Three-dimension-printed custom-made prosthetic reconstructions: from revision surgery to oncologic reconstructions

Abstract

Background The use of custom-made 3D-printed prostheses for reconstruction of severe bone defects in selected cases is increasing. The aims of this study were to evaluate (1) the feasibility of surgical reconstruction with these prostheses in oncologic and non-oncologic settings and (2) the functional results, complications, and outcomes at short-term follow-up. Methods We analyzed 13 prospectively collected patients treated between June 2016 and January 2018. Diagnoses were primary bone tumour (7 patients), metastasis (3 patients), and revision of total hip arthroplasty (3 patients). Pelvis was the most frequent site of reconstruction (7 cases). Functional results were assessed with MSTS score and complications according to Henderson et al. Statistical analysis was performed using Kaplan-Meier and log-rank test curves.Results At a mean follow-up of 13.7 months (range, 6-26 months), all patients except one were alive. Oncologic outcomes show seven patients NED (no evidence of disease), one NED after treatment of metastasis, one patient died of disease, and another one was alive with disease. Overall survival was 100% and 80% at one and two years, respectively. Seven complications occurred in five patients (38.5%). Survival to all complications was 62% at two years of follow-up. Functional outcome was good or excellent in all cases with a mean score of 80.3%. Conclusion 3D-printed custom-made prostheses represent a promising reconstructive technique in musculoskeletal oncology and challenging revision surgery. Preliminary results were satisfactory. Further studies are needed to evaluate prosthetic design, fixation methods, and stability of the implants at long-term.

Surgeons and robots

“…Robotic systems have assisted with planning closed fracture reduction and reconstruction and in performing surgery remotely such as in telemedicine in small towns, rural areas, and war zones [3,12]. Oncologic reconstruction using robotic made implants is already performed with good results [13].…”

The history of Italian Orthopaedics

“…When the failure of hip arthroplasty causes big acetabular defects, custom-made components promise good solutions with low complication rate [15]. Also, 3D-printed custom-made prostheses represent a promising reconstructive technique, both in musculoskeletal oncology and in challenging revision [16].…”

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] . This technology can not only increase the accuracy of the reconstruction, but also reduce the rate of post-operative complications and potentially improving stability [12].…”