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Luo Y, Sheng H, Zhou Y, Min L, Tu C, Luo Y. Modular Hemipelvic Prosthesis Preserves Normal Biomechanics and Showed Good Compatibility: A Finite Element Analysis. J Funct Biomater 2024; 15:276. [PMID: 39330251 PMCID: PMC11433228 DOI: 10.3390/jfb15090276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2024] [Revised: 09/13/2024] [Accepted: 09/19/2024] [Indexed: 09/28/2024] Open
Abstract
This study aimed to evaluate the biomechanical compatibility of a modular hemipelvic prosthesis by comparing stress distributions between an implanted pelvis and a healthy pelvis. Finite element analysis was used to simulate bilateral standing loads on both models, analyzing critical regions such as the sacroiliac joints, iliac crest, acetabulum, and prosthesis connection points. Six models with varied displacements of the hip joint rotational center were also introduced to assess the impact of deviations on stress distribution. The implanted pelvis had a stress distribution closely matching that of the intact pelvis, indicating that the prosthesis design maintained the biomechanical integrity of the pelvis. Stress patterns in displacement models with deviations of less than 10 mm were similar to the standard model, with only minor changes in stress magnitude. However, backward, upward, and inward deviations resulted in stress concentrations, particularly in the prosthesis connection points, increasing the likelihood of mechanical failure. The modular hemipelvic prosthesis demonstrated good biomechanical compatibility with minimal impact on pelvic stress distribution, even with moderate deviations in the hip joint's rotational center; outward, forward, and downward displacements are preferable to minimize stress concentration and prevent implant failure in cases where minor deviations in the rotational center are unavoidable during surgery.
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Affiliation(s)
- Yuanrui Luo
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Hongtao Sheng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu 610041, China
| | - Yong Zhou
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu 610041, China
| | - Li Min
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu 610041, China
| | - Chongqi Tu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu 610041, China
| | - Yi Luo
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu 610041, China
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Sun Y, Xue H, Wang X, Zhang J, Xu Z, Guo Y, Xin R, Yu Z, Han Q, Zhao X, Wang J, Ren L. Finite-element analysis of different fixation types after Enneking II + III pelvic tumor resection. Sci Rep 2024; 14:20878. [PMID: 39242632 PMCID: PMC11379819 DOI: 10.1038/s41598-024-71334-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 08/27/2024] [Indexed: 09/09/2024] Open
Abstract
The current primary treatment approach for malignant pelvic tumors involves hemipelvic prosthesis reconstruction following tumor resection. In cases of Enneking type II + III pelvic tumors, the prosthesis necessitates fixation to the remaining iliac bone. Prevailing methods for prosthesis fixation include the saddle prosthesis, ice cream prosthesis, modular hemipelvic prosthesis, and personalized prosthetics using three-dimensional printing. To prevent failure of hemipelvic arthroplasty protheses, a novel fixation method was designed and finite element analysis was conducted. In clinical cases, the third and fourth sacral screws broke, a phenomenon also observed in the results of finite element analysis. Based on the original surgical model, designs were created for auxiliary dorsal iliac, auxiliary iliac bottom, auxiliary sacral screw, and auxiliary pubic ramus fixation. A nonlinear quasi-static finite element analysis was then performed under the maximum load of the gait cycle, and the results indicated that assisted sacral dorsal fixation significantly reduces stress on the sacral screws and relative micromotion exceeding 28 μm. The fixation of the pubic ramus further increased the initial stability of the prosthesis and its interface osseointegration ability. Therefore, for hemipelvic prostheses, incorporating pubic ramus support and iliac back fixation is advisable, as it provides new options for the application of hemipelvic tumor prostheses.
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Affiliation(s)
- Yu Sun
- Orthopaedic Hospital, The Second Hospital of Jilin University, Changchun, 130012, China
| | - Haowen Xue
- Orthopaedic Hospital, The Second Hospital of Jilin University, Changchun, 130012, China
| | - Xiaonan Wang
- Orthopaedic Hospital, The Second Hospital of Jilin University, Changchun, 130012, China
| | - Jiaxin Zhang
- Orthopaedic Hospital, The Second Hospital of Jilin University, Changchun, 130012, China
| | - Zezhou Xu
- Key Laboratory of Engineering Bionics, Ministry of Education, Jilin University, Changchun, 130012, China
| | - Yunting Guo
- Key Laboratory of Engineering Bionics, Ministry of Education, Jilin University, Changchun, 130012, China
| | - Renlong Xin
- Key Laboratory of Engineering Bionics, Ministry of Education, Jilin University, Changchun, 130012, China
| | - Zhenglei Yu
- Key Laboratory of Engineering Bionics, Ministry of Education, Jilin University, Changchun, 130012, China
| | - Qing Han
- Orthopaedic Hospital, The Second Hospital of Jilin University, Changchun, 130012, China
| | - Xin Zhao
- Orthopaedic Hospital, The Second Hospital of Jilin University, Changchun, 130012, China.
| | - Jincheng Wang
- Orthopaedic Hospital, The Second Hospital of Jilin University, Changchun, 130012, China.
| | - Luquan Ren
- Key Laboratory of Engineering Bionics, Ministry of Education, Jilin University, Changchun, 130012, China.
