Clinical application of three‐dimensional printed osteotomy guide plate and personalized prosthesis in knee‐preserving tumor resection_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Weijian , WANG Baichuan , HU Hongzhi , PU Feifei , LIU Jianxiang , WU Qiang , ZHANG Zhicai , ZHANG Yingze ,  SHAO Zengwu

Department of Orthopedics, Union Hospital Affiliated of Tongji Medical College, Huazhong University of Science and Technology, Wuhan Hubei, 430022, P. R. China;

Corresponding author：

SHAO Zengwu, Email: szwpro@163.com

Keywords：

Tumor around knee joint; three‐dimensional printing technique; osteotomy guide plate; personalized prosthesis; joint‐preserving

DOI：

10.7507/1002-1892.202202080

Video：

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Objective To investigate the mid-term effectiveness of three‐dimensional (3D) printed osteotomy guide plate and personalized prosthesis in knee‐preserving tumor resection. Methods The clinical data of 12 patients who underwent knee‐preserving tumor resection and reconstruction with 3D printed osteotomy guide plate and personalized prosthesis between September 2016 and October 2018 were retrospectively analyzed. There were 7 males and 5 females. The age ranged from 7 to 59 years, with a median of 44.5 years. There were 11 cases of osteosarcoma and 1 case of fibrosarcoma, all of which were Enneking grade ⅡB. The distance from the tumor to the joint surface was 5.5-8.2 cm, with an average of 6.94 cm. Incision healing, tumor recurrence, periprosthetic fracture, and aseptic loosening were observed after operation. The Musculoskeletal Tumor Society (MSTS) scoring system was used to evaluate the function of the patients, and the knee flexion range of motion was measured. Results The 12 patients were followed up 41-66 months, with an average of 54.5 months. The length of osteotomy ranged from 14 to 26 cm, with an average of 22.08 cm. Except for 2 patients with superficial infection of incision tissue, no deep infection involving the prosthesis occurred, no patient underwent revision surgery because of prosthesis infection. During the follow-up, local recurrence occurred in 2 cases and distant metastasis occurred in 3 cases. The overall disease-free survival rate was 58.3%. Two patients died of lung metastasis, and the overall survival rate was 83.3%. One patient underwent amputation due to local recurrence, and 1 patient underwent total knee arthroplasty due to prosthesis rupture. No aseptic loosening of the prosthesis and periprosthetic fracture occurred during the follow-up, and the overall prosthesis survival rate was 83.3%. At last follow-up, 10 patients obtained satisfactory knee flexion range of motion that ranged from 95° to 125°, with an average of 110°. Two children could not cooperate with early rehabilitation treatment due to pain, and the knee flexion range of motion was not ideal (50°, 75°). All patients achieved acceptable lower limb function with MSTS scores ranged from 26 to 30, with an average of 28. All patients walked without crutches. Conclusion The treatment of malignant bone tumors around the knee joint with 3D printed osteotomy guide plate and personalized prosthesis can preserve the articular surface, obtain good limb function, reduce the risk of aseptic loosening of prosthesis, and achieve better mid-term effectiveness.

Citation： LIU Weijian, WANG Baichuan, HU Hongzhi, PU Feifei, LIU Jianxiang, WU Qiang, ZHANG Zhicai, ZHANG Yingze, SHAO Zengwu. Clinical application of three‐dimensional printed osteotomy guide plate and personalized prosthesis in knee‐preserving tumor resection. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(7): 811-816. doi: 10.7507/1002-1892.202202080 Copy

