1
|
Liang H, Chen B, Duan S, Yang L, Xu R, Zhang H, Sun M, Zhou X, Liu H, Wen H, Cai Z. Treatment of complex limb fractures with 3D printing technology combined with personalized plates: a retrospective study of case series and literature review. Front Surg 2024; 11:1383401. [PMID: 38817945 PMCID: PMC11137251 DOI: 10.3389/fsurg.2024.1383401] [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: 02/09/2024] [Accepted: 05/09/2024] [Indexed: 06/01/2024] Open
Abstract
Background In recent years, 3D printing technology has made significant strides in the medical field. With the advancement of orthopedics, there is an increasing pursuit of high surgical quality and optimal functional recovery. 3D printing enables the creation of precise physical models of fractures, and customized personalized steel plates can better realign and more comprehensively and securely fix fractures. These technologies improve preoperative diagnosis, simulation, and planning for complex limb fractures, providing patients with better treatment options. Patients and methods Five typical cases were selected from a pool of numerous patients treated with 3D printing technology combined with personalized custom steel plates at our hospital. These cases were chosen to demonstrate the entire process of printing 3D models and customizing individualized steel plates, including details of the patients' surgeries and treatment procedures. Literature reviews were conducted, with a focus on highlighting the application of 3D printing technology combined with personalized custom steel plates in the treatment of complex limb fractures. Results 3D printing technology can produce accurate physical models of fractures, and personalized custom plates can achieve better fracture realignment and more comprehensive and robust fixation. These technologies provide patients with better treatment options. Conclusion The use of 3D printing models and personalized custom steel plates can improve preoperative diagnosis, simulation, and planning for complex limb fractures, realizing personalized medicine. This approach helps reduce surgical time, minimize trauma, enhance treatment outcomes, and improve patient functional recovery.
Collapse
Affiliation(s)
- Hairui Liang
- Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
| | - Beibei Chen
- Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
| | - Siyu Duan
- Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
| | - Lei Yang
- School of Pharmacy, Inner Mongolia Medical University, Inner Mongolia Autonomous Region, Shenyang, China
| | - Rongda Xu
- Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
| | - He Zhang
- Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
| | - Ming Sun
- Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
| | - Xueting Zhou
- Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
| | - Hanfei Liu
- Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
| | - Hang Wen
- Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
| | - Zhencun Cai
- Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
- Key Laboratory of Human Ethnic Specificity and Phenomics of Critical Illness in Liaoning Province, Shenyang Medical College, Shenyang, China
| |
Collapse
|
2
|
Zhu X, Hu J, Lin J, Song G, Xu H, Lu J, Tang Q, Wang J. 3D-printed modular prostheses for reconstruction of intercalary bone defects after joint-sparing limb salvage surgery for femoral diaphyseal tumours. Bone Jt Open 2024; 5:317-323. [PMID: 38631693 PMCID: PMC11023719 DOI: 10.1302/2633-1462.54.bjo-2023-0170.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
Aims The aim of this study was to investigate the safety and efficacy of 3D-printed modular prostheses in patients who underwent joint-sparing limb salvage surgery (JSLSS) for malignant femoral diaphyseal bone tumours. Methods We retrospectively reviewed 17 patients (13 males and four females) with femoral diaphyseal tumours who underwent JSLSS in our hospital. Results In all, 17 patients with locally aggressive bone tumours (Enneking stage IIB) located in the femoral shaft underwent JSLSS and reconstruction with 3D-printed modular prostheses between January 2020 and June 2022. The median surgical time was 153 minutes (interquartile range (IQR) 117 to 248), and the median estimated blood loss was 200ml (IQR 125 to 400). Osteosarcoma was the most common pathological type (n = 12; 70.6%). The mean osteotomy length was 197.53 mm (SD 12.34), and the median follow-up was 25 months (IQR 19 to 38). Two patients experienced local recurrence and three developed distant metastases. Postoperative complications included wound infection in one patient and screw loosening in another, both of which were treated successfully with revision surgery. The median Musculoskeletal Tumor Society score at the final follow-up was 28 (IQR 27 to 28). Conclusion The 3D-printed modular prosthesis is a reliable and feasible reconstruction option for patients with malignant femoral diaphyseal tumours. It helps to improve the limb salvage rate, restore limb function, and achieve better short-term effectiveness.
Collapse
Affiliation(s)
- Xiaojun Zhu
- Department of Musculoskeletal Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jinxin Hu
- Department of Musculoskeletal Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jiaming Lin
- Department of Musculoskeletal Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Guohui Song
- Department of Musculoskeletal Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Huaiyuan Xu
- Department of Musculoskeletal Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jinchang Lu
- Department of Musculoskeletal Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Qinglian Tang
- Department of Musculoskeletal Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
- 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, Sun Yat-Sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| |
Collapse
|
3
|
Trikoupis IG, Mavrodontis II, Papadopoulos DV, Goumenos SD, Georgoulis DA, Gavriil P, Melissaridou D, Savvidou OD, Kontogeorgakos VA, Papagelopoulos PJ. 3D-printed glenoid implant reconstruction, after partial scapulectomy for malignant tumors: a case series. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1557-1562. [PMID: 38280074 PMCID: PMC10980628 DOI: 10.1007/s00590-024-03839-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/18/2024] [Indexed: 01/29/2024]
Abstract
PURPOSE Glenoid tumors are extremely rare, and reconstruction remains very challenging. The aim of this study is to present the clinical and functional outcomes, of a new glenoid reconstruction method using 3-dimensional-printed implant. METHODS Four patients with primary glenoid tumors underwent reconstruction using 3-dimensional-printed glenoid implant linked with reverse shoulder arthroplasty. We retrospectively reviewed the clinical and functional outcome, using MSTS and DASH score, as well as complications' rate. RESULTS Wide excision was achieved in all patients. No local recurrence or distant metastasis was diagnosed at the follow-up period. The mean MSTS score was 80.5%, and DASH score was 15.2%. According to Hendersons' classification, there were no postoperative complications. CONCLUSION The use of 3-dimensional-printed implants, can be a very reliable solution with satisfying clinical and functional outcomes for reconstruction, in patients with musculoskeletal malignancies of the glenoid. Level of evidence IV Treatment Study.
Collapse
Affiliation(s)
- Ioannis G Trikoupis
- First Department of Orthopedic Surgery and Traumatology, National and Kapodistrian University of Athens, School of Medicine, "ATTIKON" University General Hospital, Rimini 1, Chaidari, 12462, Athens, Greece
| | - Ioannis I Mavrodontis
- First Department of Orthopedic Surgery and Traumatology, National and Kapodistrian University of Athens, School of Medicine, "ATTIKON" University General Hospital, Rimini 1, Chaidari, 12462, Athens, Greece
| | - Dimitrios V Papadopoulos
- Second Department of Orthopedics, National and Kapodistrian University of Athens, 'Agia Olga' Hospital, Th. Konstantopoulou 3-5, Nea Ionia, 14233, Athens, Greece
| | - Stavros D Goumenos
- First Department of Orthopedic Surgery and Traumatology, National and Kapodistrian University of Athens, School of Medicine, "ATTIKON" University General Hospital, Rimini 1, Chaidari, 12462, Athens, Greece
| | - Dimitrios A Georgoulis
- First Department of Orthopedic Surgery and Traumatology, National and Kapodistrian University of Athens, School of Medicine, "ATTIKON" University General Hospital, Rimini 1, Chaidari, 12462, Athens, Greece
| | - Panagiotis Gavriil
- First Department of Orthopedic Surgery and Traumatology, National and Kapodistrian University of Athens, School of Medicine, "ATTIKON" University General Hospital, Rimini 1, Chaidari, 12462, Athens, Greece
| | - Dimitra Melissaridou
- First Department of Orthopedic Surgery and Traumatology, National and Kapodistrian University of Athens, School of Medicine, "ATTIKON" University General Hospital, Rimini 1, Chaidari, 12462, Athens, Greece
| | - Olga D Savvidou
- First Department of Orthopedic Surgery and Traumatology, National and Kapodistrian University of Athens, School of Medicine, "ATTIKON" University General Hospital, Rimini 1, Chaidari, 12462, Athens, Greece
| | - Vasileios A Kontogeorgakos
- First Department of Orthopedic Surgery and Traumatology, National and Kapodistrian University of Athens, School of Medicine, "ATTIKON" University General Hospital, Rimini 1, Chaidari, 12462, Athens, Greece
| | - Panayiotis J Papagelopoulos
- First Department of Orthopedic Surgery and Traumatology, National and Kapodistrian University of Athens, School of Medicine, "ATTIKON" University General Hospital, Rimini 1, Chaidari, 12462, Athens, Greece.
| |
Collapse
|
4
|
Li Z, Lu M, Zhang Y, Gong T, Wang J, Luo Y, Zhou Y, Chang Q, Lin J, Min L, Tu C. Reconstruction of the proximal radius with 3D-printed personalized prosthesis after tumor resection: case series. J Shoulder Elbow Surg 2024; 33:556-563. [PMID: 37783308 DOI: 10.1016/j.jse.2023.08.032] [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: 05/14/2023] [Revised: 08/27/2023] [Accepted: 08/31/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Giant cell tumor of bone (GCTB) (Campanacci III) or malignant tumors extend to the epiphyseal region of the proximal radius, and intra-articular resection of the proximal radius is often needed. In the present study, we present the patients who underwent reconstruction of the proximal radius with 3D-printed personalized prosthesis after tumor resection, aiming to describe the prosthesis design and surgical technique and evaluate the clinical outcomes of this method. METHODS Between November 2018 and January 2021, 9 patients received radial hemiarthroplasty with 3D-printed personalized prostheses after tumor resection. The pathologic diagnosis was GCTB (Campanacci III) in 7 patients, osteosarcoma (IIB) in 1 patient, and synovial sarcoma (IIB) in 1 patient. The range of motion (ROM) and strength in terms of elbow flexion/extension and forearm supination/pronation were evaluated. Pain was assessed by the visual analog scale (VAS) preoperatively and at each follow-up visit. To evaluate the functional outcome, the Mayo Elbow Performance Score (MEPS) system and the Musculoskeletal Tumor Society (MSTS) scoring system were administered at each follow-up visit. Complications and oncological outcomes were recorded. RESULTS The patients were followed from 24 to 51 months, with a median follow-up of 35 months. No patients were lost to follow-up. During the follow-up, local recurrence and metastasis were not observed. The VAS score improved from a median of 5 points (range 4-7) preoperatively to 1 point (range 0-2) at the last follow-up visit. The mean MEPS score was 88.5% (83-93), and the mean MSTS score was 25.3 (24-27) at the last follow-up visit. No complications such as infection and aseptic loosening were detected. CONCLUSIONS The implantation of a 3D-printed personalized prosthesis after proximal radial resection showed excellent oncologic outcomes and postoperative function at short-term follow-up and is a viable alternative method for reconstruction of the proximal radius bone defect after tumor resection.
Collapse
Affiliation(s)
- Zhuangzhuang Li
- Department of Orthopedics, 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, Sichuan, China
| | - Minxun Lu
- Department of Orthopedics, 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, Sichuan, China
| | - Yuqi Zhang
- Department of Orthopedics, 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, Sichuan, China
| | - Taojun Gong
- Department of Orthopedics, 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, Sichuan, China
| | - Jie Wang
- Department of Orthopedics, 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, Sichuan, China
| | - Yi Luo
- Department of Orthopedics, 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, Sichuan, China
| | - Yong Zhou
- Department of Orthopedics, 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, Sichuan, China
| | - Qing Chang
- Department of Orthopedics, 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, Sichuan, China
| | - Jingqi Lin
- Department of Orthopedics, 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, Sichuan, China
| | - Li Min
- Department of Orthopedics, 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, Sichuan, China.
| | - Chongqi Tu
- Department of Orthopedics, 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, Sichuan, China.
| |
Collapse
|
5
|
Bergemann R, Roytman GR, Ani L, Ramji AF, Leslie MP, Tommasini SM, Wiznia DH. The feasibility of a novel 3D-Printed patient specific cutting guide for extended trochanteric osteotomies. 3D Print Med 2024; 10:7. [PMID: 38427157 PMCID: PMC10905807 DOI: 10.1186/s41205-024-00204-3] [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: 08/18/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The extended trochanteric osteotomy (ETO) is a surgical technique utilized to expose the intramedullary canal of the proximal femur, protect the soft tissues and promote reliable healing. However, imprecise execution of the osteotomy can lead to fracture, soft tissue injury, non-union, and unnecessary morbidity. We developed a technique to create patient specific, 3D-printed cutting guides to aid in accurate positioning of the ETO and improve osteotomy quality and outcomes. METHODS Patient specific cutting guides were created based on CT scans using Synopysis Simpleware ScanIP and Solidworks. Custom 3D printed cutting guides were tested on synthetic femurs with foam cortical shells and on cadaveric femurs. To confirm accuracy of the osteotomies, dimensions of the performed osteotomies were compared to the virtually planned osteotomies. RESULTS Use of the patient specific ETO cutting guides resulted in successful osteotomies, exposing the femoral canal and the femoral stem both in synthetic sawbone and cadaveric testing. In cadaveric testing, the guides allowed for osteotomies without fracture and cuts made using the guide were accurate within 6 percent error from the virtually planned osteotomy. CONCLUSION The 3D-printed patient specific cutting guides used to aid in ETOs proved to be accurate. Through the iterative development of cutting guides, we found that a simple design was key to a reliable and accurate guide. While future clinical trials in human subjects are needed, we believe our custom 3D printed cutting guide design to be effective at aiding in performing ETOs for revision total hip arthroplasty surgeries.
