Reconstruction of Bony Defects after Tumor Resection with 3D‐Printed Anatomically Conforming Pelvic Prostheses through a Novel Treatment Strategy

Abstract

There has been an increasing interest and enormous applications in three-dimensional (3D) printing technology and its prosthesis, driving many orthopaedic surgeons to solve the difficult problem of bony defects and explore new ways in surgery approach. However, the most urgent problem is without an effective prosthesis and standard treatment strategy. In order to resolve these problems, this study was performed to explore the use of a 3D-printed anatomically conforming pelvic prosthesis for bony defect reconstruction following tumor resection and to describe a detailed treatment flowchart and the selection of a surgical approach. Six patients aged 48-69 years who had undergone pelvic tumor resection underwent reconstruction using 3D-printed anatomically conforming pelvic prostheses according to individualized bony defects between March 2016 and June 2018. According to the Enneking and Dunham classification, two patients with region I+II tumor involvement underwent reconstruction using the pubic tubercle-anterior superior iliac spine approach and the lateral auxiliary approach and one patient with region II+III and three patients with region I+II+III tumor involvement underwent reconstruction using the pubic tubercle-posterior superior iliac spine approach. The diagnoses were chondrosarcoma and massive osteolysis. After a mean follow-up duration of 30.33 ± 9.89 months (range, 18-42), all patients were alive, without evidence of local recurrence or distant metastases. The average blood loss and blood transfusion volumes during surgery were 2500.00 ± 1461.51 ml (range, 1200-5000) and 2220.00 ± 1277.62 m l (range, 800-4080), respectively. During follow-up, the mean visual analogue scale (VAS) score decreased, and the mean Harris hip score increased. There were no signs of hip dislocation, prosthetic loosening, delayed wound healing, or periprosthetic infection. This preliminary study suggests the clinical effectiveness of 3D-printed anatomically conforming pelvic prostheses to reconstruct bony defects and provide anatomical support for pelvic organs. A new surgical approach that can be used to expose and facilitate the installation of 3D-printed prostheses and a new treatment strategy are presented. Further studies with a longer follow-up duration and larger sample size are needed to confirm these encouraging results.

Clinical applications and prospects of 3D printing guide templates in orthopaedics

“…This reliance on 3D models of pre-curved plates to guide fracture repositioning provides a meaningful attempt to apply guide template technology to fracture repositioning [ 24 , 145 ]. Many other scholars have also made attempts to use adjunctive guides for different surgical procedures, such as personalized guided orthopedic guides and personalized bone defect repair guides [ 146 ], in order to allow more efficient and accurate solutions to difficult surgical problems [ 31 , 147 ].…”

Three‐dimensional printing‐based personalized limb salvage and reconstruction treatment of pelvic tumors

“…The outcome of patients with limb salvage reconstruction depends on the surgeon's clinical experience; therefore, different surgeons performing the procedure will lead to different outcomes (Table 3). 6,8,14,15,18‐24 In this study, we employed 3D printing, lesion models, osteotomy templates, and personalized pelvic prostheses for an integrated treatment of pelvic tumors and optimized design of the bone‐implant interface structure. Our study results showed that satisfactory early functional recovery and prosthesis survival rates were obtained based on patient prognosis, and early function.…”

“…There were nine patients with an excellent postoperative MSTS-93 lower limb functional score (>80%), eight with a good score (between 60% and 80%), and two with a fair score (between 40% and 3). 6,8,14,15,[18][19][20][21][22][23][24] In this study, we employed 3D printing, lesion models, osteotomy templates, and personalized pelvic prostheses for an integrated treatment of pelvic tumors and optimized design of the bone-implant interface structure. Our study results showed that satisfactory early functional recovery and prosthesis survival rates were obtained based on patient prognosis, and early function.…”

Reconstruction of Type I-II Internal Hemipelvectomy in a Patient With Pelvic Myxoid Chondrosarcoma: A Case Report

“…Reconstructive options can prevent significant differences in leg length and preserve hip joint function [5]. Complications are frequent, however, including infection, prosthesis loosening and failure, and fractures of the remaining bone or allografts, when used [5,7]. The choice of a particular technique for hip joint reconstruction depends on prognosis, functional capabilities of the patient, and particular surgical scenario and type of resection.…”

“…With advances in implantation techniques, oncology surgeons have gradually adopted prosthetic reconstruction of the pelvis after tumor resection [ 7 ]. Reconstructive options can prevent significant differences in leg length and preserve hip joint function [ 5 ].…”