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Oldhoff MGE, Kamal Z, Ten Duis K, Wubs FW, de Vries JPPM, Kraeima J, IJpma FFA. Semi-automated finite element analyses of surgically treated acetabular fractures to investigate the biomechanical behaviour of patient-specific compared to conventional implants. J Orthop Surg Res 2024; 19:541. [PMID: 39237975 PMCID: PMC11378568 DOI: 10.1186/s13018-024-04957-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 07/29/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND In acetabular fracture surgery, understanding the biomechanical behaviour of fractures and implants is beneficial for clinical decision-making about implant selection and postoperative (early) weightbearing protocols. This study outlines a novel approach for creating finite element models (FEA) from actual clinical cases. Our objectives were to (1) create a detailed semi-automatic three-dimensional FEA of a patient with a transverse posterior wall acetabular fracture and (2) biomechanically compare patient-specific implants with manually bent off-the-shelf implants. METHODS A computational study was performed in which we developed three finite element models. The models were derived from clinical imaging data of a 20-year-old male with a transverse posterior wall acetabular fracture treated with a patient-specific implant. This implant was designed to fit the patient's anatomy and fracture configuration, allowing for optimal placement and predetermined screw trajectories. The three FEA models included an intact hemipelvis for baseline comparison, one with a fracture fixated with a patient-specific implant, and another with a conventional implant. Two loading conditions were investigated: standing up and peak walking forces. Von Mises stress and displacement patterns in bone, implants and screws were analysed to assess the biomechanical behaviour of fracture fixation with either a patient-specific versus a conventional implant. RESULTS The finite element models demonstrated that for a transverse posterior wall type fracture, a patient-specific implant resulted in lower peak stresses in the bone (30 MPa and 56 MPa) in standing-up and peak walking scenario, respectively, compared to the conventional implant model (46 MPa and 90 MPa). The results suggested that patient-specific implant could safely withstand standing-up and walking after surgery, with maximum von Mises stresses in the implant of 156 MPa and 371 MPa, respectively. The results from the conventional implant indicate a likelihood of implant failure, with von Mises stresses in the implant (499 MPa and 1000 MPa) exceeding the yield stress of stainless steel. CONCLUSION This study presents a workflow for conducting finite element analysis of real clinical cases in acetabular fracture surgery. This concept of personalized biomechanical fracture and implant assessment can eventually be applied in clinical settings to guide implant selection, compare conventional implants with innovative patient-specific ones, optimizing implant designs (including shape, size, materials, screw positions), and determine whether immediate full weight-bearing can be safely permitted.
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Affiliation(s)
- M G E Oldhoff
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
- 3D Lab/Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Z Kamal
- 3D Lab/Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - K Ten Duis
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - F W Wubs
- Bernoulli Institute for Mathematics, Computer Science and Artificial Intelligence, University of Groningen, Groningen, The Netherlands
| | - J P P M de Vries
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J Kraeima
- 3D Lab/Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - F F A IJpma
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Lin J, Song G, Huang A, Hu J, Tang Q, Lu J, Huang Y, Gong M, Zhu X, Wang J. Design and validation of a novel 3D-printed glenohumeral fusion prosthesis for the reconstruction of proximal humerus bone defects: a biomechanical study. Front Bioeng Biotechnol 2024; 12:1428446. [PMID: 39040498 PMCID: PMC11260710 DOI: 10.3389/fbioe.2024.1428446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 06/24/2024] [Indexed: 07/24/2024] Open
Abstract
Background All available methods for reconstruction after proximal humerus tumor resection have disadvantages, and the optimal reconstruction method remains uncertain. This study aimed to design a novel 3D-printed glenohumeral fusion prosthesis and verify its feasibility and safety using biomechanical methods. Methods We verified the feasibility and safety of the 3D-printed glenohumeral fusion prosthesis by finite element analysis and biomechanical experimentation. In the finite element analysis, three reconstruction methods were used, and displacement and von Mises stress were observed; on this basis, in the biomechanical experiment, models constructed with sawbones were classified into two groups. The force‒displacement curve of the 3D-printed prosthesis was evaluated. Results In terms of displacement, the finite element analysis showed greater overall stability for the novel prosthesis than traditional glenohumeral joint arthrodesis. There was no obvious stress concentration in the internal part of the 3D-printed glenohumeral fusion prosthesis; the stable structure bore most of the stress, and the force was well distributed. Adding lateral plate fixation improved the stability and mechanical properties of the prosthesis. Furthermore, the biomechanical results showed that without lateral plate fixation, the total displacement of the prosthesis doubled; adding lateral plate fixation could reduce and disperse strain on the glenoid. Conclusion The design of the 3D-printed glenohumeral fusion prosthesis was rational, and its stability and mechanical properties were better than those of traditional glenohumeral joint arthrodesis. Biomechanical verification demonstrated the feasibility and safety of this prosthesis, indicating its potential for proximal humerus bone defect reconstruction after tumor resection.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Xiaojun Zhu
- Department of Musculoskeletal Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jin Wang
- Department of Musculoskeletal Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
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Hu X, Wen Y, Lu M, Luo Y, Zhou Y, Yang X, Tu C, Min L. Biomechanical and clinical outcomes of 3D-printed versus modular hemipelvic prostheses for limb-salvage reconstruction following periacetabular tumor resection: a mid-term retrospective cohort study. J Orthop Surg Res 2024; 19:258. [PMID: 38654343 DOI: 10.1186/s13018-024-04697-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/22/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Debates persist over optimal pelvic girdle reconstruction after acetabular tumor resection, with surgeons grappling between modular and 3D-printed hemipelvic endoprostheses. We hypothesize superior outcomes with 3D-printed versions, yet scarce comparative research exists. This study fills the gap, examining biomechanics and clinical results retrospectively. METHODS From February 2017 to June 2021, we retrospectively assessed 32 patients undergoing en bloc resection for malignant periacetabular tumors at a single institution. PRIMARY OUTCOME limb function. SECONDARY OUTCOMES implant precision, hip joint rotation center restoration, prosthesis-bone osteointegration, and complications. Biomechanical characteristics were evaluated through finite element analysis on pelvic defect models. RESULTS In the 3D-printed group, stress distribution mirrored a normal pelvis, contrasting the modular group with elevated overall stress, unstable transitions, and higher stress peaks. The 3D-printed group exhibited superior functional scores (MSTS: 24.3 ± 1.8 vs. 21.8 ± 2.0, p < 0.05; HHS: 79.8 ± 5.2 vs. 75.3 ± 3.5, p < 0.05). Prosthetic-bone interface osteointegration, measured by T-SMART, favored 3D-printed prostheses, but surgery time (426.2 ± 67.0 vs. 301.7 ± 48.6 min, p < 0.05) and blood loss (2121.1 ± 686.8 vs. 1600.0 ± 505.0 ml, p < 0.05) were higher. CONCLUSIONS The 3D-printed hemipelvic endoprosthesis offers precise pelvic ring defect matching, superior stress transmission, and function compared to modular endoprostheses. However, complexity, fabrication expertise, and challenging surgical implantation result in prolonged operation times and increased blood loss. A nuanced consideration of functional outcomes, complexity, and patient conditions is crucial for informed treatment decisions. LEVEL OF EVIDENCE Level III, therapeutic study (Retrospective comparative study).