Collapse
Affiliation(s)
- Reza Bergemann
- Orthopaedics and Rehabilitation, Yale School of Medicine, Yale University, 333 Cedar St. FMB 5, New Haven, CT, 06511, USA.
| | - Gregory R Roytman
- Orthopaedics and Rehabilitation, Yale School of Medicine, Yale University, 333 Cedar St. FMB 5, New Haven, CT, 06511, USA
- Biomedical Engineering, Yale School of Engineering and Applied Sciences, Yale University, New Haven, USA
| | - Lidia Ani
- Orthopaedics and Rehabilitation, Yale School of Medicine, Yale University, 333 Cedar St. FMB 5, New Haven, CT, 06511, USA
| | - Alim F Ramji
- Orthopaedics and Rehabilitation, Yale School of Medicine, Yale University, 333 Cedar St. FMB 5, New Haven, CT, 06511, USA
| | - Michael P Leslie
- Orthopaedics and Rehabilitation, Yale School of Medicine, Yale University, 333 Cedar St. FMB 5, New Haven, CT, 06511, USA
| | - Steven M Tommasini
- Orthopaedics and Rehabilitation, Yale School of Medicine, Yale University, 333 Cedar St. FMB 5, New Haven, CT, 06511, USA
- Biomedical Engineering, Yale School of Engineering and Applied Sciences, Yale University, New Haven, USA
| | - Daniel H Wiznia
- Orthopaedics and Rehabilitation, Yale School of Medicine, Yale University, 333 Cedar St. FMB 5, New Haven, CT, 06511, USA
- Mechanical Engineering and Material Sciences, Yale School of Engineering and Applied Science, Yale University, New Haven, CT, USA
| |
Collapse
|
6
|
Honda S, Fujibayashi S, Shimizu T, Yamaguchi S, Okuzu Y, Takaoka Y, Masuda S, Takemoto M, Kawai T, Otsuki B, Goto K, Matsuda S. Strontium-loaded 3D intramedullary nail titanium implant for critical-sized femoral defect in rabbits. J Biomed Mater Res B Appl Biomater 2024; 112:e35393. [PMID: 38385959 DOI: 10.1002/jbm.b.35393] [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: 10/13/2023] [Revised: 02/01/2024] [Accepted: 02/08/2024] [Indexed: 02/23/2024]
Abstract
The treatment of critical-sized bone defects has long been a major problem for surgeons. In this study, an intramedullary nail shaped three-dimensional (3D)-printed porous titanium implant that is capable of releasing strontium ions was developed through a simple and cost-effective surface modification technique. The feasibility of this implant as a stand-alone solution was evaluated using a rabbit's segmental diaphyseal as a defect model. The strontium-loaded implant exhibited a favorable environment for cell adhesion, and mechanical properties that were commensurate with those of a rabbit's cortical bone. Radiographic, biomechanical, and histological analyses revealed a significantly higher amount of bone ingrowth and superior bone-bonding strength in the strontium-loaded implant when compared to an untreated porous titanium implant. Furthermore, one-year histological observations revealed that the strontium-loaded implant preserved the native-like diaphyseal bone structure without failure. These findings suggest that strontium-releasing 3D-printed titanium implants have the clinical potential to induce the early and efficient repair of critical-sized, load-bearing bone defects.
Collapse
Affiliation(s)
- Shintaro Honda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shunsuke Fujibayashi
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takayoshi Shimizu
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Seiji Yamaguchi
- Department of Biomedical Sciences, College of Life and Health Sciences, Chubu University, Aichi, Japan
| | - Yaichiro Okuzu
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Takaoka
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Soichiro Masuda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Mitsuru Takemoto
- Department of Orthopaedic Surgery, Kyoto City Hospital, Kyoto, Japan
| | - Toshiyuki Kawai
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Bungo Otsuki
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Koji Goto
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| |
Collapse
|
7
|
Li Y, Huang J, Chen Y, Zhu S, Huang Z, Yang L, Li G. Nerve function restoration following targeted muscle reinnervation after varying delayed periods. Neural Regen Res 2023; 18:2762-2766. [PMID: 37449642 DOI: 10.4103/1673-5374.373659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Targeted muscle reinnervation has been proposed for reconstruction of neuromuscular function in amputees. However, it is unknown whether performing delayed targeted muscle reinnervation after nerve injury will affect restoration of function. In this rat nerve injury study, the median and musculocutaneous nerves of the forelimb were transected. The proximal median nerve stump was sutured to the distal musculocutaneous nerve stump immediately and 2 and 4 weeks after surgery to reinnervate the biceps brachii. After targeted muscle reinnervation, intramuscular myoelectric signals from the biceps brachii were recorded. Signal amplitude gradually increased with time. Biceps brachii myoelectric signals and muscle fiber morphology and grooming behavior did not significantly differ among rats subjected to delayed target muscle innervation for different periods. Targeted muscle reinnervation delayed for 4 weeks can acquire the same nerve function restoration effect as that of immediate reinnervation.
Collapse
Affiliation(s)
- Yuanheng Li
- Key Laboratory of Human-Machine Intelligence-Synergy Systems and Branch of Shenzhen Institute of Artificial Intelligence and Robotics for Society, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong Province, China
| | - Jiangping Huang
- Key Laboratory of Human-Machine Intelligence-Synergy Systems and Branch of Shenzhen Institute of Artificial Intelligence and Robotics for Society, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong Province, China
| | - Yuling Chen
- Department of Rehabilitation Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province; Department of Rehabilitation Medicine, Yibin Hospital of Traditional Chinese Medicine, Yibin, Sichuan Province, China
| | - Shanshan Zhu
- Key Laboratory of Human-Machine Intelligence-Synergy Systems and Branch of Shenzhen Institute of Artificial Intelligence and Robotics for Society, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong Province, China
| | - Zhen Huang
- Department of Rehabilitation Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province; Department of Rehabilitation Medicine, Yibin Hospital of Traditional Chinese Medicine, Yibin, Sichuan Province, China
| | - Lin Yang
- Key Laboratory of Human-Machine Intelligence-Synergy Systems and Branch of Shenzhen Institute of Artificial Intelligence and Robotics for Society, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong Province, China
| | - Guanglin Li
- Key Laboratory of Human-Machine Intelligence-Synergy Systems and Branch of Shenzhen Institute of Artificial Intelligence and Robotics for Society, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong Province, China
| |
Collapse
|
8
|
Marin E. Forged to heal: The role of metallic cellular solids in bone tissue engineering. Mater Today Bio 2023; 23:100777. [PMID: 37727867 PMCID: PMC10506110 DOI: 10.1016/j.mtbio.2023.100777] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/21/2023] Open
Abstract
Metallic cellular solids, made of biocompatible alloys like titanium, stainless steel, or cobalt-chromium, have gained attention for their mechanical strength, reliability, and biocompatibility. These three-dimensional structures provide support and aid tissue regeneration in orthopedic implants, cardiovascular stents, and other tissue engineering cellular solids. The design and material chemistry of metallic cellular solids play crucial roles in their performance: factors such as porosity, pore size, and surface roughness influence nutrient transport, cell attachment, and mechanical stability, while their microstructure imparts strength, durability and flexibility. Various techniques, including additive manufacturing and conventional fabrication methods, are utilized for producing metallic biomedical cellular solids, each offering distinct advantages and drawbacks that must be considered for optimal design and manufacturing. The combination of mechanical properties and biocompatibility makes metallic cellular solids superior to their ceramic and polymeric counterparts in most load bearing applications, in particular under cyclic fatigue conditions, and more in general in application that require long term reliability. Although challenges remain, such as reducing the production times and the associated costs or increasing the array of available materials, metallic cellular solids showed excellent long-term reliability, with high survival rates even in long term follow-ups.
Collapse
Affiliation(s)
- Elia Marin
- Ceramic Physics Laboratory, Kyoto Institute of Technology, Sakyo-ku, Matsugasaki, 606-8585, Kyoto, Japan
- Department of Dental Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan
- Department Polytechnic of Engineering and Architecture, University of Udine, 33100, Udine, Italy
- Biomedical Research Center, Kyoto Institute of Technology, Sakyo-ku, Matsugasaki, Kyoto, 606-8585, Japan
| |
Collapse
|
9
|
Beltrami G, Rajan S, Nucci AM, Galeotti A, Guido D, Campanacci D, Innocenti M. Biological Prosthesis (Hollow 3D-Printed Titanium Custom-Made Prosthesis and Bone Graft) for Humeral Reconstruction in Pediatric Oncologic Patients: Surgical Indications and Results. Bioengineering (Basel) 2023; 10:1371. [PMID: 38135962 PMCID: PMC10741201 DOI: 10.3390/bioengineering10121371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/08/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
This study presents the mid-term outcomes of a novel "biological prosthesis" for pediatric humerus reconstruction after major bone tumor removal. This approach involves a hollow 3D-printed titanium custom-made prosthesis combined with bone grafting. The primary aim was to preserve and revitalize the unaffected autologous proximal or distal humeral stump. Between 2017 and 2021, we treated five pediatric patients (mean age 11.2 years; range 7-17) with humeral bone sarcomas. A one-stage surgical procedure involved tumor resection and implanting a hollow 3D-printed custom-made prosthesis. In two cases, we preserved the proximal humerus; in two, the distal part; and in one, both. Graft materials included homologous bone chips in three cases and free vascularized fibular grafts in two cases. All patients were clinically and radiographically assessed after a mean follow-up of 32.2 months (range of 14-68). No significant complications were observed, and no implant revisions were needed. Osseointegration was evident in all cases within eight months post-surgery; vascular support for the remaining autologous stump was demonstrated in all cases. Our hollow 3D-printed custom-made prosthesis and bone grafting offer the potential for partial or complete articular surface preservation. This approach encourages revascularization of the epiphysis, leading to satisfactory outcomes in humerus reconstruction within the pediatric population.
Collapse
Affiliation(s)
- Giovanni Beltrami
- Department of Orthopedic, Traumatology and Paediatric Orthopaedic Oncology, Azienda Ospedaliero Universitaria IRCCS, Meyer Children Hospital, 50139 Florence, Italy
| | - Sreeraj Rajan
- Department of Orthopaedic Oncology, Aster MIMS, Calicut 673016, India
| | - Anna Maria Nucci
- Department of Orthopedic, Traumatology and Paediatric Orthopaedic Oncology, Azienda Ospedaliero Universitaria IRCCS, Meyer Children Hospital, 50139 Florence, Italy
| | - Alberto Galeotti
- Department of Orthopedic, Traumatology and Paediatric Orthopaedic Oncology, Azienda Ospedaliero Universitaria IRCCS, Meyer Children Hospital, 50139 Florence, Italy
| | - Davide Guido
- Department of Orthopedic, Traumatology and Paediatric Orthopaedic Oncology, Azienda Ospedaliero Universitaria IRCCS, Meyer Children Hospital, 50139 Florence, Italy
| | - Domenico Campanacci
- Department of Orthopedic Oncology and Reconstructive Microsurgery, CTO, 10100 Florence, Italy
| | - Marco Innocenti
- Orthoplastic Surgery Division, Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Takenoshita S, Asano N, Kasahara T, Hirozane T, Yamaguchi S, Mori T, Ohkita H, Nakayama R, Nakamura M, Matsumoto M. Secondary peripheral chondrosarcoma arising from solitary osteochondroma of the clavicle: A case report. J Orthop Sci 2023; 28:1592-1596. [PMID: 34924250 DOI: 10.1016/j.jos.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Shinichi Takenoshita
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Naofumi Asano
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan.
| | - Tomoki Kasahara
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Toru Hirozane
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Sayaka Yamaguchi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Tomoaki Mori
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Hajime Ohkita
- Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Robert Nakayama
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
| |
Collapse
|
12
|
Zhao J, Wang Z, Long C, He H, Zhao W, Zhang J. Using 3D printing-assisted shaping titanium cages and Masquelet techniques to reconstruct calcaneal osteomyelitis complicated by extensive soft tissue and uncontrolled defects. Injury 2023; 54:110977. [PMID: 37684116 DOI: 10.1016/j.injury.2023.110977] [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: 12/08/2022] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVE To investigate the clinical efficacy of three-dimensional (3D) printing-assisted shaping titanium cage combined with Masquelet technology in the treatment of calcaneal infectious defects. METHODS A retrospective analysis was performed of the data from nine patients with chronic calcaneal infection defects treated with distal gastronal flap coverage and one patient with free anterolateral thigh flap coverage, also using a 3D printing-assisted shaping titanium cage combined with both mask technology and rib autografting from January 2017 to January 2019. There were seven males and three females, with a mean age of 37 years (range, 17-52 years). The injury mechanism of the 10 patients included four motor vehicle incidents, four high fall injuries, and two rolling compactions. All patients were treated by two⁃stage procedures. The first stage included debridement, polymethyl methacrylate (PMMA) filling, and regional flap coverage. The soft tissue defect of the 10 cases included 80 cm2 in four cases and 56 cm2, 40 cm2, and 15 cm2 in each of two cases. The bone defect was 24 cm3 and 18 cm3 in each of four cases and 3 cm3 in two cases. The second stage was the mask technology of 3D printing-assisted shaping titanium cage combined with rib autografting. Time of bone union, calcaneus morphology, implant position, and the Maryland and AOFAS hind foot scores were recorded to evaluate the clinical outcome. RESULTS All 10 patients were followed up for a mean of 18.5 months (range, 12-30 months). Infection occurred in two patients 2 months after the first stage operation and were successfully treated by debridement and PMMA replacement. The incision of the other eight cases all healed successfully. Cultures from the 10 cases included five cases of methicillin-resistant Staphylococcus aureus, three cases of S. aureus, and one case each of Escherichia coli and Pseudomonas aeruginosa. All 10 patients exhibited calcaneus bone union after the second stage operation. The mean time for bone union was 4.32 (range, 3-8) months. Bone trabeculae were observed in a CT scan 13 (range, 10-22) months post-operation. The mean Maryland score at 12 months post-operation was 92 (range, 86-98) and the mean AOFAS ankle hind foot score was 89.8 (range, 83-100). CONCLUSION Three-dimensional printing-assisted shaping titanium cages and Masquelet technology may be effective methods for the treatment of infectious calcaneal defects.
