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

Hu, Xin; Lu, Minxun; Zhang, Yuqi; Li, Zhuangzhuang; Wang, Jie; Wang, Yitian; Xing, Zhengyi; Yang, Xiao; Tu, Chongqi; Min, Li

doi:10.1093/bjs/znad310

Cited by 7 publications

(12 citation statements)

References 70 publications

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“…(c) Preoperative software-guided surgical simulation to define tumor resection margins, design osteotomy guides, and achieve accurate osteotomy and prosthesis implantation during surgery. Reprinted with permission from Hu et al [ 16 ] ©2023 British Journal of Surgery …”

Section: Resultsmentioning

confidence: 99%

“… Complications: including infection, local recurrence, dislocation, aseptic loosening, endoprosthetic breakage, and delayed wound healing. Radiological outcome: Osteointegration was assessed using Tomosynthesis Shimadzu Metal Artefact Reduction Technology (T-SMART) [ 20 , 25 , 30 – 33 ]. The implant-host bone interfaces in all patients were analyzed.…”

Section: Methodsmentioning

confidence: 99%

“…Radiological outcome: Osteointegration was assessed using Tomosynthesis Shimadzu Metal Artefact Reduction Technology (T-SMART) [ 20 , 25 , 30 – 33 ]. The implant-host bone interfaces in all patients were analyzed.…”

Section: Methodsmentioning

confidence: 99%

“…Among them, the 3D-printed custom-made hemipelvic endoprosthesis with a porous structure offers improved stability, cosmesis, faster recovery, and unique benefits like enhanced osseointegration and long-term stability [ 12 – 15 ]. This technique has gained significant attention in clinical practice due to improved functionality and reduced postoperative complications compared to traditional methods [ 16 – 25 ].…”

Section: Introductionmentioning

confidence: 99%

“…(3) Pubic symphysis connects pelvis into a circular structure. Reprinted with permission from Hu et al [ 16 ] ©2023 British Journal of Surgery (d) West China Classification: 3D-printed pelvic prostheses were employed for Type A (hip joint loss), Type B (hip and sacroiliac joint loss), and Type C (hip, sacroiliac, and pubic symphysis joint loss) reconstructions after resecting typical pelvic tumors. Subtype a featured an intact obturator ring, while subtype b exhibited an incomplete obturator ring.…”

Section: Introductionmentioning

confidence: 99%

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3D-Printed custom-made hemipelvic endoprosthetic reconstruction following periacetabular tumor resection: utilizing a novel classification system

Hu,

Lu,

Wang

et al. 2024

BMC Musculoskelet Disord

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Background Customized 3D-printed pelvic implants with a porous structure have revolutionized periacetabular pelvic defect reconstruction after tumor resection, offering improved osteointegration, long-term stability, and anatomical fit. However, the lack of an established classification system hampers implementation and progress. Methods We formulated a novel classification system based on pelvic defect morphology and 3D-printed hemipelvis endoprostheses. It integrates surgical approach, osteotomy guide plate and prosthesis design, postoperative rehabilitation plans, and perioperative processes. Results Retrospectively analyzing 60 patients (31 males, 29 females), we classified them into Type A (15 patients: Aa = 6, Ab = 9), Type B (27 patients: Ba = 15, Bb = 12), Type C (17 patients). All underwent customized osteotomy guide plate-assisted tumor resection and 3D-printed hemipelvic endoprosthesis reconstruction. Follow-up duration was median 36.5 ± 15.0 months (range, 6 to 74 months). The mean operating time was 430.0 ± 106.7 min, intraoperative blood loss 2018.3 ± 1305.6 ml, transfusion volume 2510.0 ± 1778.1 ml. Complications occurred in 13 patients (21.7%), including poor wound healing (10.0%), deep prosthesis infection (6.7%), hip dislocation (3.3%), screw fracture (1.7%), and interface loosening (1.7%). VAS score improved from 5.5 ± 1.4 to 1.7 ± 1.3, MSTS-93 score from 14.8 ± 2.5 to 23.0 ± 5.6. Implant osseointegration success rate was 98.5% (128/130), with one Type Ba patient experiencing distal prosthesis loosening. Conclusion The West China classification may supplement the Enneking and Dunham classification, enhancing interdisciplinary communication and surgical outcomes. However, further validation and wider adoption are required to confirm clinical effectiveness.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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3D-Printed custom-made hemipelvic endoprosthetic reconstruction following periacetabular tumor resection: utilizing a novel classification system

Hu,

Lu,

Wang

et al. 2024

BMC Musculoskelet Disord

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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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Short‐to‐Mid‐Term Outcomes of Ipsilateral Femoral Head Autograft Combined with Uncemented Total Hip Replacement for Partial Periacetabular Defects Following Tumor Resection

Xie,

Ye,

Gong

et al. 2024

Orthopaedic Surgery

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ObjectivePeriacetabular tumors, especially in young to middle‐aged patients with invasive benign tumors or low‐grade malignant tumors involving type II or II + III, present significant challenges due to their rarity and the complexity of the anatomical and biomechanical structures involved. The primary difficulty lies in balancing the need to avoid unfavorable oncological outcomes while maintaining postoperative hip joint function during surgical resection. This study aimed to evaluate the effectiveness and reliability of a surgical method involving partial weight‐bearing acetabular preservation combined with the use of an uncontaminated femoral head autograft to reconstruct the segmental bone defect after intra‐articular resection of the tumorous joint, providing a solution that ensures both oncological safety and functional preservation of the hip joint in these patients.MethodsWe conducted a retrospective study with a follow‐up period of at least 36 months. From January 2010 to October 2020, we reviewed 20 cases of patients under 60 year of age with periacetabular invasive benign tumors or primary low‐grade malignant tumors. All patients underwent reconstruction of the tumorous joint using autologous femoral head grafts. Data collected included patient age, gender, tumor type, preoperative and postoperative visual analog scale (VAS) scores, Musculoskeletal Tumor Society (MSTS) scores, Harris Hip Scores (HHS), patient survival rates, postoperative tumor recurrence, and surgical complications. To analyze the data, we utilized various statistical methods, including descriptive statistics to summarize patient demographics and clinical characteristics, and paired sample t‐tests to compare preoperative and postoperative scores.ResultsThe study included 20 patients, and a total median follow‐up was 83 months. Their pathologic diagnoses comprised 13 giant cell tumors (GCTs), 5 chondrosarcomas, one chondroblastoma, and 1 leiomyosarcoma. Postoperatively, the median differences in vertical and horizontal center of rotation (COR) were 3.8 and 4.0 mm. Median limb length discrepancy (LLD) postoperatively was 5.7 mm (range, 2.3–17.8 mm). Two patients (10%) experienced delayed wound healing, resolved with antibiotics and early surgical debridement. One patient experienced dislocation 3 months postoperatively, which was promptly addressed under general anesthesia without further dislocation.ConclusionThrough multiplanar osteotomy with limited margins, femoral head autograft, and uncemented total hip replacement for pelvic segmental bone defects in selected patients in type II or II + III appears to be an encouraging limb‐sparing surgery worthy of consideration for carefully selected patients.

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

Cited by 7 publications

References 70 publications

3D-Printed custom-made hemipelvic endoprosthetic reconstruction following periacetabular tumor resection: utilizing a novel classification system

3D-Printed custom-made hemipelvic endoprosthetic reconstruction following periacetabular tumor resection: utilizing a novel classification system

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

Short‐to‐Mid‐Term Outcomes of Ipsilateral Femoral Head Autograft Combined with Uncemented Total Hip Replacement for Partial Periacetabular Defects Following Tumor Resection

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