1.	Pala E, Trovarelli G, Calabrò T, et al. Survival of modern knee tumor megaprostheses: failures, functional results, and a comparative statistical analysis. Clin Orthop Relat Res, 2015, 473(3): 891-899.
2.	Zhao D, Tang F, Min L, et al. 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.
3.	Gursan O, Celtik M, Yanik B, et al. Three-dimensionally-printed joint-preserving prosthetic reconstruction of massive bone defects after malignant tumor resection of the proximal tibia. Cureus, 2021, 13(3): e13784. doi: 10.7759/cureus.13784.
4.	Wong KC, Sze LKY, Kumta SM. Complex joint-preserving bone tumor resection and reconstruction using computer navigation and 3D-printed patient-specific guides: A technical note of three cases. J Orthop Translat, 2021, 29: 152-162.
5.	Aponte-Tinao L, Farfalli GL, Ritacco LE, et al. Intercalary femur allografts are an acceptable alternative after tumor resection. Clin Orthop Relat Res, 2012, 470(3): 728-734.
6.	Aponte-Tinao L, Ayerza MA, Muscolo DL, et al. Survival, recurrence, and function after epiphyseal preservation and allograft reconstruction in osteosarcoma of the knee. Clin Orthop Relat Res, 2015, 473(5): 1789-1796.
7.	Liu W, Shao Z, Rai S, et al. Three-dimensional-printed intercalary prosthesis for the reconstruction of large bone defect after joint-preserving tumor resection. J Surg Oncol, 2020, 121(3): 570-577.
8.	Biau D, Faure F, Katsahian S, et al. Survival of total knee replacement with a megaprosthesis after bone tumor resection. J Bone Joint Surg (Am), 2006, 88(6): 1285-1293.
9.	Muscolo DL, Ayerza MA, Aponte-Tinao LA, et al. Partial epiphyseal preservation and intercalary allograft reconstruction in high-grade metaphyseal osteosarcoma of the knee. J Bone Joint Surg (Am), 2005, 87 Suppl 1(Pt 2): 226-236.
10.	Xu LH, Zhang Q, Zhao HT, et al. Computer navigation-aided joint-preserving resection and custom-made endoprosthesis reconstruction for bone sarcomas: long-term outcomes. Chin Med J (Engl), 2021, 134(21): 2597-2602.
11.	Wang J, An J, Lu M, et al. 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(1): 235. doi: 10.1186/s12957-021-02355-7.
12.	Kiss S, Terebessy T, Szöke G, et al. Epiphysis preserving resection of malignant proximal tibial tumours. Int Orthop, 2013, 37(1): 99-104.
13.	Tsuchiya H, Wan SL, Sakayama K, et al. Reconstruction using an autograft containing tumour treated by liquid nitrogen. J Bone Joint Surg (Br), 2005, 87(2): 218-225.
14.	Takeuchi A, Yamamoto N, Hayashi K, et al. Growth of epiphysis after epiphyseal-preservation surgery for childhood osteosarcoma around the knee joint. BMC Musculoskelet Disord, 2018, 19(1): 185. doi: 10.1186/s12891-018-2109-4.
15.	Houdek MT, Rose PS, Milbrandt TA, et al. Comparison of pediatric intercalary allograft reconstructions with and without a free vascularized fibula. Plast Reconstr Surg, 2018, 142(4): 1065-1071.
16.	Lin CL, Fang JJ, Lin RM. Resection of giant invasive sacral schwannoma using image-based customized osteotomy tools. Eur Spine J, 2016, 25(12): 4103-4107.
17.	Wang B, Hao Y, Pu F, et al. Computer-aided designed, three dimensional-printed hemipelvic prosthesis for peri-acetabular malignant bone tumour. Int Orthop, 2018, 42(3): 687-694.
18.	Ruggieri P, Mavrogenis AF, Pala E, et al. Long term results of fixed-hinge megaprostheses in limb salvage for malignancy. Knee, 2012, 19(5): 543-549.
19.	Ahlmann ER, Menendez LR, Kermani C, et al. Survivorship and clinical outcome of modular endoprosthetic reconstruction for neoplastic disease of the lower limb. J Bone Joint Surg (Br), 2006, 88(6): 790-795.
20.	Wong KC, Kumta SM. Joint-preserving tumor resection and reconstruction using image-guided computer navigation. Clin Orthop Relat Res, 2013, 471(3): 762-773.
21.	Li J, Guo Z, Wang Z, et al. Does microwave ablation of the tumor edge allow for joint-sparing surgery in patients with osteosarcoma of the proximal tibia? Clin Orthop Relat Res, 2015, 473(10): 3204-3211.