Collapse
Affiliation(s)
- Jianwen Zhao
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Chinese Academy of Orthopedics, PLA General Hospital, Beijing 100048, China
| | - Zhifeng Wang
- First Orthopedic Surgery Department, Fourth Affiliated Hospital of China Medical University, Shenyang 110032, China
| | - Cheng Long
- Xiangya Hospital, Central South University, Department of Orthopedics, Changsha 410008, China
| | - Hongying He
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Chinese Academy of Orthopedics, PLA General Hospital, Beijing 100048, China
| | - Wei Zhao
- First Orthopedic Surgery Department, Fourth Affiliated Hospital of China Medical University, Shenyang 110032, China
| | - Jianzheng Zhang
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Chinese Academy of Orthopedics, PLA General Hospital, Beijing 100048, China.
| |
Collapse
|
13
|
Chai Y, Chen XB, Estoque JA, Birbilis N, Qin Q, Ward T, Smith PN, Li RW. A Novel Approach of Customized Pelvic Implant Design Based on Symmetrical Analysis and 3D Printing. 3D PRINTING AND ADDITIVE MANUFACTURING 2023; 10:984-991. [PMID: 37886407 PMCID: PMC10599429 DOI: 10.1089/3dp.2021.0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
In pelvic trauma patients, the mismatch of complex geometries between the pelvis and fixation implant is a fundamental cause of unstable and displaced pelvic ring disruption, in which secondary intervention is strongly considered. The geometrical matching in the current customized implant design and clinical practice is through the nonfractured hemi-pelvis for the fractured pelvis. This design philosophy overlooks the anatomical difference between the hemipelves, and further, the geometrical asymmetry at local area still remains unknown. This study analyzed the anatomical asymmetry of a patient's 3D pelvic models from 13 patients. The hemipelves of each patient were registered by using an iterative closet algorithm to an optimum position with minimum deviations. The high deviation regions were summarized between the hemipelves in each case, and a color map was drawn on a hemipelvis model that identified the areas that had a high possibility to be symmetrically different. A severe pelvic trauma case was used to comprehend the approach by designing a 3D printed implant. Each fracture was then registered to the mirrored uninjured hemipelvis by using the same algorithm, and customized fixation implants were designed with reference to the fractured model. The customized fixation plates showed that the implants had lower geometrical deviation when attached onto the re-stitched fracture side than onto the mirrored nonfractured bone. These results indicate that the symmetrical analysis of bone anatomy and the deviation color map can assist with implant selection and customized implant design given the geometrical difference between symmetrical bones. The novel approach provides a scientific reference that improves the accuracy and overall standard of 3D printed implants.
Collapse
Affiliation(s)
- Yuan Chai
- Trauma and Orthopaedic Research Laboratory, Department of Surgery, The Medical School, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Xiao-Bo Chen
- School of Engineering, RMIT University, Carlton, Victoria, Australia
| | - Jesse A. Estoque
- Trauma and Orthopaedic Research Laboratory, Department of Surgery, The Medical School, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Nick Birbilis
- College of Engineering and Computer Science, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Qinghua Qin
- College of Engineering and Computer Science, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Tomas Ward
- Department of Emergency, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Paul N. Smith
- Trauma and Orthopaedic Research Unit, Clinical Orthopaedic Surgery, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Rachel W. Li
- John Curtin School of Medical Research, The Australian National University, Acton, Australian Capital Territory, Australia
| |
Collapse
|
14
|
Bandyopadhyay A, Mitra I, Avila JD, Upadhyayula M, Bose S. Porous metal implants: processing, properties, and challenges. INTERNATIONAL JOURNAL OF EXTREME MANUFACTURING 2023; 5:032014. [PMID: 37476350 PMCID: PMC10355163 DOI: 10.1088/2631-7990/acdd35] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/26/2023] [Accepted: 06/09/2023] [Indexed: 07/22/2023]
Abstract
Porous and functionally graded materials have seen extensive applications in modern biomedical devices-allowing for improved site-specific performance; their appreciable mechanical, corrosive, and biocompatible properties are highly sought after for lightweight and high-strength load-bearing orthopedic and dental implants. Examples of such porous materials are metals, ceramics, and polymers. Although, easy to manufacture and lightweight, porous polymers do not inherently exhibit the required mechanical strength for hard tissue repair or replacement. Alternatively, porous ceramics are brittle and do not possess the required fatigue resistance. On the other hand, porous biocompatible metals have shown tailorable strength, fatigue resistance, and toughness. Thereby, a significant interest in investigating the manufacturing challenges of porous metals has taken place in recent years. Past research has shown that once the advantages of porous metallic structures in the orthopedic implant industry have been realized, their biological and biomechanical compatibility-with the host bone-has been followed up with extensive methodical research. Various manufacturing methods for porous or functionally graded metals are discussed and compared in this review, specifically, how the manufacturing process influences microstructure, graded composition, porosity, biocompatibility, and mechanical properties. Most of the studies discussed in this review are related to porous structures for bone implant applications; however, the understanding of these investigations may also be extended to other devices beyond the biomedical field.
Collapse
Affiliation(s)
- Amit Bandyopadhyay
- W. M. Keck Biomedical Materials Research Lab, School of Mechanical and Materials Engineering, Washington State University, Pullman, WA 99164, United States of America
| | - Indranath Mitra
- W. M. Keck Biomedical Materials Research Lab, School of Mechanical and Materials Engineering, Washington State University, Pullman, WA 99164, United States of America
| | - Jose D Avila
- W. M. Keck Biomedical Materials Research Lab, School of Mechanical and Materials Engineering, Washington State University, Pullman, WA 99164, United States of America
| | - Mahadev Upadhyayula
- W. M. Keck Biomedical Materials Research Lab, School of Mechanical and Materials Engineering, Washington State University, Pullman, WA 99164, United States of America
| | - Susmita Bose
- W. M. Keck Biomedical Materials Research Lab, School of Mechanical and Materials Engineering, Washington State University, Pullman, WA 99164, United States of America
| |
Collapse
|
15
|
Wu Y, Liu J, Kang L, Tian J, Zhang X, Hu J, Huang Y, Liu F, Wang H, Wu Z. An overview of 3D printed metal implants in orthopedic applications: Present and future perspectives. Heliyon 2023; 9:e17718. [PMID: 37456029 PMCID: PMC10344715 DOI: 10.1016/j.heliyon.2023.e17718] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 06/12/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023] Open
Abstract
With the ability to produce components with complex and precise structures, additive manufacturing or 3D printing techniques are now widely applied in both industry and consumer markets. The emergence of tissue engineering has facilitated the application of 3D printing in the field of biomedical implants. 3D printed implants with proper structural design can not only eliminate the stress shielding effect but also improve in vivo biocompatibility and functionality. By combining medical images derived from technologies such as X-ray scanning, CT, MRI, or ultrasonic scanning, 3D printing can be used to create patient-specific implants with almost the same anatomical structures as the injured tissues. Numerous clinical trials have already been conducted with customized implants. However, the limited availability of raw materials for printing and a lack of guidance from related regulations or laws may impede the development of 3D printing in medical implants. This review provides information on the current state of 3D printing techniques in orthopedic implant applications. The current challenges and future perspectives are also included.
Collapse
Affiliation(s)
- Yuanhao Wu
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jieying Liu
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Lin Kang
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jingjing Tian
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xueyi Zhang
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jin Hu
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yue Huang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Fuze Liu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Hai Wang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Zhihong Wu
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
- Beijing Key Laboratory for Genetic Research of Bone and Joint Disease, Beijing, China
| |
Collapse
|
16
|
Gonzato O, Schuster K. The role of patient advocates and sarcoma community initiatives in musculoskeletal oncology. Moving towards Evidence-Based Advocacy to empower Evidence-Based Medicine. J Cancer Policy 2023; 36:100413. [PMID: 36806641 DOI: 10.1016/j.jcpo.2023.100413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 01/29/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023]
Abstract
Musculoskeletal sarcomas are rare cancers that as the whole family of sarcomas pose several challenges at different levels, ranging from medical knowledge to clinical research and policymaking. Addressing these challenges, necessarily calls for the inclusion of patient perspective inside the decision-making processes of every area that contributes to treatment improvement, from the provision of high-quality services by healthcare organisations to research issues. Without patient-provided inputs to inform decisions, the current paradigm of patient-centred care makes no sense and sounds at the least irrational if not unethical. Putting PROMs on "centre stage" in cancer research and care, could allow to build a truly Evidence Based Advocacy (EBA) and therefore to empower Evidence Based Medicine (EBM).
Collapse
Affiliation(s)
- Ornella Gonzato
- Fondazione Paola Gonzato-Rete Sarcoma ETS, Italy; Sarcoma Patient Advocacy Global Network (SPAGN), Germany.
| | | |
Collapse
|
17
|
Palmquist A, Jolic M, Hryha E, Shah FA. Complex geometry and integrated macro-porosity: Clinical applications of electron beam melting to fabricate bespoke bone-anchored implants. Acta Biomater 2023; 156:125-145. [PMID: 35675890 DOI: 10.1016/j.actbio.2022.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/16/2022] [Accepted: 06/01/2022] [Indexed: 01/18/2023]
Abstract
The last decade has witnessed rapid advancements in manufacturing technologies for biomedical implants. Additive manufacturing (or 3D printing) has broken down major barriers in the way of producing complex 3D geometries. Electron beam melting (EBM) is one such 3D printing process applicable to metals and alloys. EBM offers build rates up to two orders of magnitude greater than comparable laser-based technologies and a high vacuum environment to prevent accumulation of trace elements. These features make EBM particularly advantageous for materials susceptible to spontaneous oxidation and nitrogen pick-up when exposed to air (e.g., titanium and titanium-based alloys). For skeletal reconstruction(s), anatomical mimickry and integrated macro-porous architecture to facilitate bone ingrowth are undoubtedly the key features of EBM manufactured implants. Using finite element modelling of physiological loading conditions, the design of a prosthesis may be further personalised. This review looks at the many unique clinical applications of EBM in skeletal repair and the ground-breaking innovations in prosthetic rehabilitation. From a simple acetabular cup to the fifth toe, from the hand-wrist complex to the shoulder, and from vertebral replacement to cranio-maxillofacial reconstruction, EBM has experienced it all. While sternocostal reconstructions might be rare, the repair of long bones using EBM manufactured implants is becoming exceedingly frequent. Despite the various merits, several challenges remain yet untackled. Nevertheless, with the capability to produce osseointegrating implants of any conceivable shape/size, and permissive of bone ingrowth and functional loading, EBM can pave the way for numerous fascinating and novel applications in skeletal repair, regeneration, and rehabilitation. STATEMENT OF SIGNIFICANCE: Electron beam melting (EBM) offers unparalleled possibilities in producing contaminant-free, complex and intricate geometries from alloys of biomedical interest, including Ti6Al4V and CoCr. We review the diverse range of clinical applications of EBM in skeletal repair, both as mass produced off-the-shelf implants and personalised, patient-specific prostheses. From replacing large volumes of disease-affected bone to complex, multi-material reconstructions, almost every part of the human skeleton has been replaced with an EBM manufactured analog to achieve macroscopic anatomical-mimickry. However, various questions regarding long-term performance of patient-specific implants remain unaddressed. Directions for further development include designing personalised implants and prostheses based on simulated loading conditions and accounting for trabecular bone microstructure with respect to physiological factors such as patient's age and disease status.
