Three-dimensional-printed hemi-pelvic prosthesis for revision of aseptic loosening or screw fracture of modular hemi-pelvic prosthesis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Xin , LUO Yi , HE Xuanhong , WANG Jie , LI Zhuangzhuang , ZHANG Yuqi , HU Xin , LU Minxun , TANG Fan , ZHOU Yong , MIN Li ,  TU Chongqi

Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,P. R. China;

Corresponding author：

TU Chongqi, Email: tuchongqi@163.com

Keywords：

Pelvic tumor; three-dimesional-printed hemi-pelvic prosthesis; modular hemi-pelvic prosthesis; revision

DOI：

10.7507/1002-1892.202306073

Video：

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Objective To investigate the effectiveness of three-dimensional (3D)-printed hemi-pelvic prosthesis for revision of aseptic loosening or screw fracture of modular hemi-pelvic prosthesis. Methods Between February 2017 and January 2020, 11 patients with aseptic loosening or screw fracture of modular hemi-pelvic prosthesis were revised using 3D-printed hemi-pelvic prostheses. There were 7 males and 4 females with an average age of 44 years (range, 25-60 years). In the first operation, all patients underwent total tumor resection, modular hemi-pelvic prosthesis reconstruction, and autologous femoral head transplantation. According to the Enneking pelvic partition system, 8 cases were resected in zones Ⅰ+Ⅱ and 3 cases in zones Ⅰ+Ⅱ+Ⅲ. The interval from the initial operation to this revision ranged from 14.3-66.2 months, with an average of 35.8 months. The operation time, the amount of intraoperative bleeding, and the occurrence of complications were recorded. At 6 months after the first operation, before revision, and at last follow-up, the American Musculoskeletal Tumor Society (MSTS) score and Harris score were used to evaluate the recovery of lower limb function. The pain-free walking distance of patients without brace assistance was recorded at last follow-up. X-ray films were taken at 1 month after the first operation, before revision, and at 1 month after revision, the acetabulum position was assessed by the differences in weight arm and cup height between bilateral hip joints. At last follow-up, the digital X-ray tomography was taken to evaluate the prosthesis-bone integration and the occurrence of aseptic loosening. Results The operation time was 182.6-238.0 minutes (mean, 197.4 minutes). The amount of intraoperative bleeding was 400-860 mL (mean, 550.0 mL). All incisions healed by first intention with no infection, hip dislocation, nerve damage, or vascular-related adverse events. The MSTS score and Harris score at last follow-up were significantly higher than those at 6 months after the first operation and before revision (P<0.05), while the score before revision was significantly lower than that at 6 months after the first operation (P<0.05). At last follow-up, the patients were able to walk more than 1 000 meters painlessly without brace assistance. Imaging review showed that the difference of cup height at 1 month after revision was significantly lower than that at 1 month after the first operation and before revision, and at 1 month after the first operation than before revision operation, and the differences were significant (P<0.05). There was no significant difference in the difference of weight arm among three time points (P>0.05). All prostheses were well integrated, and no aseptic loosening of the prosthesis or screw fracture occurred. Conclusion Revision with 3D-printed hemi-pelvic prostheses benefited in reconstructing stable pelvic ring and natural bodyweight transmission for patients encountering the aseptic loosening or screw fracture of modular hemi-pelvic prosthesis. Early postoperative rehabilitation training can maximize the recovery of patient limb function, reduce pain during walking, and reduce the incidence of complications.

Citation： LIU Xin, LUO Yi, HE Xuanhong, WANG Jie, LI Zhuangzhuang, ZHANG Yuqi, HU Xin, LU Minxun, TANG Fan, ZHOU Yong, MIN Li, TU Chongqi. Three-dimensional-printed hemi-pelvic prosthesis for revision of aseptic loosening or screw fracture of modular hemi-pelvic prosthesis. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(10): 1183-1189. doi: 10.7507/1002-1892.202306073 Copy

