and review of the literature

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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