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Affiliation(s)
- Xin Hu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xang, Chengdu, 610041, Sichuan, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yang Wen
- Department of Orthopedics, Zigong Fourth People's Hospital, Zigong, 643000, People's Republic of China
| | - Minxun Lu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xang, Chengdu, 610041, Sichuan, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yi Luo
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xang, Chengdu, 610041, Sichuan, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yong Zhou
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xang, Chengdu, 610041, Sichuan, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xiao Yang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, 610064, Sichuan, People's Republic of China.
- Provincial Engineering Research Center for Biomaterials Genome of Sichuan, Sichuan University, Chengdu, 610064, People's Republic of China.
| | - Chongqi Tu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xang, Chengdu, 610041, Sichuan, People's Republic of China.
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Li Min
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xang, Chengdu, 610041, Sichuan, People's Republic of China.
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China.
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Zhu J, Hu J, Zhu K, Ma X, Wang Y, Xu E, Huang Z, Zhu Y, Zhang C. Design of 3D-printed prostheses for reconstruction of periacetabular bone tumors using topology optimization. Front Bioeng Biotechnol 2023; 11:1289363. [PMID: 38116196 PMCID: PMC10728281 DOI: 10.3389/fbioe.2023.1289363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/22/2023] [Indexed: 12/21/2023] Open
Abstract
Background: Prostheses for the reconstruction of periacetabular bone tumors are prone to instigate stress shielding. The purpose of this study is to design 3D-printed prostheses with topology optimization (TO) for the reconstruction of periacetabular bone tumors and to add porous structures to reduce stress shielding and facilitate integration between prostheses and host bone. Methods: Utilizing patient CT data, we constructed a finite element analysis (FEA) model. Subsequent phases encompassed carrying out TO on the designated area, utilizing the solid isotropic material penalization model (SIMP), and this optimized removal area was replaced with a porous structure. Further analyses included preoperative FEA simulations to comparatively evaluate parameters, including maximum stress, stress distribution, strain energy density (SED), and the relative micromotion of prostheses before and after TO. Furthermore, FEA based on patients' postoperative CT data was conducted again to assess the potential risk of stress shielding subsequent to implantation. Ultimately, preliminary follow-up findings from two patients were documented. Results: In both prostheses, the SED before and after TO increased by 143.61% (from 0.10322 to 0.25145 mJ/mm3) and 35.050% (from 0.30964 to 0.41817 mJ/mm3) respectively, showing significant differences (p < 0.001). The peak stress in the Type II prosthesis decreased by 10.494% (from 77.227 to 69.123 MPa), while there was no significant change in peak stress for the Type I prosthesis. There were no significant changes in stress distribution or the proportion of regions with micromotion less than 28 μm before and after TO for either prosthesis. Postoperative FEA verified results showed that the stress in the pelvis and prostheses remained at relatively low levels. The results of follow-up showed that the patients had successful osseointegration and their MSTS scores at the 12th month after surgery were both 100%. Conclusion: These two types of 3D-printed porous prostheses using TO for periacetabular bone tumor reconstruction offer advantages over traditional prostheses by reducing stress shielding and promoting osseointegration, while maintaining the original stiffness of the prosthesis. Furthermore, in vivo experiments show that these prostheses meet the requirements for daily activities of patients. This study provides a valuable reference for the design of future periacetabular bone tumor reconstruction prostheses.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Chunlin Zhang
- Department of Orthopedic Surgery, Institute of Bone Tumor, Shanghai 10th People’s Hospital Affiliated to Tongji University, Tongji University School of Medicine, Shanghai, China
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Hu X, Lu M, Zhang Y, Li Z, Wang J, Wang Y, Xing Z, Yang X, Tu C, Min L. Pelvic-girdle reconstruction with three-dimensional-printed endoprostheses after limb-salvage surgery for pelvic sarcomas: current landscape. Br J Surg 2023; 110:1712-1722. [PMID: 37824784 PMCID: PMC10638540 DOI: 10.1093/bjs/znad310] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/25/2023] [Accepted: 09/09/2023] [Indexed: 10/14/2023]
Abstract
Resection of pelvic bone tumors and the subsequent reconstruction of the pelvic girdle pose challenges due to complex anatomy, load-bearing demands, and significant defects. 3D-printed implants have revolutionized pelvic girdle reconstruction by offering customized solutions, porous surface structures for precise resection with custom guides, and improved integration. Many tertiary medical centers have adopted 3Dprinted hemipelvic endoprostheses, leading to enhanced outcomes. However, most studies are limited to single centers, with a small number of cases and short follow-up periods. Additionally, the design of these implants often relies heavily on individual experience, resulting in a lack of uniformity and significant variation. To provide a comprehensive assessment of this technology, we conducted an analysis of existing literature, encompassing tumor resection classification, various types of prosthesis design, reconstruction concepts, and post-reconstruction functional outcomes.
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Affiliation(s)
- Xin Hu
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Minxun Lu
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Yuqi Zhang
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Zhuangzhuang Li
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Jie Wang
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Yitian Wang
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Zhengyi Xing
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
- Provincial Engineering Research Center for Biomaterials Genome of Sichuan, Sichuan University, Chengdu, China
| | - Xiao Yang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
- Provincial Engineering Research Center for Biomaterials Genome of Sichuan, Sichuan University, Chengdu, China
| | - Chongqi Tu
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Li Min
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
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Liu X, Gao J, Wu X, Deng J, Li Z, Li R, Zhang L, Liu J, Li M. Comparison between Novel Anatomical Locking Guide Plate and Conventional Locking Plate for Acetabular Fractures: A Finite Element Analysis. Life (Basel) 2023; 13:2108. [PMID: 38004248 PMCID: PMC10671966 DOI: 10.3390/life13112108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/15/2023] [Accepted: 10/22/2023] [Indexed: 11/26/2023] Open
Abstract
The treatment of complex acetabular fractures remains a complicated clinical challenge. Our self-designed novel anatomical locking guide plate (NALGP) has previously shown promising potential in T-shaped acetabular fractures (TAF), but a direct comparison with conventional fixations is yet to be made. The TAF model was established based on a volunteer's computer tomography data and then fixed with double column locking plates (DLP), a posterior column locking plate with anterior column screws (LPACS), and our NALGP. Forces of 200 N, 400 N, and 600 N were then loaded on the model vertically downward, respectively. The stress distribution and peaks and maximum displacements at three sites were assessed. We found that the stress area of all three plates was mainly concentrated around the fracture line, while only the matching screws of the NALGP showed no obvious stress concentration points. In addition, the NALGP and DLP showed significantly less fracture fragment displacement than the LPACS at the three main fracture sites. The NALGP was found to have less displacement than DLP at the posterior column and ischiopubic branch sites, especially under the higher loading forces of 400 N and 600 N. The fixation stability of the NALGP for TAF was similar to that of DLP but better than that of LPACS. Moreover, the NALGP and its matching screws have a more reasonable stress distribution under different loads of force and the same strength as the LPACS.