1.	Brown TS, Salib CG, Rose PS, et al. Reconstruction of the hip after resection of periacetabular oncological lesions: a systematic review. Bone Joint J, 2018, 100-B(1 Supple A): 22-30.
2.	Gradinger R, Rechl H, Hipp E. Pelvic osteosarcoma. Resection, reconstruction, local control, and survival statistics. Clin Orthop Relat Res, 1991(270): 149-158.
3.	Enneking WF, Dunham WK. Resection and reconstruction for primary neoplasms involving the innominate bone. J Bone Joint Surg (Am), 1978, 60(6): 731-746.
4.	Kunisada T, Fujiwara T, Hasei J, et al. Temporary external fixation can stabilize hip transposition arthroplasty after resection of malignant periacetabular bone tumors. Clin Orthop Relat Res, 2019, 477(8): 1892-1901.
5.	Gebert C, Wessling M, Hoffmann C, et al. Hip transposition as a limb salvage procedure following the resection of periacetabular tumors. J Surg Oncol, 2011, 103(3): 269-275.
6.	郭卫. 中国骨盆恶性肿瘤保肢治疗30年的发展与进步. 中国修复重建外科杂志, 2022, 36(7): 781-789.
7.	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.
8.	Sun W, Li J, Li Q, et al. Clinical effectiveness of hemipelvic reconstruction using computer-aided custom-made prostheses after resection of malignant pelvic tumors. J Arthroplasty, 2011, 26(8): 1508-1513.
9.	梁海杰, 郭卫, 张熠丹, 等. 3D打印半骨盆假体重建骨盆Ⅱ区或Ⅱ+Ⅲ区肿瘤切除后骨缺损的回顾性病例对照研究. 中国骨与关节杂志, 2017, 6(5): 326-333.
10.	Eilber FR, Grant TT, Sakai D, et al. Internal hemipelvectomy—excision of the hemipelvis with limb preservation. An alternative to hemipelvectomy. Cancer, 1979, 43(3): 806-809.
11.	Xie X, Jin Q, Zhao Z, et al. A novel limb-salvage reconstruction strategy with a custom hemipelvic endoprosthesis and preserved femoral head following the resection of periacetabular tumors: A preliminary study. J Surg Oncol, 2022, 126(4): 804-813.
12.	Hu X, Chen Y, Cai W, et al. Computer-aided design and 3D printing of hemipelvic endoprosthesis for personalized limb-salvage reconstruction after periacetabular tumor resection. Bioengineering (Basel), 2022, 9(8): 400.
13.	Ogura K, Susa M, Morioka H, et al. Reconstruction using a constrained-type hip tumor prosthesis after resection of malignant periacetabular tumors: A study by the Japanese Musculoskeletal Oncology Group (JMOG). J Surg Oncol, 2018, 117(7): 1455-1463.
14.	Ji T, Yang Y, Tang X, et al. 3D-printed modular hemipelvic endoprosthetic reconstruction following periacetabular tumor resection: early results of 80 consecutive cases. J Bone Joint Surg (Am), 2020, 102(17): 1530-1541.
15.	Erol B, Sofulu O, Sirin E, et al. Reconstruction after periacetabular tumor resection with Lumic^® endoprosthesis: What are the midterm results? J Surg Oncol, 2021, 123(2): 532-543.
16.	Fang X, Yu Z, Xiong Y, et al. Improved virtual surgical planning with 3D-multimodality image for malignant giant pelvic tumors. Cancer Manag Res, 2018, 10: 6769-6777.
17.	黄俊琪, 程佳佳, 王陶, 等. 骨盆Ⅱ区原发骨肿瘤切除与重建的疗效分析. 中国修复重建外科杂志, 2023, 37(3): 277-283.
18.	Zhou Y, Duan H, Liu Y, et al. Outcome after pelvic sarcoma resection and reconstruction with a modular hemipelvic prostheses. Int Orthop, 2011, 35(12): 1839-1846.
19.	郝智秀, 高相飞, 姬涛. 松动对组配式半骨盆假体应力分布的影响. 清华大学学报 (自然科学版), 2012, 52(1): 1-4, 9.
20.	Li X, Ji T, Huang S, et al. Biomechanics study of a 3D printed sacroiliac joint fixed modular hemipelvic endoprosthesis. Clin Biomech (Bristol, Avon), 2020, 74: 87-95.
21.	Zhang Y, Tang X, Ji T, et al. Is a modular pedicle-hemipelvic endoprosthesis durable at short term in patients undergoing Enneking type Ⅰ+ Ⅱ tumor resections with or without sacroiliac involvement? Clin Orthop Relat Res, 2018, 476(9): 1751-1761.
22.	Guo Z, Peng Y, Shen Q, et al. Reconstruction with 3D-printed prostheses after type Ⅰ+Ⅱ+Ⅲ internal hemipelvectomy: Finite element analysis and preliminary outcomes. Front Bioeng Biotechnol, 2023, 10: 1036882.
23.	Wang B, Zou C, Hu X, et al. Reconstruction with a novel combined hemipelvic endoprosthesis after resection of periacetabular tumors involving the sacroiliac joint: a report of 25 consecutive cases. BMC Cancer, 2019, 19(1): 861.
24.	Fujiwara T, Ogura K, Christ A, et al. Periacetabular reconstruction following limb-salvage surgery for pelvic sarcomas. J Bone Oncol, 2021, 31: 100396.
25.	Hu X, Lu M, Wang J, et al. Combined and modified gibson and ilioinguinal approaches in type Ⅱ+Ⅲ internal hemipelvectomy for periacetabular tumors. Front Oncol, 2022, 12: 934812.
26.	Liu X, Liu Y, Lu W, et al. Combined application of modified three-dimensional printed anatomic templates and customized cutting blocks in pelvic reconstruction after pelvic tumor resection. J Arthroplasty, 2019, 34(2): 338-345.
27.	Schwartz AJ, Kiatisevi P, Eilber FC, et al. The Friedman-Eilber resection arthroplasty of the pelvis. Clin Orthop Relat Res, 2009, 467(11): 2825-2830.
28.	Wang J, Min L, Lu M, et al. What are the complications of three-dimensionally printed, custom-made, integrative hemipelvic endoprostheses in patients with primary malignancies involving the acetabulum, and what is the function of these patients? Clin Orthop Relat Res, 2020, 478(11): 2487-2501.
29.	Ghouse S, Reznikov N, Boughton OR, et al. The design and in vivo testing of a locally stiffness-matched porous scaffold. Appl Mater Today, 2019, 15: 377-388.
30.	Palmquist A, Snis A, Emanuelsson L, et al. Long-term biocompatibility and osseointegration of electron beam melted, free-form-fabricated solid and porous titanium alloy: experimental studies in sheep. J Biomater Appl, 2013, 27(8): 1003-1016.
31.	Zhang Y, Sun N, Zhu M, et al. The contribution of pore size and porosity of 3D printed porous titanium scaffolds to osteogenesis. Biomater Adv, 2022, 133: 112651.
32.	Goto M, Matsumine A, Yamaguchi S, et al. Osteoconductivity of bioactive Ti-6Al-4V implants with lattice-shaped interconnected large pores fabricated by electron beam melting. J Biomater Appl, 2021, 35(9): 1153-1167.
33.	Wang J, Min L, Lu M, et al. Three-dimensional-printed custom-made hemipelvic endoprosthesis for the revision of the aseptic loosening and fracture of modular hemipelvic endoprosthesis: a pilot study. BMC Surg, 2021, 21(1): 262.

