Highly Cancellous Titanium Alloy (TiAl6V4) Surfaces on Three-Dimensionally Printed, Custom-Made Intercalary Tibia Prostheses: Promising Short- to Intermediate-Term Results

Guder, Wiebke; Hardes, Jendrik; Nottrott, Markus; Podleska, Lars Erik; Streitbürger, Arne

doi:10.3390/jpm11050351

Cited by 20 publications

(27 citation statements)

References 25 publications

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“…The separation of the prosthesis and the surrounding tissue creates a potential cavity while producing relative sliding, increasing the risk of deep infection. 3D-printed highly cancellous surface was reported to facilitate soft tissue ingrowth during revision surgery ( 43 ). In this study, we first discover the soft tissue infiltration in the heterogeneous porous structure.…”

Section: Discussionmentioning

confidence: 99%

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

Shen

Peng

et al. 2022

Front. Oncol.

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BackgroundReconstruction of pelvis girdle stability after tumor-induced hemipelvectomy remains challenging. We surgically treated 13 patients with custom-made, three-dimensional printed hemipelvic prostheses. We aim to identify the preliminary outcomes for patients who have been managed with more mixed regions of prosthetic pelvic reconstruction and the feasibility of two reconstructive systems.MethodsSeven male patients and 6 female patients treated at our center between January 2019 and May 2021 were included. There were 11 primary sarcomas and 2 solitary bone metastases. After en bloc tumor resection, two types of personalized, three-dimensional printed prostheses were fixed to restore the stability and rebuild the load transfer. The position of the reconstructed hemipelvis was evaluated on an anteroposterior plain radiograph. The complications and outcomes were traced. One amputation specimen was discovered through histological analysis of the porous structure.ResultsThe operative duration was 467 ± 144 min, and the blood loss was 3,119 ± 662 ml. During a follow-up of 22.4 ± 8.5 months, two patients had delayed wound healing and one had a second-stage flap transfer. One patient with osteosarcoma died of pulmonary metastasis 27 months after surgery. Two patients with marginal resection suffered from local recurrence and had extra surgeries. One patient had traumatic hip dislocation 2 months after surgery and manipulative reduction was performed. The acetabular inclination of the affected side was 42.2 ± 4.3°, compared with 42.1 ± 3.9° on the contralateral side. The horizontal distance between the center of the femoral head and the middle vertical line was 10.4 ± 0.6 cm, while the reconstructed side was 9.8 ± 0.8 cm. No significant difference in acetabular position after surgery was found (p > 0.05). The amputation specimen harvested from one patient with local recurrence demonstrated bone and soft tissue ingrowth within the three-dimensional printed trabecular structure. Walking ability was preserved in all patients who are still alive and no prosthesis-related complications occurred. The MSTS score was 22.0 ± 3.7.ConclusionsBoth types of custom-made, three-dimensional printed prostheses manifested excellent precision, mechanical stability, and promising functional rehabilitation. The porous structure exhibited favorable histocompatibility to facilitate the ingrowth of bone and soft tissue.

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Section: Discussionmentioning

confidence: 99%

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

Shen

Peng

et al. 2022

Front. Oncol.

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“…The lattice structure can be altered by changing the CAD model to modify mechanical properties and biological performance. The patient-individualized and anatomy-imitating implants in complex geometric and biomechanical sites have shown promising results in osteoarticular and intercalary reconstructions following limb- and joint-salvage surgeries ( 13 , 37 ). Considering several advantages of 3D-printed implants, we designed a custom-made, uncemented prosthesis.…”

Section: Discussionmentioning

confidence: 99%

“…The introduction of image processing and three-dimensional (3D) printing technology has ushered in a new era in oncological orthopedics for patient-specific reconstruction. Although there are concerns regarding the lack of international standards and evaluation systems, ability to clean lattice structures, and mechanical strength ( 12 ), 3D-printed trabecular meshwork, featured by excellent biocompatibility and intrinsic osteogenic property ( 13 , 14 ), has been applied in prosthesis fabrication.…”

Section: Introductionmentioning

confidence: 99%

Case Report: 3D-Printed Prosthesis for Limb Salvage and Joint Preservation After Tibial Sarcoma Resection

Zhang

Que

et al. 2022

Front. Surg.