Collapse
Affiliation(s)
- Anders Palmquist
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Martina Jolic
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eduard Hryha
- Department of Materials and Manufacturing Technologies, Chalmers University of Technology, Gothenburg, Sweden
| | - Furqan A Shah
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| |
Collapse
|
18
|
Li Z, Zou C, Lu M, Zhang Y, Gong T, Wang J, Luo Y, Zhou Y, Min L, Tu C. Case report: Intraosseous hemangioma of the lateral clavicle treated by surgical resection and reconstructed by three-dimensional-printed personalized prosthesis. Front Bioeng Biotechnol 2023; 10:1085674. [PMID: 36698635 PMCID: PMC9868392 DOI: 10.3389/fbioe.2022.1085674] [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: 10/31/2022] [Accepted: 12/23/2022] [Indexed: 01/11/2023] Open
Abstract
Background: Intraosseous hemangiomas occurring the clavicle is uncommon. Reconstruction of the clavicle is suggested to maintain the normal shoulder joint function and prevent adverse outcomes. Complex anatomy shape of the clavicle remains a great challenge for prosthetic reconstruction of the clavicle. Case presentation: A 37-year-old female with no conclusive history of trauma presented with progressive mass at the right lateral clavicle for 5 years. The patient was treated by surgical resection and reconstructed by three-dimensional-printed personalized prosthesis. Postoperatively radiographic examinations revealed a good position of the prosthesis, neither breakage nor loosening was detected. The right shoulder mobility returned to approximate level of preoperative shoulder 2 months after surgical reconstruction, with the range of motion of flexion 80°, extension 40°, abduction 80°, adduction 30°, external rotation 55°, and internal rotation 60°. The patient maintained the normal shoulder function during the 48 months follow-up period. There was no pain during shoulder motion. The Musculoskeletal Tumor Society Score (MSTS) score was 29 and the Functional Evaluation Form recommended by the American Shoulder and Elbow Surgeons (ASES) score was 95. Conclusion: 3D-printed personalized prosthesis is a good option to reconstruct the lateral clavicle bone defect and restore the shoulder support structure. It maintains the normal shoulder joint function and avoids adverse effects on daily activities after claviculectomy.
Collapse
Affiliation(s)
- Zhuangzhuang Li
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China,Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Chang Zou
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Minxun Lu
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China,Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Yuqi Zhang
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China,Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Taojun Gong
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China,Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Jie Wang
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China,Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Yi Luo
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China,Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Yong Zhou
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China,Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Li Min
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China,Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China,*Correspondence: Li Min, ; Chongqi Tu,
| | - Chongqi Tu
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China,Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China,*Correspondence: Li Min, ; Chongqi Tu,
| |
Collapse
|
19
|
Zhang Z, Shi Y, Fu J, Liu D, Zhu D, Liu X, Dang J, Fan H. Customized three dimensional printed prosthesis as a novel intercalary reconstruction for resection of extremity bone tumours: a retrospective cohort study. INTERNATIONAL ORTHOPAEDICS 2022; 46:2971-2981. [PMID: 36083497 DOI: 10.1007/s00264-022-05559-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/17/2022] [Indexed: 12/14/2022]
Abstract
AIMS The 3D-printed prosthesis (3DP) is a novel treatment for massive bone defect reconstruction after tumor resection. This study was aiming to explore the clinical efficacy of customized 3DP for intercalary reconstruction by comparing the clinical outcomes after implanting customized 3DP or conventional allograft in limb salvage surgery. METHODS A total of 28 patients with extremity bone tumors who underwent customized 3DP or conventional allograft reconstruction between 2011 and 2018 at our institution were analyzed retrospectively. Among them, 14 cases received customized 3DP reconstruction (3DP group), and 14 cases received conventional allograft reconstruction (control group). Demographics, surgical outcomes, radiographical assessments, limb functions, and post-operative complications between these two groups were collected to evaluate clinical outcomes. RESULTS No significant difference was observed in the demographics, mean intra-operative blood loss, MOSI scores, and MSTS scores between the two groups. Patients in 3DP group had a shorter operative time (157.9 vs 199.6 min, p = 0.03) and lesser number of fluoroscopy (4.1 vs 8.1, p < 0.001) compared to control group. The mean time to osseointegration at bone-implant interfaces in 3DP group was significantly earlier than that in control group (6.1 vs 12.2 months, p < 0.001). Moreover, the 3DP group had a significantly lower post-operative complication rate than the control group (7% vs 50%, p = 0.03). CONCLUSIONS The customized 3DP might provide a promising strategy for intercalary reconstruction in limb salvage surgery with more precise reconstruction, higher surgical efficiency, and comparable satisfactory clinical outcomes.
Collapse
Affiliation(s)
- Zhao Zhang
- Department of Orthopedic Surgery, Xi-Jing Hospital, The Fourth Military Medical University, Xi'an, 710032, China
| | - Yubo Shi
- Department of Orthopedic Surgery, Xi-Jing Hospital, The Fourth Military Medical University, Xi'an, 710032, China
| | - Jun Fu
- Department of Orthopedic Surgery, Xi-Jing Hospital, The Fourth Military Medical University, Xi'an, 710032, China
| | - Dong Liu
- Department of Orthopedic Surgery, Xi-Jing Hospital, The Fourth Military Medical University, Xi'an, 710032, China
| | - Dongze Zhu
- Department of Orthopedic Surgery, Xi-Jing Hospital, The Fourth Military Medical University, Xi'an, 710032, China
| | - Xincheng Liu
- Department of Orthopedic Surgery, Xi-Jing Hospital, The Fourth Military Medical University, Xi'an, 710032, China
| | - Jingyi Dang
- Department of Orthopedic Surgery, Xi-Jing Hospital, The Fourth Military Medical University, Xi'an, 710032, China
| | - Hongbin Fan
- Department of Orthopedic Surgery, Xi-Jing Hospital, The Fourth Military Medical University, Xi'an, 710032, China.
| |
Collapse
|
20
|
Gao Y, Cheng J, Long Z, Cheng P, Zhang S, Pei G, Li Z, Meng G. Repair of segmental ulnar bone defect in juvenile caused by osteomyelitis with induced membrane combined with tissue-engineered bone: A case report with 4-year follow-up. Int J Surg Case Rep 2022; 99:107569. [PMID: 36108376 PMCID: PMC9568728 DOI: 10.1016/j.ijscr.2022.107569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/26/2022] [Accepted: 08/26/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction and importance We used induced membrane combined with tissue-engineered bone (TEB) to repair the 14-cm juvenile ulnar defect formed after osteomyelitis debridement. The TEB was completely transformed into autologous bone after 4-year follow-up. Case presentation A 13-year-old male was hospitalized because of right ulna chronic osteomyelitis. After focal debridement, the total length of ular defect was 14 cm. Anti-infective bone cement was filled in the bone defect area. β-Tricalcium phosphate (β-TCP) was used as TEB scaffold. Autologous iliac bone marrow stromal cells (BMSCs) were cultured in vitro and were planted on β-TCP scaffold to form TEB 3 weeks later. 47 months after implantation of TEB, the repaired ulna had continuous and smooth bone cortex, completely ossification of TEB, completely recanalization of medullary cavity. The upper limb function DASH score was 35. Clinical discussion Masquelet put forward the concept of “induced membrane” and applied this technique on bone defects treatment formed after debridement of osteomyelitis. β-Tricalcium phosphate (β-TCP) is artificial bone materials commonly used in clinical. In this case, the seed cells used were autologous BMSCs and the culture medium was autologous serum. Cytokines promoting cell growth and differentiation were not used. Conclusion The results of this case showed that TEB combined with induced membrane could repair ulna segmental bone defects as long as 14 cm in adolescents. This technique gives one alternative method to repair juvenile bone defects caused by osteomyelities of trauma. More clinical cases are needed to verify the effectiveness of this technique in the next. It's the first report of using induced membrane combined with TEB to repair a 14cm bone defect caused by osteomyelities. In vitro cultured autologous BMSCs implanted in β-TCP scaffold could repair segmental bone defect. BMSCs were cultured with autologous serum without additional cytokines, which is safe and effective. This technique gives one alternative method to treat juvenile bone defects caused by osteomyelitis or trauma.
Collapse
|
21
|
[Effectiveness evaluation of three-dimensional printed titanium-alloy prosthesis reconstruction after distal tibia tumor segment resection]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:1108-1113. [PMID: 36111473 PMCID: PMC9626296 DOI: 10.7507/1002-1892.202205015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To evaluate the feasibility and short-term effectiveness of three-dimensional (3D) printed titanium-alloy prosthesis reconstruction after the distal tibia tumor segment resection. METHODS The clinical data of 6 patients with bone defect after distal tibia tumor segment resection treated with 3D printed titanium-alloy prosthesis reconstruction and tibiotalar joint fusion between January 2020 and December 2021 were retrospectively analyzed. There were 2 males and 4 females; the age ranged from 12 to 35 years, with an average of 18.5 years. Among them, 4 cases were osteosarcoma, 1 case was Ewing sarcoma, and 1 case was giant cell tumor of bone. The Enneking staging was stage ⅡA in 3 cases, stage ⅡB in 2 cases, and stage Ⅲ in 1 case. The disease duration was 2-5 months (mean, 3.2 months). All patients received preoperative neoadjuvant therapy, and patients with osteosarcoma and Ewing sarcoma started chemotherapy at3 weeks after operation. The systemic and local tumor conditions and prosthesis conditions were evaluated regularly after operation. The Musculoskeletal Tumor Society (MSTS) score and the American Orthopaedic Foot and Ankle Society (AOFAS) score were used to evaluate the lower extremity and ankle function. RESULTS All patients were followed up 8-26 months, with an average of 15.6 months. There was no local recurrence and distant metastasis during the follow-up. The ankle joints of 5 cases were all in 90° functional position at last follow-up, and there was no complication such as prosthesis loosening and fracture; the ankle joint fusion was stable, the local bone ingrowth was good, and the daily activities could be completed, but the ankle range of motion was limited and the ankle joint was stiff. The MSTS score ranged from 22 to 26, with an average of 24, and 3 cases were evaluated as excellent and 2 cases were good; the AOFAS score ranged from 71 to 86, with an average of 80.6, and 4 cases were evaluated as good and 1 case was fair. One patient had severe periprosthetic infection at 2 months after operation, resulting in failure of prosthesis implantation, pain in limb movement, and poor ankle function; MSTS score was 12, AOFAS score was 50, and both were evaluated as poor; distraction osteogenesis was performed after removal of prosthesis and infection control, at present, it was still in the process of distraction osteogenesis, and local osteogenesis was acceptable. CONCLUSION Using 3D printed titanium-alloy prosthesis and tibiotalar joint fusion to reconstruct the bone defect after distal tibia tumor segment resection has satisfactory mechanical stability and function, and is one of the effective distal tibial limb salvage methods.
Collapse
|
22
|
Xu S, Guo Z, Shen Q, Peng Y, Li J, Li S, He P, Jiang Z, Que Y, Cao K, Hu B, Hu Y. Reconstruction of Tumor-Induced Pelvic Defects With Customized, Three-Dimensional Printed Prostheses. Front Oncol 2022; 12:935059. [PMID: 35847863 PMCID: PMC9282862 DOI: 10.3389/fonc.2022.935059] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/02/2022] [Indexed: 11/17/2022] Open
Abstract
Background Reconstruction 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. Methods Seven 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. Results The 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. Conclusions Both 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.
Collapse
|
23
|
Vitiello R, Matrangolo MR, El Motassime A, Perna A, Cianni L, Maccauro G, Ziranu A. Three-Dimension-Printed Custom-Made Prosthetic Reconstructions in Bone Tumors: A Single Center Experience. Curr Oncol 2022; 29:4566-4577. [PMID: 35877221 PMCID: PMC9322169 DOI: 10.3390/curroncol29070361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/19/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022] Open
Abstract
Bone can be affected by different neoplastic conditions. Limb salvage surgery has become the preferred treatment strategy for most malignant tumors of the extremities. Advanced 3D printing technology has transformed the conventional view of oncological surgery. These types of implants are produced by electron beam melting (EBM) technology by sintering titanium powder in a scaffold shape designed following a project designed from HRCT and MRI. The aim of our study was to evaluate the outcomes and the mid-term follow-up of a population treated with 3D-printed custom-made prosthesis implantation in major oncological bone resection or after failure of primary implants. The primary outcome was the general patient satisfaction one year after surgery. The secondary outcomes were: mortality rate, treatment related complication rate, functional and clinical outcomes (KPS, ADL and IADL). Eight patients were included, five females and two males, with a mean age of 50.3 (±23.72) years at the surgery. The enrolled patients reported a mean satisfaction rate after surgery of 7.38 (±2) where 10 was the maximum value. There were no changes between pre- and postoperative mean KPS (81.43 +/−10.69). Mean preoperative ADL and IADL score was in both cases 4.86 (±1.07), while postoperative was 5 (±0.82), with a delta of 0.13 (p > 0.05). Custom-made prosthesis permits reconstructing bone defects caused by large tumor resection, especially in anatomically complex areas, restoring articular function.
Collapse
Affiliation(s)
- Raffaele Vitiello
- Orthopedics & Traumatology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Roma, Italy; (R.V.); (M.R.M.); (A.P.); (L.C.); (G.M.); (A.Z.)
