·
RESEARCH ARTICLE
·

Three-dimensional-printed titanium prostheses with bone trabeculae enable mechanical-biological reconstruction after resection of bone tumours

Feifei Pu1 ,  Wei Wu1 ,  Doudou Jing1 ,  Yihan Yu1 ,  Yizhong Peng1 ,  Jianxiang Liu1 ,  Qiang Wu1 ,  Baichuan Wang1 ,  Zhicai Zhang1* ,  Zengwu Shao1*
Show Less
1 Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
BMT 2022 , 3(2), 134–141; https://doi.org/10.12336/biomatertransl.2022.02.005
Submitted: 1 April 2022 | Revised: 22 April 2022 | Accepted: 14 May 2022 | Published: 28 June 2022
Copyright © 2022 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution–NonCommercial–ShareAlike 4.0 License.
Download PDF
Cite
XML
Abstract

Reconstruction after resection has always been an urgent problem in the treatment of bone tumours. There are many methods that can be used to reconstruct bone defects; however, there are also many complications, and it is difficult to develop a safe and effective reconstruction plan for the treatment of bone tumours. With the rapid development of digital orthopaedics, three-dimensional printing technology can solve this problem. The three-dimensional printing of personalised prostheses has many advantages. It can be used to print complex structures that are difficult to fabricate using traditional processes and overcome the problems of stress shielding and low biological activity of conventional prostheses. In this study, 12 patients with bone tumours were selected as research subjects, and based on individualised reverse-engineering design technology, a three-dimensional model of each prosthesis was designed and installed using medical image data. Ti6Al4V was used as the raw material to prepare the prostheses, which were used to repair bone defects after surgical resection. The operation time was 266.43 ± 21.08 minutes (range 180–390 minutes), and intraoperative blood loss was 857.26 ± 84.28 mL (range 800–2500 mL). One patient had delayed wound healing after surgery, but all patients survived without local tumour recurrence, and no tumour metastasis was found. No aseptic loosening or structural fracture of the prosthesis, and no non-mechanical prosthesis failure caused by infection, tumour recurrence, or progression was observed. The Musculo-Skeletal Tumour Society (MSTS) score of limb function was 22.53 ± 2.09 (range 16–26), and ten of the 12 patients scored ≥ 20 and were able to function normally. The results showed that three-dimensional printed prostheses with an individualised design can achieve satisfactory short-term clinical efficacy in the reconstruction of large bone defects after bone tumour resection.

Keywords
bone defect
bone tumour
printed biomechanical reconstruction
prostheses
three-dimensional
References

Below is the content of the Citations in the paper which has been de-formatted, however, the content stays consistent with the original.

