Biomechanical and clinical outcomes of 3D-printed versus modular hemipelvic prostheses for limb-salvage reconstruction following periacetabular tumor resection: a mid-term retrospective cohort study

Hu, Xin; Wen, Yang; Lu, Minxun; Luo, Yi; Zhou, Yong; Yang, Xiao; Tu, Chongqi; Min, Li

doi:10.1186/s13018-024-04697-w

Cited by 2 publications

(1 citation statement)

References 43 publications

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“…Small pelvic ring reconstruction is evident (red dashed circle), and outlet views show accurate sacroiliac joint screw placement, taking care to avoid the S1/S2 sacral foramina (red dashed box). Ischium and pubic bone screws provide stability and support (Reprinted with permission from Hu et al ©2024 Journal of Orthopaedic Surgery and Research [ 50 ]) …”

Section: Resultsmentioning

confidence: 99%

Advanced Pelvic Girdle Reconstruction with three dimensional-printed Custom Hemipelvic Endoprostheses following Pelvic Tumour Resection

Hu,

Lu,

Wang

et al. 2024

International Orthopaedics (SICOT)

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Purpose Resection of pelvic bone tumours and subsequent pelvic girdle reconstruction pose formidable challenges due to the intricate anatomy, weight-bearing demands, and significant defects. 3D-printed implants have improved pelvic girdle reconstruction by enabling precise resections with customized guides, offering tailored solutions for diverse bone defect morphology, and integrating porous surface structures to promote osseointegration. Our study aims to evaluate the long-term efficacy and feasibility of 3D-printed hemipelvic reconstruction following resection of malignant pelvic tumours. Methods A retrospective review was conducted on 96 patients with primary pelvic malignancies who underwent pelvic girdle reconstruction using 3D-printed custom hemipelvic endoprostheses between January 2017 and May 2022. Follow-up duration was median 48.1 ± 17.9 months (range, 6 to 76 months). Demographic data, imaging examinations, surgical outcomes, and oncological evaluations were extracted and analyzed. The primary endpoints included oncological outcomes and functional status assessed by the Musculoskeletal Tumor Society (MSTS-93) score. Secondary endpoints comprised surgical duration, intraoperative bleeding, pain control and complications. Results In 96 patients, 70 patients (72.9%) remained disease-free, 15 (15.6%) had local recurrence, and 11 (11.4%) succumbed to metastatic disease. Postoperatively, function improved with MSTS-93 score increasing from 12.2 ± 2.0 to 23.8 ± 3.8. The mean operating time was 275.1 ± 94.0 min, and the mean intraoperative blood loss was 1896.9 ± 801.1 ml. Pain was well-managed, resulting in substantial improvements in VAS score (5.3 ± 1.8 to 1.4 ± 1.1). Complications occurred in 13 patients (13.5%), including poor wound healing (6.3%), deep prosthesis infection (4.2%), hip dislocation (2.1%), screw fracture (1.0%), and interface loosening (1.0%). Additionally, all patients achieved precise implantation of customized prosthetics according to preoperative plans. T-SMART revealed excellent integration at the prosthesis-bone interface for all patients. Conclusion The use of a 3D-printed custom hemipelvic endoprosthesis, characterized by anatomically designed contours and a porous biomimetic surface structure, offers a potential option for pelvic girdle reconstruction following internal hemipelvectomy in primary pelvic tumor treatment. Initial results demonstrate stable fixation and satisfactory mid-term functional and radiographic outcomes.

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Section: Resultsmentioning

confidence: 99%

Advanced Pelvic Girdle Reconstruction with three dimensional-printed Custom Hemipelvic Endoprostheses following Pelvic Tumour Resection

Hu,

Lu,

Wang

et al. 2024

International Orthopaedics (SICOT)

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Modular Hemipelvic Prosthesis Preserves Normal Biomechanics and Showed Good Compatibility: A Finite Element Analysis

Luo,

Sheng,

Zhou

et al. 2024

JFB

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This study aimed to evaluate the biomechanical compatibility of a modular hemipelvic prosthesis by comparing stress distributions between an implanted pelvis and a healthy pelvis. Finite element analysis was used to simulate bilateral standing loads on both models, analyzing critical regions such as the sacroiliac joints, iliac crest, acetabulum, and prosthesis connection points. Six models with varied displacements of the hip joint rotational center were also introduced to assess the impact of deviations on stress distribution. The implanted pelvis had a stress distribution closely matching that of the intact pelvis, indicating that the prosthesis design maintained the biomechanical integrity of the pelvis. Stress patterns in displacement models with deviations of less than 10 mm were similar to the standard model, with only minor changes in stress magnitude. However, backward, upward, and inward deviations resulted in stress concentrations, particularly in the prosthesis connection points, increasing the likelihood of mechanical failure. The modular hemipelvic prosthesis demonstrated good biomechanical compatibility with minimal impact on pelvic stress distribution, even with moderate deviations in the hip joint’s rotational center; outward, forward, and downward displacements are preferable to minimize stress concentration and prevent implant failure in cases where minor deviations in the rotational center are unavoidable during surgery.

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Biomechanical and clinical outcomes of 3D-printed versus modular hemipelvic prostheses for limb-salvage reconstruction following periacetabular tumor resection: a mid-term retrospective cohort study

Cited by 2 publications

References 43 publications

Advanced Pelvic Girdle Reconstruction with three dimensional-printed Custom Hemipelvic Endoprostheses following Pelvic Tumour Resection

Advanced Pelvic Girdle Reconstruction with three dimensional-printed Custom Hemipelvic Endoprostheses following Pelvic Tumour Resection

Modular Hemipelvic Prosthesis Preserves Normal Biomechanics and Showed Good Compatibility: A Finite Element Analysis

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