- Orthopedics and Traumatology, Università Cattolica Del Sacro Cuore, 00168 Roma, Italy
| | - Maria Rosaria Matrangolo
- Orthopedics & Traumatology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Roma, Italy; (R.V.); (M.R.M.); (A.P.); (L.C.); (G.M.); (A.Z.)
- Orthopedics and Traumatology, Università Cattolica Del Sacro Cuore, 00168 Roma, Italy
| | - Alessandro El Motassime
- Orthopedics & Traumatology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Roma, Italy; (R.V.); (M.R.M.); (A.P.); (L.C.); (G.M.); (A.Z.)
- Orthopedics and Traumatology, Università Cattolica Del Sacro Cuore, 00168 Roma, Italy
- Correspondence: ; Fax: +39-06-305-1161
| | - Andrea Perna
- Orthopedics & Traumatology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Roma, Italy; (R.V.); (M.R.M.); (A.P.); (L.C.); (G.M.); (A.Z.)
- Orthopedics and Traumatology, Università Cattolica Del Sacro Cuore, 00168 Roma, Italy
| | - Luigi Cianni
- Orthopedics & Traumatology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Roma, Italy; (R.V.); (M.R.M.); (A.P.); (L.C.); (G.M.); (A.Z.)
- Orthopedics and Traumatology, Università Cattolica Del Sacro Cuore, 00168 Roma, Italy
| | - Giulio Maccauro
- Orthopedics & Traumatology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Roma, Italy; (R.V.); (M.R.M.); (A.P.); (L.C.); (G.M.); (A.Z.)
- Orthopedics and Traumatology, Università Cattolica Del Sacro Cuore, 00168 Roma, Italy
| | - Antonio Ziranu
- Orthopedics & Traumatology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Roma, Italy; (R.V.); (M.R.M.); (A.P.); (L.C.); (G.M.); (A.Z.)
- Orthopedics and Traumatology, Università Cattolica Del Sacro Cuore, 00168 Roma, Italy
| |
Collapse
|
24
|
Additive Manufacturing Strategies for Personalized Drug Delivery Systems and Medical Devices: Fused Filament Fabrication and Semi Solid Extrusion. MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27092784. [PMID: 35566146 PMCID: PMC9100145 DOI: 10.3390/molecules27092784] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/15/2022] [Accepted: 04/22/2022] [Indexed: 12/26/2022]
Abstract
Novel additive manufacturing (AM) techniques and particularly 3D printing (3DP) have achieved a decade of success in pharmaceutical and biomedical fields. Highly innovative personalized therapeutical solutions may be designed and manufactured through a layer-by-layer approach starting from a digital model realized according to the needs of a specific patient or a patient group. The combination of patient-tailored drug dose, dosage, or diagnostic form (shape and size) and drug release adjustment has the potential to ensure the optimal patient therapy. Among the different 3D printing techniques, extrusion-based technologies, such as fused filament fabrication (FFF) and semi solid extrusion (SSE), are the most investigated for their high versatility, precision, feasibility, and cheapness. This review provides an overview on different 3DP techniques to produce personalized drug delivery systems and medical devices, highlighting, for each method, the critical printing process parameters, the main starting materials, as well as advantages and limitations. Furthermore, the recent developments of fused filament fabrication and semi solid extrusion 3DP are discussed. In this regard, the current state of the art, based on a detailed literature survey of the different 3D products printed via extrusion-based techniques, envisioning future directions in the clinical applications and diffusion of such systems, is summarized.
Collapse
|
25
|
Lazzeri S, Talanti E, Basciano S, Barbato R, Fontanelli F, Uccheddu F, Servi M, Volpe Y, Vagnoli L, Amore E, Marzola A, McGreevy KS, Carfagni M. 3D-Printed Patient-Specific Casts for the Distal Radius in Children: Outcome and Pre-Market Survey. MATERIALS 2022; 15:ma15082863. [PMID: 35454555 PMCID: PMC9027121 DOI: 10.3390/ma15082863] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/30/2022] [Accepted: 04/11/2022] [Indexed: 11/17/2022]
Abstract
Background: Orthopaedic and Trauma surgery is expected to undergo profound transformation as a result of the adoption of 3D technology. Among the various applications, patient specific manufacturing of splints and casts would appear to be, particularly in children, an interesting implementation. This study aims to assess the safety of patient specific 3D casts obtained with a newly developed 3D-scanning devise in a small case series. We therefore conducted a clinical outcome and pre-marketing study in 10 consecutive patients with distal radius fractures treated at an Academic Level I Pediatric Trauma Center. After the application of the 3D cast, patients underwent three consecutive evaluations in the following 21 days. The main outcome measurements were: pain, skin lesions and general comfort, and acceptance of the cast. The three domains were measured with the Visual Analogue Scale (VAS), the NPUAP/EPUAP classification and the Positive affect-Negative affect Scale for Children (PANAS-C), the Self-Assessment Manikin (SAM) clinical psychology tests and a Likert-type five item questionnaire, respectively. A final mechanical analysis of the cast was carried out to confirm product integrity. Results: The results obtained were consistently positive in the investigated domains of general comfort, efficacy of contention and mechanical integrity of the 3D-printed cast as well as in the practicability of the supply chain. Conclusions: This study provides Level IV evidence that patient specific 3D printed casts obtained with a specifically designed software were safe in the management of “buckle” fractures of the distal radius in children. These results encourage to extend the technology to the treatment of more demanding fractures.
Collapse
Affiliation(s)
- Simone Lazzeri
- Meyer Children’s Hospital, Viale Gaetano Pieraccini, 24, 50139 Florence, Italy; (E.T.); (S.B.); (R.B.); (F.F.); (L.V.); (E.A.); (K.S.M.)
- Correspondence:
| | - Emiliano Talanti
- Meyer Children’s Hospital, Viale Gaetano Pieraccini, 24, 50139 Florence, Italy; (E.T.); (S.B.); (R.B.); (F.F.); (L.V.); (E.A.); (K.S.M.)
| | - Simone Basciano
- Meyer Children’s Hospital, Viale Gaetano Pieraccini, 24, 50139 Florence, Italy; (E.T.); (S.B.); (R.B.); (F.F.); (L.V.); (E.A.); (K.S.M.)
| | - Raffaele Barbato
- Meyer Children’s Hospital, Viale Gaetano Pieraccini, 24, 50139 Florence, Italy; (E.T.); (S.B.); (R.B.); (F.F.); (L.V.); (E.A.); (K.S.M.)
| | - Federico Fontanelli
- Meyer Children’s Hospital, Viale Gaetano Pieraccini, 24, 50139 Florence, Italy; (E.T.); (S.B.); (R.B.); (F.F.); (L.V.); (E.A.); (K.S.M.)
| | - Francesca Uccheddu
- Department of Industrial Engineering, University of Florence, Via Santa Marta 3, 50139 Florence, Italy; (F.U.); (M.S.); (Y.V.); (A.M.); (M.C.)
| | - Michaela Servi
- Department of Industrial Engineering, University of Florence, Via Santa Marta 3, 50139 Florence, Italy; (F.U.); (M.S.); (Y.V.); (A.M.); (M.C.)
| | - Yary Volpe
- Department of Industrial Engineering, University of Florence, Via Santa Marta 3, 50139 Florence, Italy; (F.U.); (M.S.); (Y.V.); (A.M.); (M.C.)
| | - Laura Vagnoli
- Meyer Children’s Hospital, Viale Gaetano Pieraccini, 24, 50139 Florence, Italy; (E.T.); (S.B.); (R.B.); (F.F.); (L.V.); (E.A.); (K.S.M.)
| | - Elena Amore
- Meyer Children’s Hospital, Viale Gaetano Pieraccini, 24, 50139 Florence, Italy; (E.T.); (S.B.); (R.B.); (F.F.); (L.V.); (E.A.); (K.S.M.)
| | - Antonio Marzola
- Department of Industrial Engineering, University of Florence, Via Santa Marta 3, 50139 Florence, Italy; (F.U.); (M.S.); (Y.V.); (A.M.); (M.C.)
| | - Kathleen S. McGreevy
- Meyer Children’s Hospital, Viale Gaetano Pieraccini, 24, 50139 Florence, Italy; (E.T.); (S.B.); (R.B.); (F.F.); (L.V.); (E.A.); (K.S.M.)
| | - Monica Carfagni
- Department of Industrial Engineering, University of Florence, Via Santa Marta 3, 50139 Florence, Italy; (F.U.); (M.S.); (Y.V.); (A.M.); (M.C.)
| |
Collapse
|
26
|
Wang S, Luo Y, Zhang Y, Wang Y, Zheng C, Tu C, Zhou Y. Case Report: Reconstruction of Medialis Malleolus (1/4 of the Ankle Joint) After Resection of Distal Tibia Tumor With an Uncemented Three-Dimensional-Printed Prosthesis. Front Surg 2022; 9:844334. [PMID: 35402484 PMCID: PMC8987288 DOI: 10.3389/fsurg.2022.844334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Few patients presented with a distal tibial tumor that only invaded a small area of bone in the medial malleolus. There have been no previous cases in which only the medial or lateral malleolus was removed and reconstruction was complete. This article describes our attempt to reconstruct the medial malleolus (1/4 of the ankle joint) after resection of a distal tibial tumor with an uncemented three-dimensional (3D)-printed prosthesis. Case Description A 39-year-old man presented with a lump in the right medial malleolus, and biopsy results suggested fibrosarcoma. To preserve the patient's normal bone and function, we only removed the medial malleolus and reconstructed the ankle joint using a personalized 3D-printed prosthesis. The patient had no complications other than necrosis of the skin flap that covered the wound. The patient recovered well after undergoing an additional skin flap transfer. Follow-up at 7 months and again at 3 years after surgery showed good ankle function and stability, with no pain or complications. Conclusion The 3D-printed partial ankle prosthesis had a good matching degree, strength, and osseointegration ability, but also had a few complications. The patient achieved satisfactory ankle function and stability. However, a longer follow-up period is needed, and more research is required to confirm the efficacy of the prosthesis.
Collapse
|
27
|
Baines AJ, Babazadeh-Naseri A, Dunbar NJ, Lewis VO, Fregly BJ. Bilateral asymmetry of bone density adjacent to pelvic sarcomas: A retrospective study using computed tomography. J Orthop Res 2022; 40:644-653. [PMID: 33914952 DOI: 10.1002/jor.25067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/12/2021] [Accepted: 04/26/2021] [Indexed: 02/04/2023]
Abstract
Limb-salvaging hemipelvectomy surgeries involving allograft or custom prosthesis reconstruction require high quality remaining pelvic bone for adequate device fixation. Modeling studies of custom pelvis prosthesis designs typically mirror contralateral pelvic bone material properties to the ipsilateral pelvis. However, the extent of bone material property and geometric symmetry, and thus the appropriateness of mirroring, remains unknown and should be considered when designing or analyzing the performance of pelvic prostheses. This study investigates preoperative differences between ipsilateral and contralateral pelvic bone for patients with a pelvic sarcoma. Computed tomography (CT) data were obtained retrospectively from eight patients with a pelvic sarcoma. Subject-specific computational models of the pelvic bones were constructed from the CT data. Bilateral asymmetry of bone material properties and cross-sectional areas between the ipsilateral and contralateral hemipelvis were quantified at points adjacent to the pelvic sarcoma. Large bilateral asymmetry (>20%) in trabecular but not cortical bone density was observed within 20 mm of the tumor location. Differences in trabecular bone density typically declined with increased distance from the tumor. The greatest bilateral difference in cross-sectional area occurred within 10 mm of the tumor boundary for three patients and within 40 mm from the tumor site for four patients. Our results suggest that pelvic sarcomas can cause significant bilateral asymmetries in trabecular bone density for patients with a pelvic sarcoma. These differences should be taken into account when designing custom implants for this patient population.