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IntroductionReconstruction of massive tibial defects in ankle joint-preserving surgery remains challenging though biological and prosthetic methods have been attempted. We surgically treated a patient with only 18-mm distal tibia remaining and reconstructed with a unique three-dimensional printed prosthesis.Case Presentation, Intervention, and OutcomesA 36-year-old male presented to our clinic with complaints of gradually swelling left calf and palpable painless mass for five months. Imageological exam indicated a lesion spanning the entire length of the tibia and surrounding the vascular plexus. Diagnosis of chondrosarcoma was confirmed by biopsy. Amputation was initially recommended but rejected, thus a novel one-step limb-salvage procedure was performed. After en-bloc tumor resection and blood supply rebuilding, a customized, three-dimensional printed prosthesis with porous interface was fixed that connected the tumor knee prosthesis and distal ultra-small bone segment. During a 16-month follow-up, no soft tissue or prosthesis-related complications occurred. The patient was alive with no sign of recurrence or metastasis. Walking ability and full tibiotalar range of motion were preserved.ConclusionsCustom-made, three-dimensional printed prosthesis manifested excellent mechanical stability during the follow-up in this joint-preserving surgery. Further investigation of the durability and rate of long-term complications is needed to introduce to routine clinical practice.

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“…Personalized 3D printed implants to reconstruct bone defects are on the rise. Despite their price and regulatory affairs, a growing body of literature shows the trend towards personalized medicine [ 33 – 35 ]. However, the role of 3D printed implants in limb reconstruction has yet to be defined, and innovative low-cost technology may become applicable on a large scale in resource-limited environments.…”

Section: Implant Choice Cost and Availabilitymentioning

confidence: 99%

Limb reconstruction in a resource-limited environment

Ferreira

Sabharwal

Hosny

et al. 2021

SICOT-J

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Introduction: Limb salvage and reconstruction are often challenging and even more so in the limited resource setting. The purpose of this narrative review is to explore the strategies for addressing the unique obstacles and opportunities of limb reconstructive surgery in resource-limited environments globally. Methods: We review (1) the global burden and dimension of the problem, (2) the relevance of orthopedic forums and communication, (3) free and open-access software for deformity analysis and correction, (4) bidirectional learning opportunities, and the value of fellowships and mentoring between resource-rich and resource-limited countries, and (5) how societies like SICOT can help to tackle the problem. Finally, case examples are presented to demonstrate the choice of surgical implants, their availability in regions with limited resources, and how the universal principles of limb reconstruction can be applied, irrespective of resource availability. Results: Limb reconstruction can often be life-changing surgery with the goals of limb salvage, improved function, and ambulation. The contradiction of relatively few severe limb deformities in high-income countries (HICs) with abundant resources and the considerable burden of limb deformities in resource-limited countries is striking. Free, open access to education and software planning tools are of paramount importance to achieve this goal of limb reconstruction. Bidirectional learning, i.e., knowledge exchange between individual surgeons and societies with limited and abundant resources, can be reached via fellowships and mentoring. The presented cases highlight (1) fixator-assisted wound closure obliviating the need for plastic surgery, (2) open bone transport, and (3) hinged Ilizarov frames for correction of severe deformities. These cases underline that optimal clinical outcome can be achieved with low-cost and readily available implants when the principles of limb reconstruction are skillfully applied. Discussion: Limb lengthening and reconstruction are based on universally applicable principles. These have to be applied regardless of the planning tool or surgical implant availability to achieve the goals of limb salvage and improved quality of life.

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Highly Cancellous Titanium Alloy (TiAl6V4) Surfaces on Three-Dimensionally Printed, Custom-Made Intercalary Tibia Prostheses: Promising Short- to Intermediate-Term Results

Cited by 20 publications

References 25 publications

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

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

Case Report: 3D-Printed Prosthesis for Limb Salvage and Joint Preservation After Tibial Sarcoma Resection

Limb reconstruction in a resource-limited environment

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