Three-dimensional-printed porous prosthesis for the joint-sparing reconstruction of the proximal humeral tumorous defect

Abstract

Background: Tumorous bone defect reconstructions of the proximal humerus with joint sparing is a challenge. Numerous reconstruction methods have been proposed but the proximal residual humerus is commonly sacrificed because of its extremely short length. To preserve the proximal humerus and improve clinical outcomes, we designed a three-dimensional (3D) printed uncemented prosthesis with a porous structure to treat tumorous bone defects of the proximal humerus.Methods: Our analysis included seven patients treated between March 2018 and July 2019. A 3D model was established, and related data were obtained, including the diameter of the humeral head, the resection length, and the residual length. A prosthesis was designed and fabricated based on these data. Functional and oncologic outcomes were recorded, and complications and osseointegration were evaluated.Results: The mean age of the patients was 20.3 years, and the median follow-up period was 26 months. The lengths of the residual proximal humerus were 17.9 mm on average. All the patients had preserved humeral heads and most of the rotator cuff was intact. The average postoperative range of motion (ROM) of the affected shoulder was 83.8°; flexion was 82.5°, extension was 43.8°, and adduction was 16.3°. The average Musculoskeletal Tumor Society score (MSTS) was 94.3%. Good osseointegration was observed on the interface between the bone and prosthesis.Conclusion: A 3D printed porous prosthesis with cone-like structures successfully achieved joint-sparing reconstruction of proximal humeral tumorous defects with satisfying functional outcomes. The preservation of the rotator cuff and humeral head plays an essential role in the function of the shoulder joint.

Revision for Solid‐Body Breakage of the 3D‐Printed Implant Following Joint‐Sparing Surgery: A Technical Note

“…Three‐dimensional‐printed custom‐made implants provide an appealing reconstruction technique for limb or joint salvage surgeries. Promising functional outcomes using this technique have been reported in tibial, femoral, and humeral defect reconstruction 3,5,6,8,14,15 . Additionally, the radiographic evaluation revealed that the porous interface favored bone ingrowth for prolonged fixation 16 .…”

“…Promising functional outcomes using this technique have been reported in tibial, femoral, and humeral defect reconstruction. 3,5,6,8,14,15 Additionally, the radiographic evaluation revealed that the porous interface favored bone ingrowth for prolonged fixation. 16 However, one of the concerns associated with 3D-printed custommade implants is mechanical properties.…”

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

“…(Fig. 6 A-D) iv) Effective Osseointegration: Effective osseointegration at the prosthesis-bone interface is a vital condition for long-term prosthesis survival [ 32 , 36 , 57 , 58 ]. We incorporated a porous structure mimicking trabecular bone at the interface where the prosthesis contacts the bone.…”