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Affiliation(s)
- Xiao Liu
- Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, China; (X.L.); (J.G.); (X.W.); (J.D.); (Z.L.); (R.L.); (L.Z.)
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28 Fuxin Road, Beijing 100853, China
| | - Jianpeng Gao
- Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, China; (X.L.); (J.G.); (X.W.); (J.D.); (Z.L.); (R.L.); (L.Z.)
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28 Fuxin Road, Beijing 100853, China
| | - Xiaoyong Wu
- Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, China; (X.L.); (J.G.); (X.W.); (J.D.); (Z.L.); (R.L.); (L.Z.)
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28 Fuxin Road, Beijing 100853, China
| | - Junhao Deng
- Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, China; (X.L.); (J.G.); (X.W.); (J.D.); (Z.L.); (R.L.); (L.Z.)
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28 Fuxin Road, Beijing 100853, China
| | - Zijian Li
- Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, China; (X.L.); (J.G.); (X.W.); (J.D.); (Z.L.); (R.L.); (L.Z.)
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28 Fuxin Road, Beijing 100853, China
| | - Ran Li
- Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, China; (X.L.); (J.G.); (X.W.); (J.D.); (Z.L.); (R.L.); (L.Z.)
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28 Fuxin Road, Beijing 100853, China
| | - Licheng Zhang
- Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, China; (X.L.); (J.G.); (X.W.); (J.D.); (Z.L.); (R.L.); (L.Z.)
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28 Fuxin Road, Beijing 100853, China
| | - Jianheng Liu
- Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, China; (X.L.); (J.G.); (X.W.); (J.D.); (Z.L.); (R.L.); (L.Z.)
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28 Fuxin Road, Beijing 100853, China
| | - Ming Li
- Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, China; (X.L.); (J.G.); (X.W.); (J.D.); (Z.L.); (R.L.); (L.Z.)
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28 Fuxin Road, Beijing 100853, China
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9
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Zhou R, Xue H, Wang J, Wang X, Wang Y, Zhang A, Zhang J, Han Q, Zhao X. Improving the Stability of a Hemipelvic Prosthesis Based on Bone Mineral Density Screw Channel and Prosthesis Optimization Design. Front Bioeng Biotechnol 2022; 10:892385. [PMID: 35706507 PMCID: PMC9189365 DOI: 10.3389/fbioe.2022.892385] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
In pelvic reconstruction surgery, the hemipelvic prosthesis can cause significant changes in stress distribution due to its high stiffness, and its solid structure is not suitable for osseointegration. The purpose of this study was to identify a novel bone mineral density screw channel and design the structure of the prosthesis so as to improve the distribution of stress, promote bone growth, and enhance the biomechanical properties of the prosthesis. The mechanical characteristics of bone mineral density screw and traditional screw were compared by finite element analysis method, and redesigned by topology optimization. The direction of the newly proposed screw channel was the posterolateral entrance of the auricular surface, ending at the contralateral sacral cape. Compared to the original group, the maximum stress of the optimized prosthesis was decreased by 24.39%, the maximum stress of the sacrum in the optimized group was decreased by 27.23%, and the average strain energy density of the sacrum in the optimized group was increased by 8.43%. On the surface of screw and connecting plate, the area with micromotion more than 28 μm is reduced by 12.17%. On the screw surface, the area with micromotion more than 28 μm is reduced by 22.9%. The newly determined screw channel and optimized prosthesis design can effectively improve the biomechanical properties of a prosthesis and the microenvironment of osseointegration. This method can provide a reference for the fixation of prostheses in clinical pelvic reconstruction.
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10
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Wang J, Min L, Lu M, Zhang Y, Lin J, Luo Y, Zhou Y, Tu C. Three-dimensional-printed custom-made hemipelvic endoprosthesis for the revision of the aseptic loosening and fracture of modular hemipelvic endoprosthesis: a pilot study. BMC Surg 2021; 21:262. [PMID: 34039325 PMCID: PMC8157625 DOI: 10.1186/s12893-021-01257-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 05/18/2021] [Indexed: 02/08/2023] Open
Abstract
Background The aims of this pilot study were (1) to assess the efficacy of 3D-printed custom-made hemipelvic endoprosthesis in restoring the natural location of acetabulum for normal bodyweight transmission; (2) to evaluate the short-term function of the revision with this endoprosthesis and (3) to identify short-term complications associated with the use of this endoprosthesis. Methods Between February 2017 and December 2017, seven patients received revision with 3D-printed custom-made hemipelvic endoprosthesis. The body weight moment arm (BWMA) and cup height discrepancy (CHD) after primary and revisional surgery were analyzed to assess acetabulum location with plain radiography. After a median follow-up duration of 29 months (range 24–34), the function was evaluated with the Musculoskeletal Tumor Society (MSTS-93) score and Harris hip score (HHS). Complications were recorded by chart review. Results The acetabulum locations were deemed reasonable, as evaluated by median BWMA (primary vs. revision, 10 cm vs. 10 cm) and median CHD (primary vs. revision, 10 mm vs. 8 mm). The median MSTS-93 score and HHS score were 21 (range 18–23) and 78 (range 75–82) after the revision. No short or mid-term complication was observed in the follow-up of this series. Conclusions Revision with 3D-printed custom-made hemipelvic endoprostheses benefited in reconstructing stable pelvic ring and natural bodyweight transmission for patients encountering the aseptic loosening and fracture of modular hemipelvic endoprosthesis. The revision surgery and appropriate rehabilitation program improved patients’ function to a median MSTS score of 22 and pain-free ambulation. The incidence of the complications was low via this individualized workflow.
