Rigid reconstruction with periacetabular multiple screws after the resection of malignant pelvic tumours involving the sacroiliac joint

Otsuki, Bungo; Okamoto, Takeshi; Fujibayashi, Shunsuke; Sakamoto, Akio; Toguchida, Junya; Murata, Koichi; Shimizu, Takayoshi; Matsuda, Shinya

doi:10.1007/s00264-021-05096-0

Cited by 3 publications

(3 citation statements)

References 31 publications

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“…Therefore, immobilizing the lumbosacral region of the healthy side could contribute to a more even displacement level, avoiding increased compensatory range of motion and secondary joint degeneration to a certain extent. In addition, bilateral fixation acts against torsional stress and provides reliable stability ( Otsuki et al, 2021 ). Consequently, under vertical load, the pedicle screws and rods restrict the lower lumbar spine from physiological movement, causing it to endure greater stress, thereby becoming sites with peak stress in the entire reconstruction system ( Figures 4D–G ).…”

Section: Discussionmentioning

confidence: 99%

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

Peng¹,

Shen²,

Li³

et al. 2023

Front. Bioeng. Biotechnol.

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Background: Prosthetic reconstruction after type I + II+ III internal hemipelvectomy remains challenging due to the lack of osseointegration and presence of giant shear force at the sacroiliac joint. The purpose of this study was to evaluate the biomechanical properties of the novel 3D-printed, custom-made prosthesis with pedicle screw–rod system and sacral tray using finite element analysis.Methods: Four models that included one intact pelvis were established for validation. Forces of 500 N and 2,000 N were applied, respectively, to simulate static bipedal standing and the most loaded condition during a gait cycle. Biomechanical analysis was performed, and the results were compared; the preliminary outcomes of four patients were recorded.Results: For the reconstructed hemipelvis, stress was mainly concentrated on the sacral screws, bone–prosthesis interface, and upper endplate of the L5 vertebra. The optimization of the design with the sacral tray structure could decrease the peak stress of the sacral screws by 18.6%, while the maximal stress of the prosthesis increased by 60.7%. The addition of the lumbosacral pedicle–rod system further alleviated stress of the sacral screws and prosthesis by 30.2% and 19.4%, respectively. The site of peak stress was contemporaneously transferred to the connecting rods within an elastic range. In the retrospective clinical study, four patients who had undergone prosthetic reconstruction were included. During a follow-up of 16.6 ± 7.5 months, the walking ability was found preserved in all patients who are still alive and no prosthesis-related complications had occurred except for one hip dislocation. The Musculoskeletal Tumor Society (MSTS) score was found to be 19.5 ± 2.9.Conclusion: The novel reconstructive system yielded favorable biomechanical characteristics and demonstrated promising preliminary outcomes. The method can be used as a reference for reconstruction after type I + II + III hemipelvectomy.

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Section: Discussionmentioning

confidence: 99%

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

Peng¹,

Shen²,

Li³

et al. 2023

Front. Bioeng. Biotechnol.

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“…In this study, six consecutive patients underwent 3D-printed personalized implant reconstruction after Enneking type I + IV primary bone tumor resection ( Otsuki et al, 2021 ). To improve the stability of the reconstruction and allow for an early return to function, the prosthesis is screwed to the sacrum and acetabular roof.…”

Section: Discussionmentioning

confidence: 99%

A 3D-printed patient-specific modular implants for pelvic reconstruction of bone tumors involving the sacroiliac joint

Lv,

Li,

Yang

et al. 2023

Front. Bioeng. Biotechnol.

