Computer-Aided Design and 3D Printing of Hemipelvic Endoprosthesis for Personalized Limb-Salvage Reconstruction after Periacetabular Tumor Resection

Abstract

3D-printed hemipelvic endoprosthesis is an emerging solution for personalized limb-salvage reconstruction after periacetabular tumor resection. Further clinical studies are still required to report its surgical characteristics, outcomes, benefits and drawbacks. Sixteen consecutive patients underwent periacetabular tumor wide resection and pelvic reconstruction with a 3D-printed hemipelvic endoprosthesis from 2018 to 2021. The surgical characteristics and outcomes are described. The mean follow-up duration was 14.8 months (range, 3 to 43 months). Five patients underwent surgery for type I + II resection and reconstruction, seven for type II + III resection and reconstruction, three for type II resection and reconstruction, and one for type I + II + IV resection and reconstruction. The incidence of postoperative complication was 12.5% (2/16) for deep venous thrombosis (DVT), 12.5% (2/16) for pneumonia, and 12.5% (2/16) for would deep or superficial infection. During follow-up, two patients (12.5%) suffered hip dislocation and underwent revision surgery. CT demonstrated an obvious prosthetic porous structure–bone fusion after follow-up of at least 6 months. At the final follow-up, 12 lived with no evidence of disease while four lived with disease; no patients experienced pain; and 15 had independent ambulation, with a mean Musculoskeletal Tumor Society (MSTS) score of 85.8% (range, 26.7% to 100%). 3D-printed hemipelvic endoprosthesis facilitates wide resection of periacetabular tumor and limb-salvage reconstruction, thus resulting in good oncological and functional outcomes. The custom-made nature is able to well mimic the skeletal anatomy and microstructure and promote osseointegration. Perioperative complications and rehabilitation exercise still need to be stressed for this engineering technology-assisted major orthopedic surgery.

Point-of-Care Orthopedic Oncology Device Development

“…The areas away from the bone had a larger pore size and thicker beams to facilitate better manufacturability and the removal of trapped and un-melted powder particles after laser-based powder-bed fusion 3D printing, while the bone-contact regions had values as recommended in the literature, e.g., ~60-70% porosity with ~0.6 mm pore size [66,67]. Numerous 3D-printed implantable devices featuring cellular architectures have been researched, commercialized, and cleared by the FDA [12,13], and postoperative follow-ups of such porous morphologies have been proven to have good short-and mid-term outcomes [3,[75][76][77], including hemi-pelvic endo-prostheses that have shown good oncological and functional outcomes with stable fixation and good osseointegration without severe complications [78][79][80][81][82][83][84].…”

Implementation of an In-House 3D Manufacturing Unit in a Public Hospital’s Radiology Department

“…Thus, it should be borne in mind that it is in these complex cases where finding a comparative pair within a higher-level clinical study may not be feasible in the short term. Even the bias that this type of study may have must be considered, considering that 3D printing represents a small part of the clinical process, in addition to the continuous innovation of surgical techniques [ 44 ]. In these cases, clinical experience or the evolution of the surgical treatments themselves may have more impact on the final patient outcome than any other variable introduced in the process.…”

Pelvic-girdle reconstruction with three-dimensional-printed endoprostheses after limb-salvage surgery for pelvic sarcomas: current landscape

“…An incomplete pelvic ring reconstructive endoprosthesis 25 , 30 , 31 , 35 , 60 , as the name implies, refers to an implant that does not prioritize the comprehensive reconstruction of the pelvic ring. Instead, its primary objective lies in restoring the functionality of the hip joint and facilitating the transmission of weight-bearing forces through the sciatic buttress to the sacroiliac joint and/or sacrum.…”