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Affiliation(s)
- Jie Wang
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, People's Republic of China.,Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Li Min
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, People's Republic of China.,Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Minxun Lu
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, People's Republic of China.,Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yuqi Zhang
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, People's Republic of China.,Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jingqi Lin
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, People's Republic of China
| | - Yi Luo
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, People's Republic of China.,Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yong Zhou
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, People's Republic of China.,Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Chongqi Tu
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, People's Republic of China. .,Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
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11
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Luo Y, Jiang M, Fang J, Min L, Zhou Y, Tang F, Lu M, Wang Y, Duan H, Tu C. Prolonged balloon occlusion of the lower abdominal aorta during pelvic or sacral tumor resection. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:416. [PMID: 33842637 PMCID: PMC8033300 DOI: 10.21037/atm-21-138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background To explore the efficacy of lower abdominal aorta balloon occlusion technology in pelvis and sacral tumor surgery and to assess the safety of prolonged balloon occlusion. Methods From January 2008 to January 2017, 81 patients were diagnosed with sacrum or pelvic tumor and underwent surgery in our institution. Balloon catheters were placed through the femoral artery to occlude the abdominal aorta of the pelvic tumor and sacrum region undergoing tumor resection. These patients were divided into two group based on single balloon blocking time. Group A had a balloon blocking time of 60 minutes or less, and group B had a balloon occlusion time greater than 60 minutes. The patients in the two groups were compared with regards to operation time, intraoperative blood loss, blood transfusion volume, average length of hospital stay, and postoperative complications. Results No balloon displacement or leakage of the abdominal aorta occurred during the operations. The difference in operation time between the two groups was statistically significant (P≤0.05), and the differences in intraoperative blood loss, blood transfusion volume, and average hospital stay between groups A and B were not significant (P>0.05). The incidence of postoperative complications was 12% in group A, and 22.6% in group B, with no statistically significant differences (P>0.05). Conclusions Prolonged balloon occlusion was safe and effective in the surgical treatment of complicated pelvic and sacral tumors. It did not increase the incidence of postoperative complications such as distal limb paralysis, arterial thrombosis, or ischemic necrosis.
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Affiliation(s)
- Yi Luo
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Mingyan Jiang
- West China School of Stomatology, Sichuan University, Chengdu, China
| | - Jianguo Fang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Li Min
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Zhou
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Fan Tang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Minxun Lu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Yitian Wang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Duan
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Chongqi Tu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
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Biomechanical comparison of a 3D-printed sacrum prosthesis versus rod-screw systems for reconstruction after total sacrectomy: A finite element analysis. Clin Biomech (Bristol, Avon) 2019; 70:203-208. [PMID: 31655451 DOI: 10.1016/j.clinbiomech.2019.10.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 10/11/2019] [Accepted: 10/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Reconstruction after total sacrectomy is a difficult problem in the field of orthopedic oncology. Current reconstruction methods have not completely solved the problems associated with instrumentation failure. The purpose of this study was to evaluate the biomechanical properties of a 3D-printed total sacrum prosthesis and to conduct biomechanical comparisons between the total sacrum prosthesis and rod-screw systems for lumbosacral reconstruction after total sacrectomy. METHODS Three types of reconstruction were explored, and corresponding finite element models were simulated: four-rod reconstruction, four-rod plus anterior column reconstruction, and 3D-printed total sacrum prosthesis reconstruction. A vertical load of 600 N was applied to the L4 vertebra, and the bilateral acetabula were set as the boundary with six degrees of freedom fixed, simulating the bipedal standing position. FINDINGS The order of the reconstructions according to decreasing maximum von Mises stress was as follows: four-rod reconstruction > four-rod plus anterior column reconstruction >3D-printed total sacrum prosthesis reconstruction. The order of reconstructions according to decreasing L5 shift-down displacement was as follows: four-rod reconstruction >3D-printed total sacrum prosthesis reconstruction > four-rod plus anterior column reconstruction. INTERPRETATION Compared with the rod-screw systems, the total sacrum prosthesis reconstruction has the biomechanical advantages of a more uniform stress distribution, a lower peak stress and better stability and can thus serve as an alternative choice for reconstruction after total sacrectomy.
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13
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Iqbal T, Shi L, Wang L, Liu Y, Li D, Qin M, Jin Z. Development of finite element model for customized prostheses design for patient with pelvic bone tumor. Proc Inst Mech Eng H 2018. [PMID: 28639517 DOI: 10.1177/0954411917692009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to design a hemi-pelvic prosthesis for a patient affected by pelvic sarcoma. To investigate the biomechanical functionality of the pelvis reconstructed with designed custom-made prosthesis, a patient-specific finite element model of whole pelvis with primary ligaments inclusive was constructed based on the computed tomography images of the patient. Then, a finite element analysis was performed to calculate and compare the stress distribution between the normal and implanted pelvis models when undergoing three different static conditions-both-leg standing, single-leg standing for the healthy and the affected one. No significant differences were observed in the stresses between the normal and reconstructed pelvis for both-leg standing, but 20%-40% larger stresses were predicted for the peak stress of the single-leg standing (affected side). Moreover, two- to threefold of peak stresses were predicted within the prostheses compared to that of the normal pelvis especially for single-leg standing case, however, still below the allowable fatigue limitation. The study on the load transmission functionality of prosthesis indicated that it is crucial to carry out finite element analysis for functional evaluation of the designed customized prostheses before three-dimensional printing manufacturing, allowing better understanding of the possible peak stresses within the bone as well as the implants for safety precaution. The finite element model can be equally applicable to other bone tumor model for biomechanical studying.