1. Brown TS, Salib CG, Rose PS, et al. Reconstruction of the hip after resection of periacetabular oncological lesions: a systematic review. Bone Joint J, 2018, 100-B(1 Supple A): 22-30.
2. Gradinger R, Rechl H, Hipp E. Pelvic osteosarcoma. Resection, reconstruction, local control, and survival statistics. Clin Orthop Relat Res, 1991(270): 149-158.
3. Enneking WF, Dunham WK. Resection and reconstruction for primary neoplasms involving the innominate bone. J Bone Joint Surg (Am), 1978, 60(6): 731-746.
4. Kunisada T, Fujiwara T, Hasei J, et al. Temporary external fixation can stabilize hip transposition arthroplasty after resection of malignant periacetabular bone tumors. Clin Orthop Relat Res, 2019, 477(8): 1892-1901.
5. Gebert C, Wessling M, Hoffmann C, et al. Hip transposition as a limb salvage procedure following the resection of periacetabular tumors. J Surg Oncol, 2011, 103(3): 269-275.
6. 郭卫. 中国骨盆恶性肿瘤保肢治疗30年的发展与进步. 中国修复重建外科杂志, 2022, 36(7): 781-789.
7. 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.
8. Sun W, Li J, Li Q, et al. Clinical effectiveness of hemipelvic reconstruction using computer-aided custom-made prostheses after resection of malignant pelvic tumors. J Arthroplasty, 2011, 26(8): 1508-1513.
9. 梁海杰, 郭卫, 张熠丹, 等. 3D打印半骨盆假体重建骨盆Ⅱ区或Ⅱ+Ⅲ区肿瘤切除后骨缺损的回顾性病例对照研究. 中国骨与关节杂志, 2017, 6(5): 326-333.
10. Eilber FR, Grant TT, Sakai D, et al. Internal hemipelvectomy—excision of the hemipelvis with limb preservation. An alternative to hemipelvectomy. Cancer, 1979, 43(3): 806-809.
11. Xie X, Jin Q, Zhao Z, et al. A novel limb-salvage reconstruction strategy with a custom hemipelvic endoprosthesis and preserved femoral head following the resection of periacetabular tumors: A preliminary study. J Surg Oncol, 2022, 126(4): 804-813.
12. Hu X, Chen Y, Cai W, et al. Computer-aided design and 3D printing of hemipelvic endoprosthesis for personalized limb-salvage reconstruction after periacetabular tumor resection. Bioengineering (Basel), 2022, 9(8): 400.
13. Ogura K, Susa M, Morioka H, et al. Reconstruction using a constrained-type hip tumor prosthesis after resection of malignant periacetabular tumors: A study by the Japanese Musculoskeletal Oncology Group (JMOG). J Surg Oncol, 2018, 117(7): 1455-1463.
14. Ji T, Yang Y, Tang X, et al. 3D-printed modular hemipelvic endoprosthetic reconstruction following periacetabular tumor resection: early results of 80 consecutive cases. J Bone Joint Surg (Am), 2020, 102(17): 1530-1541.
15. Erol B, Sofulu O, Sirin E, et al. Reconstruction after periacetabular tumor resection with Lumic^® endoprosthesis: What are the midterm results? J Surg Oncol, 2021, 123(2): 532-543.
16. Fang X, Yu Z, Xiong Y, et al. Improved virtual surgical planning with 3D-multimodality image for malignant giant pelvic tumors. Cancer Manag Res, 2018, 10: 6769-6777.
17. 黄俊琪, 程佳佳, 王陶, 等. 骨盆Ⅱ区原发骨肿瘤切除与重建的疗效分析. 中国修复重建外科杂志, 2023, 37(3): 277-283.
18. Zhou Y, Duan H, Liu Y, et al. Outcome after pelvic sarcoma resection and reconstruction with a modular hemipelvic prostheses. Int Orthop, 2011, 35(12): 1839-1846.
19. 郝智秀, 高相飞, 姬涛. 松动对组配式半骨盆假体应力分布的影响. 清华大学学报 (自然科学版), 2012, 52(1): 1-4, 9.