Collapse
Affiliation(s)
- Andrew J Baines
- Department of Mechanical Engineering, Rice University, Houston, Texas, USA
| | | | - Nicholas J Dunbar
- Department of Mechanical Engineering, Rice University, Houston, Texas, USA
| | - Valerae O Lewis
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Benjamin J Fregly
- Department of Mechanical Engineering, Rice University, Houston, Texas, USA
| |
Collapse
|
28
|
Moriel-Garceso DJ, González-Quevedo D, García de Quevedo D, Tamimi I. Three-dimensional printed titanium pseudo-prosthesis for the treatment of a tumoral bone defect. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:81-86. [PMID: 37588280 PMCID: PMC10426679 DOI: 10.1016/j.xrrt.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
| | - David González-Quevedo
- Department of Orthopaedic Surgery, Regional University Hospital of Malaga, Malaga, Spain
| | | | - Iskandar Tamimi
- Department of Orthopaedic Surgery, Regional University Hospital of Malaga, Malaga, Spain
| |
Collapse
|
29
|
AlSanawi H, Albishi W, AlDhaheri M, AlMugren T, AlAmer N. Chondrosarcoma of the proximal radius treated by wide resection and reconstructed by 3D printed implant: A case report and description of surgical technique. Int J Surg Case Rep 2022; 91:106770. [PMID: 35042125 PMCID: PMC8777282 DOI: 10.1016/j.ijscr.2022.106770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Chondrosarcoma is the second most common primary malignancy of bone that can occur in multiple locations in the skeleton. It has been rarely reported in the proximal radius. While surgical resection is the primary treatment modality for individuals with localized disease, reconstruction can be challenging in the elbow joint due to its complex anatomy. 3D printing technology can be used in such complex cases to restore the normal anatomy after resection. Case presentation We present a case of mesenchymal chondrosarcoma in a 33-year-old male occurring in the proximal radius, restricting his elbow motion. That was resected and reconstructed using 3D modeling. Restoring a functional range of motion without instability. Discussion Many surgical options for chondrosarcoma presented over the years including en bloc resection, resection with or without reconstruction, or amputation. Usage of 3D modeling in the orthopedic surgery field is relatively new and it can be used in pre-operative planning and shortens surgical time. 3D printing in our case helped in obtaining a full range of motion (flexion, extension, pronation, and supination) for the patient. Conclusion It's important to reconstruct elbow joint support structure and function after resection of such a large malignant tumor in young patients. We used 3D printed implant to maintain a functional limb and it was an excellent alternative treatment. Chondrosarcoma occurring in the proximal radius is very rare. Up to our knowledge, this is the second case report. We report a case of proximal radius chondrosarcoma managed by reconstruction with Three-Dimension printed implant. 3D printing in the field of orthopedic surgery is relatively new and has upscaled medical management. A description of a surgical technique to reconstruct proximal radius and maintaining full range of motion of the elbow.
Collapse
Affiliation(s)
- Hisham AlSanawi
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Waleed Albishi
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed AlDhaheri
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Turki AlMugren
- Department of Surgery, King Abdul-aziz Medical City, Riyadh, Saudi Arabia
| | - Naif AlAmer
- Department of Orthopedic Surgery, Ministry of Health, Upper Extremity Fellow, King Saud University, Riyadh, Saudi Arabia.
| |
Collapse
|
30
|
Lu W, Li JP, Jiang ZD, Yang L, Liu XZ. Effects of targeted muscle reinnervation on spinal cord motor neurons in rats following tibial nerve transection. Neural Regen Res 2022; 17:1827-1832. [PMID: 35017445 PMCID: PMC8820695 DOI: 10.4103/1673-5374.332153] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Targeted muscle reinnervation (TMR) is a surgical procedure used to transfer residual peripheral nerves from amputated limbs to targeted muscles, which allows the target muscles to become sources of motor control information for function reconstruction. However, the effect of TMR on injured motor neurons is still unclear. In this study, we aimed to explore the effect of hind limb TMR surgery on injured motor neurons in the spinal cord of rats after tibial nerve transection. We found that the reduction in hind limb motor function and atrophy in mice caused by tibial nerve transection improved after TMR. TMR enhanced nerve regeneration by increasing the number of axons and myelin sheath thickness in the tibial nerve, increasing the number of anterior horn motor neurons, and increasing the number of choline acetyltransferase-positive cells and immunofluorescence intensity of synaptophysin in rat spinal cord. Our findings suggest that TMR may enable the reconnection of residual nerve fibers to target muscles, thus restoring hind limb motor function on the injured side.
Collapse
Affiliation(s)
- Wei Lu
- Department of Human Anatomy, School of Basic Medical Scinences, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region; Department of Human Anatomy, Zhuhai Campus of Zunyi Medical University, Zhuhai, Guangdong Province, China
| | - Jian-Ping Li
- Department of Human Anatomy, Zhuhai Campus of Zunyi Medical University, Zhuhai, Guangdong Province, China
| | - Zhen-Dong Jiang
- Department of Human Anatomy, Zhuhai Campus of Zunyi Medical University, Zhuhai, Guangdong Province, China
| | - Lin Yang
- Department of Human Anatomy, Zhuhai Campus of Zunyi Medical University, Zhuhai, Guangdong Province, China
| | - Xue-Zheng Liu
- Department of Human Anatomy, School of Basic Medical Scinences, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| |
Collapse
|
31
|
Grygier D, Kujawa M, Kowalewski P. Deposition of Biocompatible Polymers by 3D Printing (FDM) on Titanium Alloy. Polymers (Basel) 2022; 14:polym14020235. [PMID: 35054641 PMCID: PMC8780568 DOI: 10.3390/polym14020235] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/30/2021] [Accepted: 01/05/2022] [Indexed: 01/27/2023] Open
Abstract
Nowadays, the replacement of a hip joint is a standard surgical procedure. However, researchers have continuingly been trying to upgrade endoprostheses and make them more similar to natural joints. The use of 3D printing could be helpful in such cases, since 3D-printed elements could mimic the natural lubrication mechanism of the meniscus. In this paper, we propose a method to deposit plastics directly on titanium alloy using 3D printing (FDM). This procedure allows one to obtain endoprostheses that are more similar to natural joints, easier to manufacture and have fewer components. During the research, biocompatible polymers suitable for 3D FDM printing were used, namely polylactide (PLA) and polyamide (PA). The research included tensile and shear tests of metal–polymer bonds, friction coefficient measurements and microscopic observations. The friction coefficient measurements revealed that only PA was promising for endoprostheses (the friction coefficient for PLA was too high). The strength tests and microscopic observations showed that PLA and PA deposition by 3D FDM printing directly on Ti6Al4V titanium alloy is possible; however, the achieved bonding strength and repeatability of the process were unsatisfactory. Nevertheless, the benefits arising from application of this method mean that it is worthwhile to continue working on this issue.
Collapse
|
32
|
Zhang HR. Application and Development of Megaprostheses in Limb Salvage for Bone Tumors Around the Knee Joint. Cancer Control 2022; 29:10732748221099219. [PMID: 35499495 PMCID: PMC9067034 DOI: 10.1177/10732748221099219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In recent decades, limb-salvage surgery has replaced amputation as the first choice for the treatment of bone tumors around knee. After tumor resection, there are a variety of reconstruction methods for us to choose, including autograft or allograft, inactivation and reimplantation, artificial prosthesis replacement, and allograft-prosthesis compound reconstruction. Compared with other reconstruction methods, artificial prosthesis reconstruction has some advantages: relatively simple, early weight bearing, fewer early complications, and good function in the early and mid-term follow-up. After decades of continuous improvements, the design of tumor prosthesis has reached a relatively mature stage, and the failure rate of prosthesis has also been declining year by year. However, artificial prostheses also have multiple complications such as infection, aseptic loosening, prosthetic breakage, and patients sometimes face the risk of revision or amputation. Therefore, clinicians need to deeply understand the characteristics of related complications and the principles of treatment.
Collapse
|
33
|
Lang A, Segonds F, Jean C, Gazo C, Guegan J, Buisine S, Mantelet F. Augmented Design with Additive Manufacturing Methodology: Tangible Object-Based Method to Enhance Creativity in Design for Additive Manufacturing. 3D PRINTING AND ADDITIVE MANUFACTURING 2021; 8:281-292. [PMID: 36654933 PMCID: PMC9828623 DOI: 10.1089/3dp.2020.0286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Additive manufacturing (AM) brings new design potential compared with traditional manufacturing. Nevertheless, traditional manufacturing knowledge remains embedded in the minds of designers and is a real cognitive barrier to design in AM. Design for Additive Manufacturing (DfAM) provides tools, techniques, and guidelines to optimize design with the specifics of AM. These methods are usable at different moments of the design process. Only few DfAMs focus on the early stages of design, the ideation phase, which allows for the most innovation. The literature highlights the effectiveness of methodologies based on tangible tools, such as cards or objects, to generate creativity. The difficulty with such tools is to be inspirational as well as formative. Therefore, this article presents a method to help designers capture the design potential of AM to design creative solutions at the early stages of product design, named the Augmented Design with AM Methodology (ADAM2). This methodology relies on the potential of AM, defined in 14 opportunities and a set of 14 inspirational objects, each representing an opportunity. Dedicated to creativity sessions, this methodology allows forcing the association between knowledge of a company's sector and the design potential of AM. To validate the effectiveness of the ADAM2 methodology, we use it for an industrial application in a jewelry and watchmaking company. The results showed that ADAM2 promote the generation of creative solutions and the exploitation of the design potential of AM during the early design stages.
Collapse
Affiliation(s)
- Armand Lang
- LCPI, Arts et Métiers Institute of Technology, HESAM Université, Paris, France
| | - Frédéric Segonds
- LCPI, Arts et Métiers Institute of Technology, HESAM Université, Paris, France
| | - Camille Jean
- LCPI, Arts et Métiers Institute of Technology, HESAM Université, Paris, France
| | - Claude Gazo
- LCPI, Arts et Métiers Institute of Technology, HESAM Université, Paris, France
| | - Jérôme Guegan
- LaPEA, Université de Paris and Univ Gustave Eiffel, Boulogne-Billancourt, France
| | | | - Fabrice Mantelet
- LCPI, Arts et Métiers Institute of Technology, HESAM Université, Paris, France
| |
Collapse
|
34
|
Abdalbary SA, Amr SM, Abdelghany K, Nssef AA, El-Shaarawy EAA. A Case Report of the Reconstruction of a Bone Defect Following Resection of a Comminuted Fracture of the Lateral Clavicle Using a Titanium Prosthesis. Front Surg 2021; 8:646989. [PMID: 34540884 PMCID: PMC8447902 DOI: 10.3389/fsurg.2021.646989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/09/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: This case report describes the reconstruction of a severe comminuted fracture and bone defect in the lateral half of the clavicle using a novel titanium prosthesis. This unique prosthesis has been specifically designed and three dimensionally printed for the clavicle, as opposed to the Oklahoma cemented composite prosthesis used in common practice. The aims of this study were to: (1) describe the prosthesis, its stress analysis, and its surgical fixation and (2) to demonstrate the results of the 2-year follow-up of the patient with the lateral clavicle prosthesis. Patient's Main Concerns: A 20-year-old, right-handed woman complaining of severe pain in the right shoulder was admitted to our hospital following a traffic accident. Physical examination revealed pain, swelling, tenderness, limb weakness, asymmetric posturing, and loss of function in the right shoulder. Diagnosis, Intervention, and Outcomes: Radiographic evaluation in the emergency room showed complete destruction with a comminuted fracture of the lateral half of the right clavicle and a comminuted fracture of the coracoid. We designed a new prosthesis for the lateral half of the clavicle, which was then tested by finite element analysis and implanted. Use of the new prosthesis was effective in the reconstruction of the comminuted fracture in the lateral half of the clavicle. After 2 years of follow-up, the patient had an aesthetically acceptable curve and was able to perform her activities of daily living. Her pain was relieved, and the disabilities of the arm, shoulder, and hand score improved. Active range of motion of the shoulder joint and muscle strength were also improved. Conclusion: This novel prosthesis is recommended for reconstruction of the lateral half of the clavicle following development of bony defects due to fracture. Our patient achieved functional and aesthetic satisfaction with this prosthesis.
Collapse
Affiliation(s)
- Sahar Ahmed Abdalbary
- Department of Orthopaedic Physical Therapy, Faculty of Physical Therapy, Nahda University, Beni Suef, Egypt
| | - Sherif M Amr
- Department of Orthopaedic Surgery, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Khaled Abdelghany
- Advanced Manufacturing Division, The Central Metallurgical Research and Development Institute, Helwan, Egypt
| | - Amr A Nssef
- Department of Intervention Radiology, Radiology and Vascular Imaging, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Ehab A A El-Shaarawy
- Department of Anatomy and Embryology, Faculty of Medicine, Cairo University, Giza, Egypt
| |
Collapse
|
35
|
Computer Assisted Surgery and 3D Printing in Orthopaedic Oncology: A Lesson Learned by Cranio-Maxillo-Facial Surgery. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11188584] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Primary bone sarcomas are rare tumors and surgical resection in combination with chemo and radiation therapy is the mainstay of treatment. Some specific anatomical sites still represent a reconstructive challenge due to their complex three-dimensional anatomy. In recent years, patient specific instruments along with 3D printing technology has come to represent innovative techniques in orthopaedic oncology. We retrospectively reviewed 23 patients affected by primary bone sarcoma treated with patient-specific instruments and 3D printing custom made prostheses. At follow up after approximately two years, the infection rate was 26%, mechanical complication rate 13%, and local recurrence rate 13% (with a five-years implant survival rate of 74%). Based on our experience, patient-specific instruments and 3D custom-made prostheses represents a reliable and safe technique for improving the accuracy of resection of primary bone tumour, with a particular use in pelvic surgery ameliorating functional results.
