A Case Report: Custom Made Porous Titanium Implants in Revision: A New Option for Complex Issues

Abstract

Background: Bone loss management is considered one of the most difficult challenges for orthopaedic surgeon. In massive bone defects, few surgical options are available and they do not offer a reliable or optimal solution for knee reconstruction. Objective: The aim of this paper is to present and justify a new custom-made approach for complex metadiaphyseal bone defects management in knee revision surgery. Methods: We report a case of a 66-year-old woman who underwent a staged left total knee arthroplasty revision for infection with Anderson Orthopaedic Research Institute classification III uncontained femoral and tibial metadiaphyseal bone defects following five prior surgeries. Along with a case discussion, we describe clinical and radiological outcomes of 3 similar patients treated with this new custom-made device. Results: To manage these problems, we developed new, custom porous titanium devices for both femoral and tibial reconstruction tailored to a patient’s specific bone loss. Since, 2014, we treated four cases using custom-made porous titanium cones and we had optimal clinical and radiological results, with no instances of loosening, component migration, or mismatches between preoperative planning and intraoperative findings. Conclusion: In extremely selected cases, this new device can be considered a possible and viable surgical step between “off the shelf” reconstruction implants and knee substitution with a tumor megaprosthesis.

Numerical and Experimental Analysis of the Change in the Mechanical Properties Induced by Different Material Internal Features

“…Comparison has been made with several studies that showed lower and homogeneous stresses' distribution on porous implants when compared with traditional nonporous materials. 28,34,35 In addition to that, nowadays, a single component can be produced using 3D printing, enabling every aspect, and achieving high-dimensional accuracy in small geometries. Nowadays, several companies are using 3D printing for the increasing need for optimization and customization of medical devices in the orthopedic ¯eld.…”

Acetábulo de metal trabeculado customizado na revisão de artroplastia total do quadril

“…Such models can add improvements to the fixation inserting flanges to add screws in the ilium, ischium, and/or pubic bone. 6 Another advantage is to foresee the difficulties of insertion of the made-to-measure acetabular component. Ideally, these advantages lead to a shorter surgical time, management of bone defect issues, and implant stability in a separate way.…”

“…Tais modelos podem agregar melhorias à fixação, inserindo flanges para agregar parafusos no ílio, ísquio e/ou osso púbico. 6 Outra vantagem é antecipar dificuldades de inserção do componente acetabular feito sob medida. Idealmente, essas vantagens levam a um tempo cirúrgico mais curto e ao gerenciamento dos problemas de defeitos ósseos, e à estabilidade do implante separadamente.…”

Custom-made endofemoral sleeves in knee revision surgery: case report and technical notes

“…Custom-made devices are a new and promising option in several complex surgical settings 4 . Burastero et al firstly reported the experience with custom porous titanium cones in complex knee revision surgery showing optimal short-term clinical and radiological outcomes 5 . These results are confirmed by Cherny et al 6 .…”