3D-printed hemipelvic prosthesis combined with a dual mobility bearing in patients with primary malignant neoplasm involving the acetabulum: clinical outcomes and finite element analysis

Abstract

Background Limb salvage reconstruction for pelvic tumors, especially periacetabular tumors, is challenging. We combined the use of dual mobility bearing and 3D-printed hemipelvic prosthesis to improve function and reduce the probability of complications after hemi-pelvic resection in patients with primary acetabular malignancy. The purpose of this study was to evaluate the efficacy and safety of this combination. Methods Between October 2011 and May 2021, 11 patients with malignancies involving the acetabulum received hemipelvic replacement with a 3D-printed prosthesis and dual mobility bearing. Follow‐up of postoperative survival, complications, and Musculoskeletal Tumor Society 93 (MSTS-93) lower limb functional scores were carried out. A finite element model of the postoperative pelvis was developed and input into the finite element analysis software. The Von Mises equivalent stress formula was used to analyze the stress distribution of each part of the pelvis under one gait cycle and the stress distribution at different angles of the hip joint. Results By the last follow-up, 9 of the 11 patients (81.8%) were still alive, and 2 patients had local tumor recurrence. The complications including 1 deep infection and 1 dislocation of the artificial joint. Excluding 1 amputation patient, the average score of the remaining 8 patients at the last follow-up was 21.4/30 (71.3%) on the MSTS-93. In the reconstructed pelvis, stress distributions were concentrated on the junction between hemipelvic prosthesis and screw and iliac bone on the resected side, and between femoral prosthesis stem and femoral bulb, while the stress of polyethylene lining was small. Before impact, the polyethylene lining will rotate at a small angle, about 3°. The inner stress of polyethylene liner is greater than the outer stress in all conditions. The polyethylene liner has no tendency to slide out. Conclusion Pelvic tumor resection and reconstruction using 3D-printed hemipelvic prosthesis combined with dual mobility bearing was an effective treatment for pelvic tumors. Our patients achieved good early postoperative efficacy and functional recovery. The dual mobility bearing is beneficial to prevent dislocation, and the mechanical distribution and wear of the prosthesis are acceptable.

Analysis of contact pressure in a 3D model of dual-mobility hip joint prosthesis under a gait cycle

“…Furthermore, the gait cycle in the present study was adopted from Paul 35 with quasistatic force at specific time points to simplify the computational configuration. Dynamic force at the complete cycle is required to obtain more realistically accurate contact pressure results on dual-mobility hip joint prostheses 49,50 . Finally, the present results were only validated by Gao et al 31,37 on computational simulation results on single-and dual-mobility hip joint prostheses, but a comparison with corresponding experiments was not performed in the present study.…”

Three‐Dimensional Printed Plate Template Versus Hemipelvis Model in Patient‐Specific Plate Preparation for Posterior Wall Acetabular Fractures

“…In recent years, computer technology and advanced manufacturing have witnessed rapid development, and 3D printing technology is widely applied for orthopedic trauma for exactly contouring reconstruction plates 8,20–22 . By using the 3D printing‐based pre‐contoured plate for acetabular fracture reduction and plate fixation, Wang et al 22 pointed out that the surgery had less blood loss and shorter surgical time.…”

“…8,[10][11][12]19 In recent years, computer technology and advanced manufacturing have witnessed rapid development, and 3D printing technology is widely applied for orthopedic trauma for exactly contouring reconstruction plates. 8,[20][21][22] By using the 3D printing-based pre-contoured plate for acetabular fracture reduction and plate fixation, Wang et al 22 pointed out that the surgery had less blood loss and shorter surgical time. Compared with traditional intraoperative contouring, Chen et al 10 indicated that there were better clinical outcomes through the application of 3D printing technology and pre-contoured reconstruction plates in acetabular fracture surgery.…”

Reconstruction with 3D-printed prostheses after type I + II + III internal hemipelvectomy: Finite element analysis and preliminary outcomes

“…The four models were subjected to bipedal standing (Control, Model 1–3_B), and the femoral neck of the healthy and reconstructed sides was constrained symmetrically. An axial load of 2,000 N was imposed on the center of the artificial acetabulum in Model 3 (Model 3_E) to mimic the most loaded circumstance in one gait cycle ( Bergmann et al, 2001 ; Wang et al, 2022 ; Zhou et al, 2022 ). In terms of boundary conditions, the area of the upper surface of the L4 vertebral body was considered to be fully bonded ( Figure 2 ).…”