3D-printed personalised prostheses for bone defect repair and reconstruction following resection of metacarpal giant cell tumours

Xu, Lin; Qin, Hao; Cheng, Zhilin; Jiang, Wenbo; Tan, Jia; Luo, Xiang; Huang, Wenhua

doi:10.21037/atm-21-3400

Cited by 7 publications

(6 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A spacer works well in unique anatomic bone, such as the calcaneus and talus, which cannot be replaced by any type of bone graft. Our metacarpal reconstruction showed excellent functional results and longevity, comparable to the result of Xu et al [32] (Table 2). However, for a spacer without a stem or joint for phalangeal bone, Beltrami [1] did not report subluxation, as we did.…”

Section: Discussionsupporting

confidence: 88%

What Are the MSTS Scores and Complications Associated With the Use of Three-dimensional Printed, Custom-made Prostheses in Patients Who Had Resection of Tumors of the Hand and Foot?

Chandhanayingyong,

Thanapipatsiri,

Pairojboriboon

et al. 2023

Clin Orthop Relat Res

View full text Add to dashboard Cite

Background There are a few good options for restoring bone defects in the hand and foot. 3D-printed implants have been used in the pelvis and elsewhere, but to our knowledge, they have not been evaluated in the hand and foot. The functional outcome, complications, and longevity of 3D-printed prostheses in small bones are not well known. Questions/purposes (1) What are the functional outcomes of patients with hand or foot tumors who were treated with tumor resection and reconstruction with a 3D-printed custom prosthesis? (2) What complications are associated with using these prostheses? (3) What is the 5-year Kaplan-Meier cumulative incidence of implant breakage and reoperation? Methods Between January 2017 and October 2020, we treated 276 patients who had tumors of the hands or feet. Of those, we considered as potentially eligible patients who might have extensive loss in their joint that could not be fixed with a bone graft, cement, or any prostheses available on the market. Based on this, 93 patients were eligible; a further 77 were excluded because they received nonoperative treatment such as chemoradiation, resection without reconstruction, reconstruction using other materials, or ray amputation; another three were lost before the minimum study follow-up of 2 years and two had incomplete datasets, leaving 11 for analysis in this retrospective study. There were seven women and four men. The median age was 29 years (range 11 to 71 years). There were five hand tumors and six tumors of the feet. Tumor types were giant cell tumor of bone (five), chondroblastoma (two), osteosarcoma (two), neuroendocrine tumor (one), and squamous cell carcinoma (one). Margin status after resection was ≥ 1 mm. All patients were followed for a minimum of 24 months. The median follow-up time was 47 months (range 25 to 67 months). Clinical data; function according to the Musculoskeletal Tumor Society, DASH, and American Orthopedic Foot and Ankle Society scores; complications; and survivorship of implants were recorded during follow-up in the clinic, or patients with complete charts and recorded data were interviewed on the telephone by our research associates, orthopaedic oncology fellows, or the surgeons who performed the surgery. The cumulative incidence of implant breakage and reoperation was assessed using a Kaplan-Meier analysis. Results The median Musculoskeletal Tumor Society score was 28 of 30 (range 21 to 30). Seven of 11 patients experienced postoperative complications, primarily including hyperextension deformity and joint stiffness (three patients), joint subluxation (two), aseptic loosening (one), broken stem (one), and broken plate (one), but no infection or local recurrence occurred. Subluxations of the metacarpophalangeal and proximal interphalangeal joints in two patients’ hands were caused by the design of the prosthesis without a joint or stem. These prostheses were revised to a second-generation prosthesis with joint and stem, leading to improved dexterity. The cumulative incidence of implant breakage and reoperation in the Kaplan-Meier analysis was 35% (95% CI 6% to 69%) and 29% (95% CI 3% to 66%) at 5 years, respectively. Conclusion These preliminary findings suggest that 3D implants may be an option for reconstruction after resections that leave large bone and joint defects in the hand and foot. Although the functional results generally appeared to be good to excellent, complications and reoperations were frequent; thus, we believe this approach could be considered when patients have few or no alternatives other than amputation. Future studies will need to compare this approach to bone grafting or bone cementation. Level of Evidence Level IV, therapeutic study.

show abstract

Section: Discussionsupporting

confidence: 88%

What Are the MSTS Scores and Complications Associated With the Use of Three-dimensional Printed, Custom-made Prostheses in Patients Who Had Resection of Tumors of the Hand and Foot?