1. Pala E, Trovarelli G, Calabrò T, et al. Survival of modern knee tumor megaprostheses: failures, functional results, and a comparative statistical analysis. Clin Orthop Relat Res, 2015, 473(3): 891-899.
2. Zhao D, Tang F, Min L, et al. 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.
3. Gursan O, Celtik M, Yanik B, et al. Three-dimensionally-printed joint-preserving prosthetic reconstruction of massive bone defects after malignant tumor resection of the proximal tibia. Cureus, 2021, 13(3): e13784. doi: 10.7759/cureus.13784.
4. Wong KC, Sze LKY, Kumta SM. Complex joint-preserving bone tumor resection and reconstruction using computer navigation and 3D-printed patient-specific guides: A technical note of three cases. J Orthop Translat, 2021, 29: 152-162.
5. Aponte-Tinao L, Farfalli GL, Ritacco LE, et al. Intercalary femur allografts are an acceptable alternative after tumor resection. Clin Orthop Relat Res, 2012, 470(3): 728-734.
6. Aponte-Tinao L, Ayerza MA, Muscolo DL, et al. Survival, recurrence, and function after epiphyseal preservation and allograft reconstruction in osteosarcoma of the knee. Clin Orthop Relat Res, 2015, 473(5): 1789-1796.
7. Liu W, Shao Z, Rai S, et al. Three-dimensional-printed intercalary prosthesis for the reconstruction of large bone defect after joint-preserving tumor resection. J Surg Oncol, 2020, 121(3): 570-577.
8. Biau D, Faure F, Katsahian S, et al. Survival of total knee replacement with a megaprosthesis after bone tumor resection. J Bone Joint Surg (Am), 2006, 88(6): 1285-1293.
9. Muscolo DL, Ayerza MA, Aponte-Tinao LA, et al. Partial epiphyseal preservation and intercalary allograft reconstruction in high-grade metaphyseal osteosarcoma of the knee. J Bone Joint Surg (Am), 2005, 87 Suppl 1(Pt 2): 226-236.
10. Xu LH, Zhang Q, Zhao HT, et al. Computer navigation-aided joint-preserving resection and custom-made endoprosthesis reconstruction for bone sarcomas: long-term outcomes. Chin Med J (Engl), 2021, 134(21): 2597-2602.
11. Wang J, An J, Lu M, et al. 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(1): 235. doi: 10.1186/s12957-021-02355-7.
12. Kiss S, Terebessy T, Szöke G, et al. Epiphysis preserving resection of malignant proximal tibial tumours. Int Orthop, 2013, 37(1): 99-104.
13. Tsuchiya H, Wan SL, Sakayama K, et al. Reconstruction using an autograft containing tumour treated by liquid nitrogen. J Bone Joint Surg (Br), 2005, 87(2): 218-225.
14. Takeuchi A, Yamamoto N, Hayashi K, et al. Growth of epiphysis after epiphyseal-preservation surgery for childhood osteosarcoma around the knee joint. BMC Musculoskelet Disord, 2018, 19(1): 185. doi: 10.1186/s12891-018-2109-4.
15. Houdek MT, Rose PS, Milbrandt TA, et al. Comparison of pediatric intercalary allograft reconstructions with and without a free vascularized fibula. Plast Reconstr Surg, 2018, 142(4): 1065-1071.
16. Lin CL, Fang JJ, Lin RM. Resection of giant invasive sacral schwannoma using image-based customized osteotomy tools. Eur Spine J, 2016, 25(12): 4103-4107.
17. Wang B, Hao Y, Pu F, et al. Computer-aided designed, three dimensional-printed hemipelvic prosthesis for peri-acetabular malignant bone tumour. Int Orthop, 2018, 42(3): 687-694.
18. Ruggieri P, Mavrogenis AF, Pala E, et al. Long term results of fixed-hinge megaprostheses in limb salvage for malignancy. Knee, 2012, 19(5): 543-549.
19. Ahlmann ER, Menendez LR, Kermani C, et al. Survivorship and clinical outcome of modular endoprosthetic reconstruction for neoplastic disease of the lower limb. J Bone Joint Surg (Br), 2006, 88(6): 790-795.
20. Wong KC, Kumta SM. Joint-preserving tumor resection and reconstruction using image-guided computer navigation. Clin Orthop Relat Res, 2013, 471(3): 762-773.
21. Li J, Guo Z, Wang Z, et al. Does microwave ablation of the tumor edge allow for joint-sparing surgery in patients with osteosarcoma of the proximal tibia? Clin Orthop Relat Res, 2015, 473(10): 3204-3211.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical application of three‐dimensional printed osteotomy guide plate and personalized prosthesis in knee‐preserving tumor resection

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