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Affiliation(s)
- Taimoor Iqbal
- 1 State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Lei Shi
- 2 Department of Orthopedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Ling Wang
- 1 State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Yaxiong Liu
- 1 State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Dichen Li
- 1 State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Mian Qin
- 1 State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Zhongmin Jin
- 1 State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China.,3 Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
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Li D, Xie L, Guo W, Tang X, Ji T, Yang R. Extra-articular resection is a limb-salvage option for sarcoma involving the hip joint. INTERNATIONAL ORTHOPAEDICS 2018; 42:695-703. [PMID: 29404667 DOI: 10.1007/s00264-018-3771-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 01/05/2018] [Indexed: 12/26/2022]
Abstract
INTRODUCTION With the development of surgical techniques and improvements in hemi-pelvic prosthesis systems, extra-articular resection can be performed as a limb-salvage procedure in selected patients whose hip joint is invaded by a sarcoma. The aim of this study was to describe the indications for and the technical details, post-operative complications, and oncologic and functional outcomes of this procedure. METHODS Eighteen patients with Enneking IIB or IB sarcoma who underwent extra-articular resection of the hip joint were enrolled. A modular pelvic endoprosthesis combined with a femoral endoprosthesis was used to reconstruct the bone and joint defect. Pathological diagnoses included osteosarcoma (7 patients), chondrosarcoma (7), undifferentiated high-grade pleomorphic sarcoma (3), and malignant peripheral nerve-sheath tumour (1). RESULTS Wide, marginal and intralesional surgical margin was achieved in 13, four and one patients, respectively. There was one peri-operative death and the other 17 patients were followed up for 35.0 months (range, 10-75 months). Three patients had early-stage dislocations. One had a traumatic dislocation three years later. Two patients had wound complications. The average MSTS 93 score was 63.5% ± 10.8%. Four patients had local recurrence. The estimated three-year disease-free survival and overall survival for the 18 patients were both 50.0%. CONCLUSION Although technically demanding, extra-articular resection of hip is a limb-salvage procedure that is worth considering for carefully selected patients.
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Affiliation(s)
- Dasen Li
- Musculoskeletal Tumour Centre, Peking University People's Hospital, Beijing, 100044, China
| | - Lu Xie
- Musculoskeletal Tumour Centre, Peking University People's Hospital, Beijing, 100044, China
| | - Wei Guo
- Musculoskeletal Tumour Centre, Peking University People's Hospital, Beijing, 100044, China.
| | - Xiaodong Tang
- Musculoskeletal Tumour Centre, Peking University People's Hospital, Beijing, 100044, China
| | - Tao Ji
- Musculoskeletal Tumour Centre, Peking University People's Hospital, Beijing, 100044, China
| | - Rongli Yang
- Musculoskeletal Tumour Centre, Peking University People's Hospital, Beijing, 100044, China
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15
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Hu P, Wu T, Wang HZ, Qi XZ, Yao J, Cheng XD, Chen W, Zhang YZ. Influence of Different Boundary Conditions in Finite Element Analysis on Pelvic Biomechanical Load Transmission. Orthop Surg 2017; 9:115-122. [PMID: 28300359 DOI: 10.1111/os.12315] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 11/21/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To observe the effects of boundary conditions and connect conditions on biomechanics predictions in finite element (FE) pelvic models. METHODS Three FE pelvic models were constructed to analyze the effect of boundary conditions and connect conditions in the hip joint: an intact pelvic model assumed contact of the hip joint on both sides (Model I); and a pelvic model assumed the hip joint connecting surfaces fused together with (Model II) or without proximal femurs (Model III). The model was validated by bone surface strains obtained from strain gauges in an in vitro pelvic experiment. Vertical load was applied to the pelvic specimen, and the same load was simulated in the FE model. RESULTS There was a strong correlation between the FE analysis results of Model I and the experimental results (R 2 = 0.979); meanwhile, the correlation coefficient and the linear regression function increased slightly with increasing load force. Comparing the three models, the stress values in the point near the pubic symphysis in Model III were 48.52 and 39.1% lower, respectively, in comparison with Models I and II. Furthermore, the stress values on the dome region of the acetabulum in Models II and III were 103.61 and 390.53% less than those of Model I. Besides, the posterior acetabular wall stress values of Model II were 197.15 and 305.17% higher than those of Models I and III, respectively. CONCLUSIONS These findings suggest that the effect of the connect condition in the hip joint should not be neglected, especially in studies related to clinical applications.
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Affiliation(s)
- Pan Hu
- Department of Orthopaedic Surgery, Emergency Center of Trauma, Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Tao Wu
- Department of Orthopaedic Surgery, Emergency Center of Trauma, Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hui-Zhi Wang
- International Research Center for Implantable and Interventional Medical Devices, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xin-Zheng Qi
- International Research Center for Implantable and Interventional Medical Devices, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Jie Yao
- International Research Center for Implantable and Interventional Medical Devices, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xiao-Dong Cheng
- Department of Orthopaedic Surgery, Emergency Center of Trauma, Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Chen
- Department of Orthopaedic Surgery, Emergency Center of Trauma, Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ying-Ze Zhang
- Department of Orthopaedic Surgery, Emergency Center of Trauma, Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, China
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Liang H, Ji T, Zhang Y, Wang Y, Guo W. Reconstruction with 3D-printed pelvic endoprostheses after resection of a pelvic tumour. Bone Joint J 2017; 99-B:267-275. [PMID: 28148672 DOI: 10.1302/0301-620x.99b2.bjj-2016-0654.r1] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 09/28/2016] [Indexed: 11/05/2022]
Abstract
Aims The aims of this retrospective study were to report the feasibility of using 3D-printing technology for patients with a pelvic tumour who underwent reconstruction. Patients and Methods A total of 35 patients underwent resection of a pelvic tumour and reconstruction using 3D-printed endoprostheses between September 2013 and December 2015. According to Enneking’s classification of bone defects, there were three Type I lesions, 12 Type II+III lesions, five Type I+II lesions, two Type I+II+III lesions, ten type I+II+IV lesions and three type I+II+III+IV lesions. A total of three patients underwent reconstruction using an iliac prosthesis, 12 using a standard hemipelvic prosthesis and 20 using a screw-rod connected hemipelvic prosthesis. Results All patients had an en bloc resection. Margins were wide in 15 patients, marginal in 14 and intralesional in six. After a mean follow-up of 20.5 months (6 to 30), 25 patients survived without evidence of disease, five were alive with disease and five had died from metastatic disease. Complications included seven patients with delayed wound healing and two with a dislocation of the hip. None had a deep infection. For the 30 surviving patients, the mean Musculoskeletal Society 93 score was 22.7 (20 to 25) for patients with an iliac prosthesis, 19.8 (15 to 26) for those with a standard prosthesis, and 17.7 (9 to 25) for those with a screw-rod connected prosthesis. Conclusion The application of 3D-printing technology can facilitate the precise matching and osseointegration between implants and the host bone. We found that the use of 3D-printed pelvic prostheses for reconstruction of the bony defect after resection of a pelvic tumour was safe, without additional complications, and gave good short-term functional results. Cite this article: Bone Joint J 2017;99-B:267–75.