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Background: Current reconstruction methods of the pelvic ring after extensive resection of tumors involving the sacroiliac joint have a high incidence of failure. We aimed to study the effect of 3D-printed patient-specific implant reconstruction to show that this method is stable and has a low risk of failure.Methods: Between February 2017 and November 2021, six patients with bone tumors involving the sacroiliac joint (Enneking I + IV) who received 3D-printed patient-specific implants for pelvic reconstructive surgery were retrospectively analyzed. Two female and four male patients with a mean age of 41.83 years (range 25–65 years) were included. Two were osteosarcomas, two chondrosarcomas, one malignant fibrous histiocytoma, and one giant cell tumor of bone. For each patient, preoperative osteotomy guides were designed to ensure accurate tumor resection and individualized prostheses were designed to ensure a perfect fit of the bone defect. General, oncologic, and functional outcomes, implant status, and complications were retrospectively analyzed. The Visual Analog Scale (VAS) was used to assess pain and the Musculoskeletal Tumor Society (MSTS) score was used to assess hip function. Osseointegration was assessed by CT.Results: According to the preoperative design, complete resection of the entire tumor and reconstruction with a custom 3D-printed sacroiliac joint implant was completed without perioperative severe complications or deaths. Relatively satisfactory surgical margins were achieved. The mean operative time and intraoperative blood loss were 495 min (420–600 min) and 2533.33 mL (range, 1,200–3,500 mL), respectively. The mean follow-up was 49.83 months (range, 18–75 months). At the last follow-up, all four patients were disease-free, and the two patients who developed lung metastases were alive with tumors. All patients could walk unassisted. The mean VAS was 1.33 (range, 0–2). The mean MSTS score was 25.33 (range, 24–27). CT showed complete osseointegration of the implant to the ilium and sacrum.Conclusion: The 3D-printed custom prosthesis can effectively reconstruct pelvic stability after total sacroiliac joint resection with satisfactory clinical results.

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“…The results indicated that it was a relatively acceptable method with a lower complication rate, satisfactory functional outcomes, and feasibility for reconstruction for any type of periacetabular tumor resection ( 15 ). Despite this, the incidence of structural failures such as loosening and breakage of internal fixation has been reported to be between 11% and 33% ( 7 , 15 – 18 ). In recent years, with the application of 3D printing technology in orthopedics, 3D-printed prosthesis (3DP) has been used for reconstructing pelvic bone defect after tumor resection.…”

Section: Introductionmentioning

confidence: 99%

Comparison of customized 3D-printed prosthesis and screw-rod-cage system reconstruction following resection of periacetabular tumors

Zhu

Wang²,

Fu³

et al. 2022

Front. Oncol.

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Background and purposeVarious operative methods are used for reconstructing pelvic girdle after resection of primary malignant periacetabular tumor has been reported. The objective of this study was to evaluate the accuracy, effectiveness, and safety of customized three dimensional-printed prosthesis (3DP) in the reconstruction of bone defects compared with conventional reconstruction using the screw-rod-cage system.MethodsA retrospective case–control analysis of 40 patients who underwent pelvic tumor resection and reconstruction with a customized 3D-printed prosthesis (3DP), or screw-rod-cage system (SRCS) between January 2010 and December 2019 was performed. The minimum follow-up time for patients alive was 2 years. Blood loss, operation time, complications, surgical margin, local recurrence, distant metastases, status at time of latest follow-up, MSTS-93 score, Harris hip score, and postoperative radiographic parameters were recorded. Moreover, overall survival, tumor-free survival, and prosthesis survival rates in both groups were compared.ResultsCustomized 3DP reconstruction was performed in 15 patients, and SRCS reconstruction was done in 25 patients. The group of patients treated with customized 3DP reconstruction had significantly shorter operation time (323.7 ± 83.7 vs. 393.6 ± 98.8 min; P = 0.028) and more precise (all P < 0.05) radiographic reconstruction parameters than patients in the SRCS group. Fewer complications (P = 0.026), better MSTS score (P = 0.030), and better Harris hip score (P = 0.016) were achieved in the 3DP group. Furthermore, the survival rate of prosthesis was also significantly better in the 3DP group (P = 0.039). However, blood loss, surgical margin, local recurrence, distant metastases, and status at time of latest follow-up had no significant difference between two groups.ConclusionCompared with the screw-rod-cage system reconstruction, the customized 3D-printed prosthesis reconstruction is equally safe and effective, but it is more accurate and time-saving and is associated with fewer complications.

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Rigid reconstruction with periacetabular multiple screws after the resection of malignant pelvic tumours involving the sacroiliac joint

Cited by 3 publications

References 31 publications

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

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

A 3D-printed patient-specific modular implants for pelvic reconstruction of bone tumors involving the sacroiliac joint

Comparison of customized 3D-printed prosthesis and screw-rod-cage system reconstruction following resection of periacetabular tumors

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