Implantation of customized 3-D printed titanium prosthesis in limb salvage surgery: a case series and review of the literature

Abstract

BackgroundAlthough modular prosthesis is commercially available to meet requirements in most limb salvage surgeries, customized prosthesis is still needed. In contrast to traditional complicated procedures, rapid prototyping (RP) technique can directly manufacture customized titanium prosthesis. The objectives of this study were to describe the workflow of this technique and show the follow-up results of patients.MethodsThree patients with clavicle Ewing’s sarcoma (ES), scapular ES, and pelvic chondrosarcoma (CS) were scanned by computer tomography (CT). The images were segmented and reconstructed for preoperative planning and prosthesis design. Then, the data of prosthesis were imported into an electron beam melting system to manufacture implants. These three patients received prosthesis implantation after tumor excision. They were followed up to evaluate survival rate, functional outcome, and complications.ResultsAll patients were alive with no evidence of disease. The Musculoskeletal Tumor Society (MSTS) scores were 93, 73, and 90 % for patients with clavicle ES, scapular ES, and pelvic CS, respectively. No surgical complications including limb length discrepancy, screw loosening, and implant breakage were observed in current study.ConclusionsElectron beam melting (EBM) is a useful method to directly manufacture customized titanium prostheses. It might improve the effectiveness of limb salvage surgery for sarcomas in unusual sites.

Additive manufactured metallic implants for orthopaedic applications

“…The early case series are encouraging in various field of complex orthopaedic procedures, like bone tumour surgery [8][9][10]14], revision hip surgery [6,7,11], spinal implants [12][13][14] and trauma fracture fixation and reconstruction [15,16]. The additive manufacturing technology may address the reconstructive challenges that off-the-shelf, standard implants cannot provide for implant-size or disease-specific surgical requirement.…”

“…AM metallic implants have the great potential to customise the reconstructive needs at various locations of patients' skeleton. AM patient-specific implants have recently been applied for reconstruction in clavicular, scapular, calcaneal, pelvic and sacral bone tumours, which have complex bony geometry and no off-the-shelf implants available for bone reconstruction [8][9][10]14]. A case series of three patients with clavicle, scapular and pelvic bone sarcoma underwent tumour resection, and the bone defects were reconstructed with EBM fabricated titanium prostheses.…”

“…. . might improve the effectiveness of limb-saving surgery for sarcomas in unusual sites [8]. A series of 35 patients underwent resection of a pelvic tumour and reconstruction using AM tumour prostheses.…”

“…The standard traditional implants may not address the reconstructive challenges such as severe bone deformity or bone loss after implant loosening and bone tumour resection. With the advent of digital technologies in medical imaging, computer programming in three-dimensional (3D) modelling [1] and computer-assisted tools [2][3][4][5] in precise implant placement, there has been increasing interest in using patientspecific implants for complex orthopaedic reconstruction [6][7][8][9][10][11][12][13][14][15][16].…”

Advancements in three-dimensional titanium alloy mesh scaffolds fabricated by electron beam melting for biomedical devices: mechanical and biological aspects

“…To overcome this disadvantage, 3D porous Ti mesh/cage using EBM, was developed [160]. Research is in progress to 3D print titanium alloys to produce customized titanium prosthesis in limb salvage surgery to replace bones lost due to sarcoma [161]. Studies have demonstrated that porous Ti implants into the frontal skull of domestic pigs exhibited enhanced bone formation within the implant [162].…”