Individualized reconstruction for severe periprosthetic fractures around the tumor prosthesis of knee under assistance of 3D printing technology

Abstract

Introduction:Periprosthetic femoral fractures (PFF) around tumor prosthesis of knee are stubborn problems for surgeons, huge bone defect and inappropriate biomechanics of the revision implant design can be disaster for reconstruction. With the development of three-dimensional (3D) printing technology, surgeons participate more in precise preoperative design and simulation for treatment of such fractures. In this study we explored an accurate and feasible way to restore normal anatomy and function of the knee joint with 3D printing technology.Case presentation:Rationale: This report explored an accurate and feasible way to treat PFF around tumor knee prosthesis in a 32 years old women with 3D printing technology, which restored normal anatomy and function of the knee joint. Patient concerns: Pain in left thigh lasted for 10 months after resection of left femoral chondroma and knee joint replacement four years ago. Diagnoses: periprosthetic femoral fractures (PFF) around tumor knee prosthesis.Interventions:CT images of the patient were collected and reconstructed. Parameters of bilateral femurs were virtually sliced and measured. Novel femoral stem and nail paths were specially designed by doctors according to these parameters. The prosthetic femoral stem components and navigator were customized by engineers according to the doctor's design. The residual femoral resin model, customized components and navigator were printed with Stereo Lithography Apparatus 3D printer. The shape-preconcerted allograft bone was selected as patch for the bone defect before operation with the printed bone model. All the steps were simulated preoperatively with the models printed, and then the operation was carried out. Outcomes: The operation was successfully performed. The postoperative x-ray image, MSTS93 scores were examined and the function restoration sustained well in the follow-up period from 1 month to 27 months. Lessons: 3D printing and medical interaction are key points in complex PFF cases.Conclusion:As for PFF of the complex tumor of knee, preoperative design and simulation with 3D printing technology may provide more accurate and effective operative outcome than traditional methods, which might be considered as a method suitable for popularization in complex and severe cases.

Correlation Between Conditional Approval and Customized Bone Implant Devices

“…Recent study on custom‐designed bone implants has mainly focuses on dentures or teeth, maxillary or mandible, and femurs. Other notable implant types include those for the humerus, the cranium/skull, and the tibia …”

Periprosthetic femoral fractures around tumor endoprostheses treated with limited revision surgery combined with allograft

“…Approximately 10% to 46% of femur fractures have recurred at the femoral anterior arch due to the anatomy of the anterior arch of the femur, which is also consistent with our case. [9,12,21] For our patient, the possible causes of OPFF may also be mechanical causes, such as a mismatch of the femur arc. Due to the mismatch between the angle at the femoral junction of the tumor prosthesis and the angle of the femoral arch, the indirect stress was concentrated on a certain point of the bone; with the addition of a trauma injury, slow damage occurred in the femoral cortex.…”

“…In contrast, Macdonald et al, [7] in a series of 14 fractures treated by revision of the implant, showed a more favorable outcome with no revision at 8 years. Recently, Han et al [12] applied 3D printing technology to design prosthetic components and navigators for the treatment of PFF around the knee joint. According to the detailed and comprehensive information of this case, first, we suggested a complete revision surgery with a high rate of risk and complication, but the patient and her family refused for personal concern.…”

“…[7,13] Tumor endoprostheses are massive, often with limited bone available for fixation, and patients with old periprosthetic femoral fractures (OPFFs) usually exhibit large-scale bone defects, difficult-to-identify anatomic structures due to soft-tissue pigmentation, and limb shortening with accompanied peripheral soft tissue damage. [8,12] Furthermore, these patients may be reluctant to undergo revision surgery associated with a high rate of risk and complications. To the best of our knowledge, there is very limited evidence regarding the treatment of OPFFs around tumor endoprostheses.…”

Retrospective Analysis of Articular Surface Defect Cases Caused by Pathological Fracture of Giant Cell Tumor of Distal Femur Treated With Three-Dimension-Printed Custom-Made Prostheses Versus Conventional Endoprosthesis Replacement: Three-Dimension-Printed Custom-Made Prostheses Have Better Function Outcome

“…In recent decades, with the development of technology, 3D-printing technology was reported that had enhanced the accuracy and individuation of orthopedic surgeries [7][8][9]. The use of 3D-printing technology in orthopedic surgery allows greater freedom of prosthetic design and the fabrication of more complex shapes [10], so it is the possibility to reconstruct defects in musculoskeletal oncology with personalized custom-made prostheses [11] .…”