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Affiliation(s)
- H. Liang
- Peking University People’s Hospital, and
Key Laboratory for Musculoskeletal Tumor of Beijing, Xizhimen
Nan 11, Xicheng District, Beijing
100044, China
| | - T. Ji
- Peking University People’s Hospital, and
Key Laboratory for Musculoskeletal Tumor of Beijing, Xizhimen
Nan 11, Xicheng District, Beijing
100044, China
| | - Y. Zhang
- Peking University People’s Hospital, and
Key Laboratory for Musculoskeletal Tumor of Beijing, Xizhimen
Nan 11, Xicheng District, Beijing
100044, China
| | - Y. Wang
- Peking University People’s Hospital, and
Key Laboratory for Musculoskeletal Tumor of Beijing, Xizhimen
Nan 11, Xicheng District, Beijing
100044, China
| | - W. Guo
- Peking University People’s Hospital, and
Key Laboratory for Musculoskeletal Tumor of Beijing, Xizhimen
Nan 11, Xicheng District, Beijing
100044, China
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Liu D, Hua Z, Yan X, Jin Z. Design and biomechanical study of a novel adjustable hemipelvic prosthesis. Med Eng Phys 2016; 38:1416-1425. [PMID: 27720636 DOI: 10.1016/j.medengphy.2016.09.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 09/01/2016] [Accepted: 09/23/2016] [Indexed: 10/20/2022]
Abstract
A pelvic endoprosthesis is commonly used in orthopedic surgeries to reconstruct the pelvis after internal hemipelvectomy. This study presents the detailed design of a novel type I+II+III adjustable hemipelvic prosthesis based on the geometrical features of massive human pelvises. Finite element analysis is conducted to estimate the biomechanical performance of the newly designed adjustable hemipelvic prosthesis. Detailed numerical models of the natural and reconstructed pelvises including related soft tissues are developed. Hip contact forces during normal walking, which is one of the most frequent dynamic activities in daily living, are imposed on the pelvis. Results show that the peak stress observed in the reconstructed pelvis model is still within a low and elastic range below the yielding strength of the cortical bone and Ti6Al4V. No significant difference of the stress transferring route, displacement distributions and principal stress vectors is observed between the reconstructed and natural pelvises. The results indicate that the load transferring function of the partially resected pelvis is able to be reliably recovered by the adjustable hemipelvic prosthesis. The principal stress vectors in both pelvis models predict that bone absorption may not apparently occur in the long run. Long-term biomechanical performance of this newly designed prosthesis may be stability.
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Affiliation(s)
- Dongxu Liu
- School of Mechatronics Engineering and Automation, Shanghai University, No. 149, Yanchang Rd, 200072 Shanghai, PR China
| | - Zikai Hua
- School of Mechatronics Engineering and Automation, Shanghai University, No. 149, Yanchang Rd, 200072 Shanghai, PR China.
| | - Xinyi Yan
- School of Mechatronics Engineering and Automation, Shanghai University, No. 149, Yanchang Rd, 200072 Shanghai, PR China
| | - Zhongmin Jin
- School of Mechanical Engineering, Xi'an Jiaotong University, PR China; School of Mechanical Engineering, University of Leeds, UK
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18
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Zhang YD, Guo W, Yang RL, Tang XD, Yan TQ, Ji T. Malignant Pelvic Tumors Involving the Sacrum: Surgical Approaches and Procedures Based on a New Classification. Orthop Surg 2016; 8:150-61. [PMID: 27384723 DOI: 10.1111/os.12240] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 03/21/2016] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To introduce a new classification of Enneking type IV pelvic tumors involving the sacrum and a corresponding system of standardized surgical approaches and procedures for resection of such tumors, and to investigate the feasibility and therapeutic effect of the new system. METHODS Data on 59 patients treated between February 2003 and February 2013 by standardized surgical approaches and procedures were retrospectively reviewed. The study subjects comprised 28 male and 31 female patients with a mean age at diagnosis of 36 years (range, 2-72 years). There are four subtypes in the new classification: (i) subtype IVa, neoplasms invading the ipsilateral sacral wing; (ii) subtype IVb, neoplasms invading the ipsilateral sacral foramina; (iii) subtype IVc, neoplasms invading the contralateral sacral foramina; and (iv) subtype IVd, neoplasms invading the whole of the sacrum. Standardized surgical approaches and procedures were devised for en-bloc resection for each subtype with adequate margins. RESULTS Adequate margins were achieved in 43/59 patients (72.9%). The mean operation time was 5.0 h and the mean intraoperative blood loss 2157 mL. At the final follow-up, 27/53 patients (50.9%) who had been followed up were alive and in complete remission. The mean Musculoskeletal Tumor Society 93 score was 17.4 (58%) of a possible 30 points. The mean functional score for patients who had undergone a pelvic zone II resection was 15.2, compared with 19.0 for those with an intact pelvic zone II. CONCLUSIONS The proposed standardized protocols should help orthopaedic surgeons to achieve adequate margins, manage risk, achieve better oncologic and functional outcomes, and minimize perioperative complications when treating massive pelvic tumors involving the sacrum.