Collapse
|
36
|
Wang J, An J, Lu M, Zhang Y, Lin J, Luo Y, Zhou Y, Min L, Tu C. Is three-dimensional-printed custom-made ultra-short stem with a porous structure an acceptable reconstructive alternative in peri-knee metaphysis for the tumorous bone defect? World J Surg Oncol 2021; 19:235. [PMID: 34365976 PMCID: PMC8349501 DOI: 10.1186/s12957-021-02355-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/01/2021] [Indexed: 02/08/2023] Open
Abstract
Background Long-lasting reconstruction after extensive resection involving peri-knee metaphysis is a challenging problem in orthopedic oncology. Various reconstruction methods have been proposed, but they are characterized by a high complication rate. The purposes of this study were to (1) assess osseointegration at the bone implant interface and correlated incidence of aseptic loosening; (2) identify complications including infection, endoprosthesis fracture, periprosthetic fracture, leg length discrepancy, and wound healing problem in this case series; and (3) evaluate the short-term function of the patient who received this personalized reconstruction system. Methods Between September 2016 and June 2018, our center treated 15 patients with malignancies arising in the femur or tibia shaft using endoprosthesis with a 3D-printed custom-made stem. Osseointegration and aseptic loosening were assessed with digital tomosynthesis. Complications were recorded by reviewing the patients’ records. The function was evaluated with the 1993 version of the Musculoskeletal Tumor Society (MSTS-93) score at a median of 42 (range, 34 to 54) months after reconstruction. Results One patient who experienced early aseptic loosening was managed with immobilization and bisphosphonates infusion. All implants were well osseointegrated at the final follow-up examination. There are two periprosthetic fractures intraoperatively. The wire was applied to assist fixation, and the fracture healed at the latest follow-up. Two patients experienced significant leg length discrepancies. The median MSTS-93 score was 26 (range, 23 to 30). Conclusions A 3D-printed custom-made ultra-short stem with a porous structure provides acceptable early outcomes in patients who received peri-knee metaphyseal reconstruction. With detailed preoperative design and precise intraoperative techniques, the reasonable initial stability benefits osseointegration to osteoconductive porous titanium, and therefore ensures short- and possibly long-term durability. Personalized adaptive endoprosthesis, careful intraoperative operation, and strict follow-up management enable effective prevention and treatment of complications. The functional results in our series were acceptable thanks to reliable fixation in the bone-endoprosthesis interface and an individualized rehabilitation program. These positive results indicate this device series can be a feasible alternative for critical bone defect reconstruction. Nevertheless, longer follow-up is required to determine whether this technique is superior to other forms of fixation.
Collapse
Affiliation(s)
- Jie Wang
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, 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
| | - Jingjing An
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China.,Department of Operating Room, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, People's Republic of China
| | - Minxun Lu
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, 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, Chengdu, 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, Chengdu, People's Republic of China
| | - Yi Luo
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, 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, Chengdu, 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, Chengdu, 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, Chengdu, 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.
| |
Collapse
|
37
|
Skewes J, Chen MY, Forrestal D, Rukin NJ, Woodruff MA. 3D Printing Improved Testicular Prostheses: Using Lattice Infill Structure to Modify Mechanical Properties. Front Surg 2021; 8:626143. [PMID: 33959629 PMCID: PMC8093764 DOI: 10.3389/fsurg.2021.626143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/08/2021] [Indexed: 12/20/2022] Open
Abstract
Patients often opt for implantation of testicular prostheses following orchidectomy for cancer or torsion. Recipients of testicular prostheses report issues regarding firmness, shape, size, and position, aspects of which relate to current limitations of silicone materials used and manufacturing methods for soft prostheses. We aim to create a 3D printable testicular prosthesis which mimics the natural shape and stiffness of a human testicle using a lattice infill structure. Porous testicular prostheses were engineered with relative densities from 0.1 to 0.9 using a repeating cubic unit cell lattice inside an anatomically accurate testicle 3D model. These models were printed using a multi-jetting process with an elastomeric material and compared with current market prostheses using shore hardness tests. Additionally, standard sized porous specimens were printed for compression testing to verify and match the stiffness to human testicle elastic modulus (E-modulus) values from literature. The resulting 3D printed testicular prosthesis of relative density between 0.3 and 0.4 successfully achieved a reduction of its bulk compressive E-modulus from 360 KPa to a human testicle at 28 Kpa. Additionally, this is the first study to quantitatively show that current commercial testicular prostheses are too firm compared to native tissue. 3D printing allows us to create metamaterials that match the properties of human tissue to create customisable patient specific prostheses. This method expands the use cases for existing biomaterials by tuning their properties and could be applied to other implants mimicking native tissues.
Collapse
Affiliation(s)
- Jacob Skewes
- Engineering Faculty, Queensland University of Technology, Brisbane, QLD, Australia
| | - Michael Y Chen
- Engineering Faculty, Queensland University of Technology, Brisbane, QLD, Australia.,Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, QLD, Australia.,Redcliffe Hospital, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - David Forrestal
- Engineering Faculty, Queensland University of Technology, Brisbane, QLD, Australia.,Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Nicholas J Rukin
- Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, QLD, Australia.,Redcliffe Hospital, Metro North Hospital and Health Service, Brisbane, QLD, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Maria A Woodruff
- Engineering Faculty, Queensland University of Technology, Brisbane, QLD, Australia
| |
Collapse
|
38
|
Chen G, Muheremu A, Yang L, Wu X, He P, Fan H, Liu J, Chen C, Li Z, Wang F. Three-dimensional printed implant for reconstruction of pelvic bone after removal of giant chondrosarcoma: a case report. J Int Med Res 2021; 48:300060520917275. [PMID: 32290744 PMCID: PMC7160782 DOI: 10.1177/0300060520917275] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Three-dimensional (3D) reconstruction has been used for various diseases, but
few reports have described its application in pelvic reconstruction after
removal of giant chondrosarcoma. Case reports describing the clinical
application of personalized 3D-printed titanium implants are needed for
future clinical reference. Case presentation: We herein describe a 29-year-old woman with a
giant chondrosarcoma treated with a personalized 3D titanium implant. The
surgery was successful, and the patient recovered with significant pain
relief and good functional recovery after the surgery. No implant-related
complications occurred during the 12-month follow-up. The current case
represents successful application of 3D printing technology to the treatment
of a massive bone defect due to the removal of a giant osteoporotic
tumor. Conclusions Personalized 3D titanium implants can be used in the reconstruction of
massive bone defects after the removal of giant pelvic sarcomas. The
methodology and results described in the current case report can be a used
as reference in the treatment of similar cases in future.
Collapse
Affiliation(s)
- Ge Chen
- Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, P.R. China
| | | | - Liu Yang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University, Chongqing, P.R. China
| | - Xianzhe Wu
- Chongqing Institute of Optics and Mechanics, Chongqing, P.R. China
| | - Peng He
- Chongqing ITMDC Technology Co., Ltd., Chongqing, P.R. China
| | - Huaquan Fan
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University, Chongqing, P.R. China
| | - Juncai Liu
- Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, P.R. China
| | - Chang Chen
- Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, P.R. China
| | - Zhong Li
- Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, P.R. China
| | - Fuyou Wang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University, Chongqing, P.R. China
| |
Collapse
|
39
|
Zhu D, Fu J, Wang L, Guo Z, Wang Z, Fan H. Reconstruction with customized, 3D-printed prosthesis after resection of periacetabular Ewing's sarcoma in children using "triradiate cartilage-based" surgical strategy:a technical note. J Orthop Translat 2021; 28:108-117. [PMID: 33868923 PMCID: PMC8022806 DOI: 10.1016/j.jot.2020.12.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/15/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022] Open
Abstract
Background Surgery for Ewing sarcoma involving acetabulum in children is challenging. Considering the intrinsic structure of immature pelvis, trans-acetabular osteotomy through triradiate cartilage might be applied. The study was to describe the surgical technique and function outcomes of trans-acetabular osteotomy through triradiate cartilage and reconstruction with customized, 3D-printed prosthesis. Methods Two children with periacetabular ES were admitted to our hospital. The pre-operative imaging showed the triradiate cartilage was not penetrated or wholly affected by tumor. After neoadjuvant chemotherapy, the tumor was excised by trans-acetabular osteotomy basing on “triradiate cartilage strategy” and the acetabulum was reconstructed with the customized, 3D-printed prosthesis. The prosthesis was designed in Mimics software basing on the images from CT, optimized by topology technique, and examined in FE model. After implantation, the oncological and functional outcomes were evaluated with radiography, CT, and MSTS score. Results The operation time and intra-operative blood loss in these two children were 3.5h, 2.5h and 300 ml, 600 ml, respectively. The postoperative specimen showed the tumor was en bloc removed with safe margin. In the latest follow-up (48 months and 24 months), both patients were free of disease and had satisfactory function according to MSTS score. The radiography indicated the prosthesis fit the defect well without loosening. Conclusion The customized, 3D-printed prosthesis could provide optimal reconstruction of pelvic ring and satisfactory hip function after trans-acetabular osteotomy in children. The translational potential of this article This study provides promising results of implantation of customized 3D printing prosthesis in children’s pelvic sarcoma, which may bring a new design method for orthopaedic implants.
Collapse
Affiliation(s)
- Dongze Zhu
- Department of Orthopedic Surgery, Xi-jing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Jun Fu
- Department of Orthopedic Surgery, Xi-jing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Ling Wang
- State Key Laboratory for Manufacturing System Engineering, Xi'an Jiaotong University, Xi'an, 710054, China
| | - Zheng Guo
- Department of Orthopedic Surgery, Xi-jing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Zhen Wang
- Department of Orthopedic Surgery, Xi-jing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Hongbin Fan
- Department of Orthopedic Surgery, Xi-jing Hospital, Air Force Medical University, Xi'an, 710032, China
| |
Collapse
|
40
|
Custom-Made 3D-Printed Implants as Novel Approach to Reconstructive Surgery after Oncologic Resection in Pediatric Patients. J Clin Med 2021; 10:jcm10051056. [PMID: 33806387 PMCID: PMC7961419 DOI: 10.3390/jcm10051056] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/23/2021] [Accepted: 02/27/2021] [Indexed: 11/16/2022] Open
Abstract
Recently, custom-made 3D-printed prostheses have been introduced for limb salvage surgery in adult patients, but their use has not been described in pediatric patients. A series of 11 pediatric patients (mean age 10.8 years; range 2-13) with skeletal tumors treated with custom-made implants for the reconstruction of bony defects is described. Patients were followed up every 3 months. Functional results were evaluated by the Musculoskeletal Tumor Society Score (MSTS) for upper and lower limbs. The mean follow-up was 25.7 months (range 14-44). Three patients died after a mean of 19.3 months postoperatively-two because of disease progression and the other from a previous malignancy. Three patients experienced complications related to soft tissues. One patient required device removal, debridement, and antibiotic pearls for postoperative infection. Partial osseointegration between grafts and host bone was observed within a mean of 4 months. At the final follow-up, mean MSTS score was 75%. 3D prostheses may yield biological advantages due to possible integration with the host bone and also through the use of vascularized flaps. Further research is warranted.
Collapse
|
41
|
Park JW, Kang HG, Kim JH, Kim HS. The application of 3D-printing technology in pelvic bone tumor surgery. J Orthop Sci 2021; 26:276-283. [PMID: 32247647 DOI: 10.1016/j.jos.2020.03.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/22/2020] [Accepted: 03/03/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Three-dimensional (3D)-printing technology provides an advanced approach to pelvic bone tumor resection and reconstruction. However, only a few cases of pelvic bone tumor surgery using 3D-printing have been reported due to limited time since the introduction of the new implant. This study introduces pelvic bone tumor surgeries using 3D-printed bone-cutting guides and implants. METHODS This single-center retrospective review included 12 patients who underwent malignant pelvic bone tumor surgeries using a 3D-printed bone-cutting guide and/or implant. Clinical information was collected regarding patient demographics, tumor characteristics, pathologic diagnosis, surgery details, and functional recovery. RESULTS Type I internal hemipelvectomy was performed using 3D-printed bone-cutting guides for 4 patients that underwent cavitary bone tumor resection of the ilium. For 3 of these 4 patients, cavitary bone defects were filled with structural allobone graft precisely trimmed by the 3D-printed allograft-shaping guide (n = 1) and 3D-printed mesh-style titanium spacer (n = 2). For type II and III areas, one and two patients, respectively, underwent 3D-printing-assisted surgery. Five patients underwent type I, II, and III pelvic resection using 3D-printed cutting guides and reconstruction with 3D-printed implants. In all patients, independent gait was recovered except for a patient who underwent hindquarter amputation 4 months postoperatively because of local recurrence. CONCLUSIONS This study provides preliminary, short-term data on the efficacy and safety of pelvic bone tumor surgery using 3D-printing.
