Three‐dimensional‐printed customized prosthesis for pubic defect: clinical outcomes in 5 cases at a mean follow‐up of 24 months

Abstract

Background Pubic defects resulting from type III hemipelvectomy are commonly not reconstructed due to the need to preserve the weight-bearing axis. However, the opening of the anterior pelvic ring will inevitably lead to increased pelvic instability. To improve long-term pelvic stability, three-dimensional (3D)-printed customized prostheses were designed to reconstruct pubic defects. This study presents and evaluates the short-term clinical outcomes and complications from the use of this construct. Methods Five patients who underwent type III hemipelvectomy and 3D-printed customized prosthesis reconstruction at our institution between 2017 and 2019 were retrospectively analysed. Operation time and blood loss during the operation were recorded. Local and functional recovery was assessed. Prosthetic position and osseointegration were evaluated. Oncology results and complications were recorded. Results The prostheses consisted of three with stems and two without. The mean follow-up time was 23.6 months. At the last follow-up, all five patients were alive with no evidence of disease. No deep infections or local recurrence had occurred. The mean blood loss and mean intraoperative time were 1680 ml and 294 min, respectively. The mean functional MSTS score at the final follow-up was 29.8. Fretting wear around the prosthetic stem was found in 3 patients, while bone wear on the normal-side pubis was found in 2 patients. Osseointegration was observed in all patients. Conclusions 3D-printed customized prostheses for reconstructing pubic bone defects after type III hemipelvectomy showed acceptable early outcomes. The good outcomes were inseparable from the precision prosthesis design, strict surgical procedures, and sensible postoperative management.

Reconstruction with 3D-printed prostheses after type I + II + III internal hemipelvectomy: Finite element analysis and preliminary outcomes

“…The transposition leads to weak adductor strength and the limb tends to rotate externally, making it prone to Frontiers in Bioengineering and Biotechnology frontiersin.org anterior dislocation. The advantage of region III reconstruction is that it provides a rigid attachment for soft tissue reconstruction, which not only provides a direct barrier against pelvic viscera but also facilitates the attachment of the mesh for abdominal wall reconstruction to prevent the formation of hernias (Zhang et al, 2021). At the same time, the adductor muscles and hamstring muscles could be reattached anatomically, ensuring better functional recovery and pain improvement.…”

The pedicled sartorius flap and mesh (PSM) technique vs no reconstruction in repairing the defect after type III pelvic bone tumor resection: a retrospective study

“…On top of wound infections, herniation of the bladder or other organs has also been reported following type III pelvic bone tumor resections [14,22]. Multiple methods have been proposed to address postoperative herniation [14,15,23]. Allograft bones have been used to repair the pelvic ring defect following type III pelvic bone tumor resection with reportedly good results [15].…”

Reconstruction of Tumor-Induced Pelvic Defects With Customized, Three-Dimensional Printed Prostheses

“…Additionally, patients who underwent combined anterior-posterior ring fixation presented longer surgery time and operation-discharge interval (38). Zhang et al (39) attempted to reconstruct the pubic symphysis in patients with pubis defects. Fretting wear happened eventually around the stem inserting into contralateral pubis due to the low mobility of the sacroiliac joint.…”

“…Zhang et al. ( 39 ) attempted to reconstruct the pubic symphysis in patients with pubis defects. Fretting wear happened eventually around the stem inserting into contralateral pubis due to the low mobility of the sacroiliac joint.…”