Chandhanayingyong,

Thanapipatsiri,

Pairojboriboon

et al. 2023

Clin Orthop Relat Res

View full text Add to dashboard Cite

show abstract

“…Applying 3D printed titanium alloy prostheses to repair critical metaphyseal bone defects is a feasible treatment option, whose major advantages include: 1) the shape and structure of a prosthesis can be customized based on the irregular defect outline; 2) the appropriate mechanical strength of titanium alloy can rebuild the local biomechanical stability and help patients perform weight-bearing and functional exercise; 3) it can stimulate the bone growth in contact with the prosthesis (Ji et al, 2020;Migliorini et al, 2021;Xu et al, 2021). Tetsworth et al (2017) and Nwankwo et al (2019) successfully applied 3D printed framed-structured scaffolds to reconstruct distal femoral and tibial metaphyseal defects caused by comminuted fractures.…”

Section: Introductionmentioning

confidence: 99%

Mechanical Distribution and New Bone Regeneration After Implanting 3D Printed Prostheses for Repairing Metaphyseal Bone Defects: A Finite Element Analysis and Prospective Clinical Study

Liu

Li²,

Qiu³

et al. 2022

Front. Bioeng. Biotechnol.

View full text Add to dashboard Cite

Critical metaphyseal bone defects caused by nonunion and osteomyelitis are intractable to repair in clinical practice owing to the rigorous demanding of structure and performance. Compared with traditional treatment methods, 3D printing of customized porous titanium alloy prostheses offer feasible and safe opportunities in repairing such bone defects. Yet, so far, no standard guidelines for optimal 3D printed prostheses design and fixation mode have been proposed to further promote prosthesis stability as well as ensure the continuous growth of new bone. In this study, we used a finite element analysis (FEA) to explore the biomechanical distribution and observed new bone regeneration in clinical practice after implanting 3D printed prostheses for repairing metaphyseal bone defects. The results reflected that different fixation modes could result in diverse prosthesis mechanical conductions. If an intramedullary (IM) nail was applied, the stress mainly conducted equally along the nail instead of bone and prosthesis structure. While the stress would transfer more to the lateral bone and prosthesis’s body when the printed wing and screws are selected to accomplish fixation. All these fixation modes could guarantee the initial and long-term stability of the implanted prosthesis, but new bone regenerated with varying degrees under special biomechanical environments. The fixation mode of IM nail was more conducive to new bone regeneration and remodeling, which conformed to the Wolff’s law. Nevertheless, when the prosthesis was fixed by screws alone, no dense new callus could be observed. This fixation mode was optional for defects extremely close to the articular surface. In conclusion, our innovative study could provide valuable references for the fixation mode selection of 3D printed prosthesis to repair metaphyseal bone defect.

show abstract

“…9 c-f). The excised bone was replaced with prostheses having a head-and-handle geometry and a smooth surface [87] .…”

Section: Hand (Phalanx and Metacarpal)mentioning

confidence: 99%

Complex geometry and integrated macro-porosity: Clinical applications of electron beam melting to fabricate bespoke bone-anchored implants

Palmquist

Jolic²,

Hryha³

et al. 2023

Acta Biomaterialia

View full text Add to dashboard Cite

3D-printed personalised prostheses for bone defect repair and reconstruction following resection of metacarpal giant cell tumours

Cited by 7 publications

References 19 publications

What Are the MSTS Scores and Complications Associated With the Use of Three-dimensional Printed, Custom-made Prostheses in Patients Who Had Resection of Tumors of the Hand and Foot?

What Are the MSTS Scores and Complications Associated With the Use of Three-dimensional Printed, Custom-made Prostheses in Patients Who Had Resection of Tumors of the Hand and Foot?

Mechanical Distribution and New Bone Regeneration After Implanting 3D Printed Prostheses for Repairing Metaphyseal Bone Defects: A Finite Element Analysis and Prospective Clinical Study

Complex geometry and integrated macro-porosity: Clinical applications of electron beam melting to fabricate bespoke bone-anchored implants

Contact Info

Product

Resources

About