Collapse
Affiliation(s)
- Jong Woong Park
- Orthopaedic Oncology Clinic, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si Gyeonggi-do, 10408, South Korea; Division of Convergence Technology, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si Gyeonggi-do, 10408, South Korea
| | - Hyun Guy Kang
- Orthopaedic Oncology Clinic, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si Gyeonggi-do, 10408, South Korea; Division of Convergence Technology, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si Gyeonggi-do, 10408, South Korea.
| | - June Hyuk Kim
- Orthopaedic Oncology Clinic, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si Gyeonggi-do, 10408, South Korea
| | - Han-Soo Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul 03080, South Korea
| |
Collapse
|
42
|
Assessment of Mechanical, Chemical, and Biological Properties of Ti-Nb-Zr Alloy for Medical Applications. MATERIALS 2020; 14:ma14010126. [PMID: 33396757 PMCID: PMC7796223 DOI: 10.3390/ma14010126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/22/2020] [Accepted: 12/25/2020] [Indexed: 12/13/2022]
Abstract
The purpose of this work is to obtain comprehensive reference data of the Ti-13Nb-13Zr alloy base material: its microstructure, mechanical, and physicochemical properties. In order to obtain extensive information on the tested materials, a number of examination methods were used, including SEM, XRD, and XPS to determine the phases occurring in the material, while mechanical properties were verified with static tensile, compression, and bending tests. Moreover, the alloy's corrosion resistance in Ringer's solution and the cytotoxicity were investigated using the MTT test. Studies have shown that this alloy has the structure α', α, and β phases, indicating that parts of the β phase transformed to α', which was confirmed by mechanical properties and the shape of fractures. Due to the good mechanical properties (E = 84.1 GPa), high corrosion resistance, as well as the lack of cytotoxicity on MC3T3 and NHDF cells, this alloy meets the requirements for medical implant materials. Ti-13Nb-13Zr alloy can be successfully used in implants, including bone tissue engineering products and dental applications.
Collapse
|
43
|
Reconstruction of Bony Defects after Tumor Resection with 3D-Printed Anatomically Conforming Pelvic Prostheses through a Novel Treatment Strategy. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8513070. [PMID: 33335928 PMCID: PMC7723494 DOI: 10.1155/2020/8513070] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/09/2020] [Accepted: 11/11/2020] [Indexed: 01/07/2023]
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 ml (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.
Collapse
|
44
|
Beltrami G, Ristori G, Galeotti A, Scoccianti G, Tamburini A, Campanacci D, Capanna R, Innocenti M. A hollow, custom-made prosthesis combined with a vascularized flap and bone graft for skeletal reconstruction after bone tumour resection. Surg Oncol 2020; 36:56-60. [PMID: 33310675 DOI: 10.1016/j.suronc.2020.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/15/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE While limb-sparing surgery is now possible for more than 80% of patients with bone tumours, wide resection is often required, necessitating bone reconstruction. This paper aims to present a surgical technique that combines the advantages of a hollow, titanium, custom-made prosthesis and the biological aspects of microsurgical flaps and bone graft. PATIENTS AND METHODS From June 2016 to September 2017 at our institution, six consecutive patients with skeletal tumours underwent one-stage reconstructive surgery with concomitant implantation of a 3D-printed prosthesis. RESULTS At an average follow-up of 30 months (range: 18-45), no early complications were observed, and no implant removals were needed. One patient experienced a delayed haematogenous deep infection, which healed after surgical debridement. Three patients died of their underlying disease 18, 22, and 23 months after surgery, respectively. All flaps and custom reconstructions were successful, with primary osseointegration at a mean of four months (range: 2-7). Patients' average Musculoskeletal Tumour Society score was 23.2 (range: 18-28). CONCLUSION A hollow, custom-made, titanium prosthesis filled with bone graft, used in conjunction with a microsurgical flap, may offer good osseointegration in different anatomic locations among a patient population with a high risk of infection, pseudarthrosis, and long-term mechanical complications. The surgical technique's advantages are preliminarily demonstrated. Further studies with longer follow-up periods and larger sample sizes are required to confirm our findings.
Collapse
Affiliation(s)
- Giovanni Beltrami
- Department of Orthopedic, Traumatology and Paediatric Orthopaedic Oncology, Azienda Ospedaliero Universitaria, Meyer Children Hospital, Florence, Italy.
| | - Gabriele Ristori
- Department of Orthopedic, Traumatology and Paediatric Orthopaedic Oncology, Azienda Ospedaliero Universitaria, Meyer Children Hospital, Florence, Italy.
| | - Alberto Galeotti
- Department of Orthopedic, Traumatology and Paediatric Orthopaedic Oncology, Azienda Ospedaliero Universitaria, Meyer Children Hospital, Florence, Italy.
| | - Guido Scoccianti
- Department of Reconstructive and Oncologic Orthopaedics, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
| | - Angela Tamburini
- Department of Paediatric Onco-Hematology, Azienda Ospedaliero Universitaria, Meyer Children Hospital, Florence, Italy.
| | - Domenico Campanacci
- Department of Reconstructive and Oncologic Orthopaedics, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
| | - Rodolfo Capanna
- Department of Ortopaedics and Traumatology, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
| | - Marco Innocenti
- Department of Plastic Surgery and Microsurgery, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
| |
Collapse
|
45
|
Reconstruction of Total Bone Defects following Resection of Malignant Tumors of the Upper Extremity with 3D Printed Prostheses: Presentation of Two Patients with a Follow-Up of Three Years. Case Rep Orthop 2020; 2020:8822466. [PMID: 33083074 PMCID: PMC7559838 DOI: 10.1155/2020/8822466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/09/2020] [Accepted: 09/27/2020] [Indexed: 11/21/2022] Open
Abstract
Wide tumor resection is the local treatment of choice for patients with primary malignant bone tumors and a prerequisite for long-term survival. We present two patients that underwent total bone resection in the upper limb because of primary malignant bone tumors. The defects were then reconstructed by a 3D printed prosthesis, a procedure that, to our knowledge, has not been reported for bone defects of the upper extremity so far. Complete resection of the affected bone was required in a five-year-old girl with a high-grade osteoblastic osteosarcoma of the humerus and a 53-year-old man with a dedifferentiated leiomyosarcoma of the radius, due to the tumor's extent. Following neoadjuvant chemotherapy, resection of the entire affected humerus including the axillary nerve took place in the first case and the entire affected radius including parts of the radial nerve in the second case. Approximately three years after surgery, both patients are alive and pain-free. Despite a postoperative drop hand that affected the now 56-year-old man, he is able to carry out everyday activities such as brushing his teeth, writing, and eating. The now eight-year-old girl is also able to engage in normal activities with her left arm such as eating and carrying lightweight objects. Both patients are tumor-free to date.
Collapse
|
46
|
Howe BM, Broski SM, Littrell LA, Pepin KM, Wenger DE. Quantitative Musculoskeletal Tumor Imaging. Semin Musculoskelet Radiol 2020; 24:428-440. [PMID: 32992370 DOI: 10.1055/s-0040-1708825] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The role of quantitative magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) techniques continues to grow and evolve in the evaluation of musculoskeletal tumors. In this review we discuss the MRI quantitative techniques of volumetric measurement, chemical shift imaging, diffusion-weighted imaging, elastography, spectroscopy, and dynamic contrast enhancement. We also review quantitative PET techniques in the evaluation of musculoskeletal tumors, as well as virtual surgical planning and three-dimensional printing.
Collapse
Affiliation(s)
- B Matthew Howe
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Kay M Pepin
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Doris E Wenger
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
47
|
Implementation of the three-dimensional printing technology in treatment of bone tumours: a case series. INTERNATIONAL ORTHOPAEDICS 2020; 45:1079-1085. [PMID: 32901331 DOI: 10.1007/s00264-020-04787-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/25/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE With the ability to overcome specific anatomical and pathological challenges, 3D printing technology is setting itself as an important tool in patient-specific orthopaedics, delivering anatomical models, patient-specific instruments, and custom-made implants. One of the most demanding procedures in limb salvage surgery is the reconstruction of bony defects after tumour resection. Even though still limited in clinical practice, early results of the use of 3D technology are gradually revealing its potentially huge impact in bone tumour surgery. Here, we present a case series illustrating our experience with the use of 3D printing technology in the reconstruction of bone defects after tumour resection, and its impact on cosmesis and quality of life. METHODS We performed a retrospective analysis of 11 patients in whom a custom-made 3D-printed prosthesis was used to reconstruct a bone defect after resection for a bone tumour. Ten out of 11 patients were children (aged between 5 and 16 years) with osteosarcoma or Ewing sarcoma of the pelvis (2 children) or the arm (8 children), and one patient was a 67-year-old lady with a chondrosarcoma of the pelvis. All underwent wide resections resulting in considerable bone defects necessitating further reconstruction. RESULTS Custom-made implants were extremely useful both in reconstruction of bone defects and in terms of cosmesis, recovery facilitation, and quality of life. In this respect, pelvic and humeral reconstructions with 3D-printed custom implants particularly showed a great potential. The mean follow-up was 33 months. Four patients died of disease (36%) and overall the major and minor complication rate was 54% (6 out of 11 patients). Three patients had implant dislocation (27% [3/11 cases]), one had leg-compartment syndrome, and one patient reported limited range of motion. Only two out of 11 patients developed local recurrence. CONCLUSION Use of 3D customized implant helped us achieve two major goals in orthopaedic oncology-clear surgical resection and functional recovery with a good quality of life. Large studies with long-term follow-up are needed to reveal the value and future of 3D printing in orthopaedic oncology.
Collapse
|
48
|
Brandsma ASE, Veen EJD, Glaudemans AWJM, Jutte PC, Ploegmakers JJW. Customized treatment for an oncologic lesion near a joint: case report of a custom-made 3D-printed prosthesis for a grade II chondrosarcoma of the proximal ulna. JSES Int 2020; 5:42-45. [PMID: 33554162 PMCID: PMC7846681 DOI: 10.1016/j.jseint.2020.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Annemarie S E Brandsma
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Egbert Jan D Veen
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - Paul C Jutte
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Joris J W Ploegmakers
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, the Netherlands
| |
Collapse
|
49
|
Li H, Fan W, Zhu X. Three‐dimensional printing: The potential technology widely used in medical fields. J Biomed Mater Res A 2020; 108:2217-2229. [DOI: 10.1002/jbm.a.36979] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/30/2020] [Accepted: 04/04/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Hongjian Li
- Southern Marine Science and Engineering Guangdong Laboratory ZhanjiangMarine Medical Research Institute of Guangdong Zhanjiang (GDZJMMRI), Guangdong Medical University Zhanjiang China
| | - Wenguo Fan
- Department of Anesthesiology, Guanghua School of StomatologyHospital of Stomatology, Sun Yat‐sen University Guangzhou China
| | - Xiao Zhu
- Southern Marine Science and Engineering Guangdong Laboratory ZhanjiangMarine Medical Research Institute of Guangdong Zhanjiang (GDZJMMRI), Guangdong Medical University Zhanjiang China
| |
Collapse
|
50
|
Zhao D, Tang F, Min L, Lu M, Wang J, Zhang Y, Zhao K, Zhou Y, Luo Y, Tu C. Intercalary Reconstruction of the "Ultra-Critical Sized Bone Defect" by 3D-Printed Porous Prosthesis After Resection of Tibial Malignant Tumor. Cancer Manag Res 2020; 12:2503-2512. [PMID: 32308487 PMCID: PMC7152541 DOI: 10.2147/cmar.s245949] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 03/13/2020] [Indexed: 02/05/2023] Open
Abstract
Purpose This study aimed to evaluate the early stability, limb function, and mechanical complications of 3D-printed porous prosthetic reconstruction for "ultra-critical sized bone defects" following intercalary tibial tumor resections. Methods This study defined an "ultra-critical sized bone defect" in the tibia when the length of segmental defect in the tibia was >15.0 cm or >60% of the full tibia and the length of the residual fragment in proximal or distal tibia was between 0.5 cm and 4.0 cm. Thus, five patients with "ultra-critical sized bone defects" following an intercalary tibial malignant tumor resection treated with 3D-printed porous prosthesis between June 2014 and June 2018 were retrospectively reviewed. Patient information, implants design and fabrication, surgical procedures, and early clinical outcome data were collected and evaluated. Results Among the five patients, three were male and two were female, with an average age of 30.2 years. Pathological diagnoses were two osteosarcomas, one Ewing sarcoma, one pseudo-myogenic hemangioendothelioma, and one undifferentiated pleomorphic sarcoma . The average length of the bone defects following tumor resection was 22.8cm, and the average length of ultra-short residual bone was 2.65cm (range=0.6cm-3.8cm). The mean follow-up time was 27.6 months (range=14.0-62.0 months). Early biological fixation was achieved in all five patients. The average time of clinical osseointegration at the bone-porous interface was 3.2 months. All patients were reported to be pain free and have no limitations in their walking distance. No prosthetic mechanical complications were observed. Conclusion Reconstruction of the "ultra-critical sized bone defect" after an intercalary tibial tumor resection using 3D-printed porous prosthesis achieved satisfactory overall early biological fixation and limb function. Excellent primary stability and the following rigid biological fixation were key factors for success. The outcomes of this study were supposed to support further clinical application and evaluation of 3D-printed porous prosthetic reconstruction for "ultra-critical sized bone defects" in the tibia.
Collapse
Affiliation(s)
- Dingyun Zhao
- Department of Orthopeadics, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Fan Tang
- Department of Orthopeadics, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Li Min
- Department of Orthopeadics, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Minxun Lu
- Department of Orthopeadics, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Jie Wang
- Department of Orthopeadics, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Yuqi Zhang
- Department of Orthopeadics, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Kun Zhao
- Department of Orthopeadics, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People's Republic of China.,Department of Orthopeadics, Tianjin Fifth Central Hospital, Tianjin 300450, People's Republic of China
| | - Yong Zhou
- Department of Orthopeadics, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Yi Luo
- Department of Orthopeadics, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Chongqi Tu
- Department of Orthopeadics, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| |
Collapse
|