3D-Printed Modular Endoprosthesis Reconstruction Following Total Calcanectomy in Calcaneal Malignancy

Abstract

Background: The use of 3D-printed endoprosthesis has been proposed as a viable limb-salvage procedure following total calcanectomy in patients with calcaneal malignancy. However, certain drawbacks persist concerning the prosthetic design. In this case series, we designed a modular endoprosthesis incorporating a novel drainage system, aiming to improve the functional outcomes and to promote wound healing. Methods: We retrospectively analyzed patients with calcaneal malignancy who underwent 3D-printed modular endoprosthesis reconstruction. Clinically, we evaluated functional outcomes using the 10-cm visual analog scale (VAS) score, the 1993 version of the Musculoskeletal Tumor Society (MSTS-93) score, and the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score. Complications were also recorded. Results: Five male patients met the final inclusion criteria. The median age was 20 years (range 13-47 years). The median follow-up time was 28 months (range, 13-65 months). Median postoperative functional MSTS-93, VAS, and AOFAS scores were 27 points (range, 25-29), 0 points (range, 0-1), and 86 points (range, 83-93), respectively. Wound healing was observed in all patients, and there were no complications related to the endoprosthesis at the last follow-up. Conclusion: The use of 3D-printed modular endoprosthesis was associated with satisfactory short-term outcomes in patients undergoing calcaneal reconstruction. The incorporation of a novel design featuring an integrated draining system has the potential to enhance wound healing and expedite functional recovery. Level of Evidence: Level IV, case series.

Foot & Ankle

“…Authors from Chengdu (China) described the surgical technique and initial outcomes for a case series of patients treated with a novel calcaneal replacement endoprosthesis. 2 They included five patients who underwent 3D-printed modular endoprosthetic reconstruction between June 2015 and January 2022. Patients had to have a histologically confirmed calcaneal malignancy, a favourable response of the tumour to neoadjuvant chemotherapy as confirmed by MRI without the involvement of neurovascular structures, absence of peripheral vascular disease, diabetes, tobacco use, and pulmonary metastasis at the time of diagnosis.…”