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Affiliation(s)
- Yi-Dan Zhang
- Beijing Key Laboratory for Musculoskeletal Tumors, Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China
| | - Wei Guo
- Beijing Key Laboratory for Musculoskeletal Tumors, Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China
| | - Rong-Li Yang
- Beijing Key Laboratory for Musculoskeletal Tumors, Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China
| | - Xiao-Dong Tang
- Beijing Key Laboratory for Musculoskeletal Tumors, Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China
| | - Tai-Qiang Yan
- Beijing Key Laboratory for Musculoskeletal Tumors, Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China
| | - Tao Ji
- Beijing Key Laboratory for Musculoskeletal Tumors, Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China
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Liu XM, Pan CW, Wang GD, Cai XH, Chen L, Meng CF, Huang JC. Finite element analysis of the stability of combined plate internal fixation in posterior wall fractures of acetabulum. Int J Clin Exp Med 2015; 8:13393-13397. [PMID: 26550272 PMCID: PMC4612957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 07/11/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE This study aims to explore the mechanical stability of combined plate internal fixation in posterior wall fractures of the acetabulum. METHODS The fracture and internal fixation models were established in this study and they were divided into four kinds of internal fixation models, finite element analysis was performed. The four groups were 2 mini-plates and 1 reconstruction plate fixation (A), Reconstruction plate internal fixation group (B), 2 screws internal fixation group (C) and mini-plates internal fixation group (D). The displacement of each node was measured and evaluated. RESULTS There was no distortion in the geometric shape of the finite element model. The results of stress showed that it was less in the anterior pelvic ring and distributed uniform in labrum acetabulare; the stress was bigger in the upper and middle of sacroiliac joint and sciatic notch in sitting position. CONCLUSIONS Combined plate internal fixation for posterior wall fractures of acetabular were stable and reliable, it is better than the other three methods.
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Affiliation(s)
- Xi-Ming Liu
- Department of Orthopedics, Wuhan General Hospital of Guangzhou Military CommandWuhan 430070, Hubei, China
| | - Chang-Wu Pan
- Department of Orthopedics, The People’s Hospital of Tuan FengHuanggang 4380000, Hubei, China
| | - Guo-Dong Wang
- Department of Orthopedics, Wuhan General Hospital of Guangzhou Military CommandWuhan 430070, Hubei, China
| | - Xian-Hua Cai
- Department of Orthopedics, Wuhan General Hospital of Guangzhou Military CommandWuhan 430070, Hubei, China
| | - Lei Chen
- Department of Orthopedics, Wuhan General Hospital of Guangzhou Military CommandWuhan 430070, Hubei, China
| | - Cheng-Fei Meng
- Department of Orthopedics, Wuhan General Hospital of Guangzhou Military CommandWuhan 430070, Hubei, China
| | - Jin-Cheng Huang
- Department of Orthopedics, The Second People’s Hospital of Yi ChangYi Chang 443000, Hubei, China
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Mei J, Ni M, Gao YS, Wang ZY. Femur performed better than tibia in autologous transplantation during hemipelvis reconstruction. World J Surg Oncol 2014; 12:1. [PMID: 24387189 PMCID: PMC3895820 DOI: 10.1186/1477-7819-12-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 12/21/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pelvic reconstruction after hemipelvectomy can greatly improve the weight-bearing stability of the supporting skeleton and improve patients' quality of life. Although an autograft can be used to reconstruct pelvic defects, the most suitable choice of autograft, i.e., the use of either femur or tibia, has not been determined. We aimed to analyze the mechanical stresses of a pelvic ring reconstructed using femur or tibia after hemipelvectomy using finite element (FE) analysis. METHODS FE models of normal and reconstructed pelvis were established based on computed tomography images, and the stress distributions were analyzed under physiological loading from 0 to 500 N in both intact and restored pelvic models using femur or tibia. RESULTS The vertical displacement of the intact pelvis was less than that of reconstructed pelvis, but there was no significant difference between the two reconstructed models. In FE analysis, the stress distribution of the intact pelvic model was bilaterally symmetric and the maximum stresses were located at the sacroiliac joint, arcuate line, ischiatic ramus, and ischial tuberosity. The maximum stress in each part of the reconstructed pelvis greatly exceeded that of the intact model. The maximum von Mises stress of the femur was 13.9 MPa, and that of the tibia was 6.41 MPa. However, the stress distribution was different in the two types of reconstructed pelvises. The tibial reconstruction model induced concentrated stress on the tibia shaft making it more vulnerable to fracture. The maximum stress on the femur was concentrated on the connections between the femur and the screws. CONCLUSIONS From a biomechanical point of view, the reconstruction of hemipelvic defects with femur is a better choice.
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Affiliation(s)
- Jiong Mei
- Department of Orthopedics, Tongji Hospital, Tongji University, Shanghai, 200065, China.
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Luo Y, Duan H, Liu W, Min L, Shi R, Zhang W, Zhou Y, Tu C. Clinical evaluation for lower abdominal aorta balloon occluding in the pelvic and sacral tumor resection. J Surg Oncol 2013; 108:148-51. [PMID: 23846994 DOI: 10.1002/jso.23376] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 06/13/2013] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate the values of clinical application of lower abdominal aorta balloon occluding in the pelvic and sacral tumor resection. METHOD From January 2004 to January 2010, 137 patients were diagnosed as sacral or pelvic tumors and underwent surgery in our institution. Forty-five patients underwent resection combined with lower abdominal aorta balloon occluding to control hemorrhage (balloon occluding group), the remaining 92 patients underwent conventional resection (conventional therapy group). We compared operative time, intraoperative hemorrhage, the amount of blood transfusion, postoperative complications, mean hospital stay as well as rates of tumor recurrence or metastasis at 3 years. RESULTS En-bloc resection was performed in 93.3% (42/45) patients in balloon occluding group while the conventional therapy group was 78.2% (79/92). The balloon occluding group showed significantly shorter mean operating time, lower blood loss, lower blood transfusion, and lower postoperative drainage volume than did the conventional therapy group. The two treatment groups showed no significant difference in mean hospital stay, frequency of postoperative complications or rates of tumor recurrence or metastasis at 3 years. CONCLUSION The application of lower abdominal aorta balloon occluding to control hemorrhage during the surgery contributes to a more clear operation field, less operation time as well as less blood loss and blood transfusion. Moderate prolong of the occluding duration can improve the safety of the surgery and contribute to more radical resection of the tumor without increase of the risks for complications.
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Affiliation(s)
- Yi Luo
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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Resection hip arthroplasty as a feasible surgical procedure for periacetabular tumors of the pelvis. Eur J Surg Oncol 2012; 38:692-9. [DOI: 10.1016/j.ejso.2012.04.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 03/23/2012] [Accepted: 04/29/2012] [Indexed: 11/30/2022] Open
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