20. Li X, Ji T, Huang S, et al. Biomechanics study of a 3D printed sacroiliac joint fixed modular hemipelvic endoprosthesis. Clin Biomech (Bristol, Avon), 2020, 74: 87-95.
21. Zhang Y, Tang X, Ji T, et al. Is a modular pedicle-hemipelvic endoprosthesis durable at short term in patients undergoing Enneking type Ⅰ+ Ⅱ tumor resections with or without sacroiliac involvement? Clin Orthop Relat Res, 2018, 476(9): 1751-1761.
22. Guo Z, Peng Y, Shen Q, et al. Reconstruction with 3D-printed prostheses after type Ⅰ+Ⅱ+Ⅲ internal hemipelvectomy: Finite element analysis and preliminary outcomes. Front Bioeng Biotechnol, 2023, 10: 1036882.
23. Wang B, Zou C, Hu X, et al. Reconstruction with a novel combined hemipelvic endoprosthesis after resection of periacetabular tumors involving the sacroiliac joint: a report of 25 consecutive cases. BMC Cancer, 2019, 19(1): 861.
24. Fujiwara T, Ogura K, Christ A, et al. Periacetabular reconstruction following limb-salvage surgery for pelvic sarcomas. J Bone Oncol, 2021, 31: 100396.
25. Hu X, Lu M, Wang J, et al. Combined and modified gibson and ilioinguinal approaches in type Ⅱ+Ⅲ internal hemipelvectomy for periacetabular tumors. Front Oncol, 2022, 12: 934812.
26. Liu X, Liu Y, Lu W, et al. Combined application of modified three-dimensional printed anatomic templates and customized cutting blocks in pelvic reconstruction after pelvic tumor resection. J Arthroplasty, 2019, 34(2): 338-345.
27. Schwartz AJ, Kiatisevi P, Eilber FC, et al. The Friedman-Eilber resection arthroplasty of the pelvis. Clin Orthop Relat Res, 2009, 467(11): 2825-2830.
28. Wang J, Min L, Lu M, et al. What are the complications of three-dimensionally printed, custom-made, integrative hemipelvic endoprostheses in patients with primary malignancies involving the acetabulum, and what is the function of these patients? Clin Orthop Relat Res, 2020, 478(11): 2487-2501.
29. Ghouse S, Reznikov N, Boughton OR, et al. The design and in vivo testing of a locally stiffness-matched porous scaffold. Appl Mater Today, 2019, 15: 377-388.
30. Palmquist A, Snis A, Emanuelsson L, et al. Long-term biocompatibility and osseointegration of electron beam melted, free-form-fabricated solid and porous titanium alloy: experimental studies in sheep. J Biomater Appl, 2013, 27(8): 1003-1016.
31. Zhang Y, Sun N, Zhu M, et al. The contribution of pore size and porosity of 3D printed porous titanium scaffolds to osteogenesis. Biomater Adv, 2022, 133: 112651.
32. Goto M, Matsumine A, Yamaguchi S, et al. Osteoconductivity of bioactive Ti-6Al-4V implants with lattice-shaped interconnected large pores fabricated by electron beam melting. J Biomater Appl, 2021, 35(9): 1153-1167.
33. Wang J, Min L, Lu M, et al. Three-dimensional-printed custom-made hemipelvic endoprosthesis for the revision of the aseptic loosening and fracture of modular hemipelvic endoprosthesis: a pilot study. BMC Surg, 2021, 21(1): 262.

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Three-dimensional-printed hemi-pelvic prosthesis for revision of aseptic loosening or screw fracture of modular hemi-pelvic prosthesis

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