1. Strauss, S. J.; Whelan, J. S. Current questions in bone sarcomas. Curr Opin Oncol. 2018, 30, 252-259.
2. Zekry, K. M.; Yamamoto, N.; Hayashi, K.; Takeuchi, A.; Alkhooly, A. Z. A.; Abd-Elfattah, A. S.; Elsaid, A. N. S.; Ahmed, A. R.; Tsuchiya, H. Reconstruction of intercalary bone defect after resection of malignant bone tumor. J Orthop Surg (Hong Kong). 2019, 27, 2309499019832970.
3. Gangi, A.; Tsoumakidou, G.; Buy, X.; Quoix, E. Quality improvement guidelines for bone tumour management. Cardiovasc Intervent Radiol. 2010, 33, 706-713.
4. Piccioli, A.; Rossi, B.; Sacchetti, F. M.; Spinelli, M. S.; Di Martino, A. Fractures in bone tumour prosthesis. Int Orthop. 2015, 39, 1981-1987.
5. Severyns, M.; Briand, S.; Waast, D.; Touchais, S.; Hamel, A.; Gouin, F. Postoperative infections after limb-sparing surgery for primary bone tumors of the pelvis: Incidence, characterization and functional impact. Surg Oncol. 2017, 26, 171-177.
6. Pu, F.; Liu, J.; Shi, D.; Huang, X.; Zhang, J.; Wang, B.; Wu, Q.; Zhang, Z.; Shao, Z. Reconstruction with 3D-printed prostheses after sacroiliac joint tumor resection: a retrospective case-control study. Front Oncol. 2021, 11, 764938.
7. Wang, B.; Hao, Y.; Pu, F.; Jiang, W.; Shao, Z. Computer-aided designed, three dimensional-printed hemipelvic prosthesis for peri-acetabular malignant bone tumour. Int Orthop. 2018, 42, 687-694.
8. Liu, W.; Shao, Z.; Rai, S.; Hu, B.; Wu, Q.; Hu, H.; Zhang, S.; Wang, B. Three-dimensional-printed intercalary prosthesis for the reconstruction of large bone defect after joint-preserving tumor resection. J Surg Oncol. 2020, 121, 570-577.
9. Hu, H.; Liu, W.; Zeng, Q.; Wang, S.; Zhang, Z.; Liu, J.; Zhang, Y.; Shao, Z.; Wang, B. The personalized shoulder reconstruction assisted by 3D printing technology after resection of the proximal humerus tumours. Cancer Manag Res. 2019, 11, 10665-10673.
10. Wu, J.; Xie, K.; Luo, D.; Wang, L.; Wu, W.; Yan, M.; Ai, S.; Dai, K.; Hao, Y. Three-dimensional printing-based personalized limb salvage and reconstruction treatment of pelvic tumors. J Surg Oncol. 2021, 124, 420-430.
11. Bolia, I. K.; Savvidou, O. D.; Kang, H. P.; Chatzichristodoulou, N.; Megaloikonomos, P. D.; Mitsiokapa, E.; Mavrogenis, A. F.; Papagelopoulos, P. J. Cross-cultural adaptation and validation of the Musculoskeletal Tumor Society (MSTS) scoring system and Toronto Extremity Salvage Score (TESS) for musculoskeletal sarcoma patients in Greece. Eur J Orthop Surg Traumatol. 2021, 31, 1631-1638.
12. Chen, X.; Xu, L.; Wang, Y.; Hao, Y.; Wang, L. Image-guided installation of 3D-printed patient-specific implant and its application in pelvic tumor resection and reconstruction surgery. Comput Methods Programs Biomed. 2016, 125, 66-78.
13. Hao, Y.; Luo, D.; Wu, J.; Wang, L.; Xie, K.; Yan, M.; Dai, K.; Hao, Y. A novel revision system for complex pelvic defects utilizing 3D-printed custom prosthesis. J Orthop Translat. 2021, 31, 102-109.
14. Li, X.; Ji, T.; Huang, S.; Wang, C.; Zheng, Y.; Guo, W. Biomechanics study of a 3D printed sacroiliac joint fixed modular hemipelvic endoprosthesis. Clin Biomech (Bristol, Avon). 2020, 74, 87-95.
15. Ji, T.; Yang, Y.; Tang, X.; Liang, H.; Yan, T.; Yang, R.; Guo, W. 3D-printed modular hemipelvic endoprosthetic reconstruction following periacetabular tumor resection: early results of 80 consecutive cases. J Bone Joint Surg Am. 2020, 102, 1530-1541.
16. Wei, R.; Guo, W.; Ji, T.; Zhang, Y.; Liang, H. One-step reconstruction with a 3D-printed, custom-made prosthesis after total en bloc sacrectomy: a technical note. Eur Spine J. 2017, 26, 1902-1909.
17. Cai, H.; Liu, Z.; Wei, F.; Yu, M.; Xu, N.; Li, Z. 3D printing in spine surgery. Adv Exp Med Biol. 2018, 1093, 345-359.
18. Xie, K.; Guo, Y.; Zhao, S.; Wang, L.; Wu, J.; Tan, J.; Yang, Y.; Wu, W.; Jiang, W.; Hao, Y. Partially melted Ti6Al4V particles increase bacterial adhesion and inhibit osteogenic activity on 3D-printed implants: an in vitro study. Clin Orthop Relat Res. 2019, 477, 2772-2782.
19. Jing, Z.; Zhang, T.; Xiu, P.; Cai, H.; Wei, Q.; Fan, D.; Lin, X.; Song, C.; Liu, Z. Functionalization of 3D-printed titanium alloy orthopedic implants: a literature review. Biomed Mater. 2020, 15, 052003.
20. Hua, L.; Lei, T.; Qian, H.; Zhang, Y.; Hu, Y.; Lei, P. 3D-printed porous tantalum: recent application in various drug delivery systems to repair hard tissue defects. Expert Opin Drug Deliv. 2021, 18, 625-634.
21. Wang, H.; Su, K.; Su, L.; Liang, P.; Ji, P.; Wang, C. Comparison of 3D-printed porous tantalum and titanium scaffolds on osteointegration and osteogenesis. Mater Sci Eng C Mater Biol Appl. 2019, 104, 109908.
22. Wei, X.; Liu, B.; Liu, G.; Yang, F.; Cao, F.; Dou, X.; Yu, W.; Wang, B.; Zheng, G.; Cheng, L.; Ma, Z.; Zhang, Y.; Yang, J.; Wang, Z.; Li, J.; Cui, D.; Wang, W.; Xie, H.; Li, L.; Zhang, F.; Lineaweaver, W. C.; Zhao, D. Mesenchymal stem cell-loaded porous tantalum integrated with biomimetic 3D collagen-based scaffold to repair large osteochondral defects in goats. Stem Cell Res Ther. 2019, 10, 72.
23. Zhang, T.; Wei, Q.; Fan, D.; Liu, X.; Li, W.; Song, C.; Tian, Y.; Cai, H.; Zheng, Y.; Liu, Z. Improved osseointegration with rhBMP-2 intraoperatively loaded in a specifically designed 3D-printed porous Ti6Al4V vertebral implant. Biomater Sci. 2020, 8, 1279-1289.
24. Yin, C.; Zhang, T.; Wei, Q.; Cai, H.; Cheng, Y.; Tian, Y.; Leng, H.; Wang, C.; Feng, S.; Liu, Z. Surface treatment of 3D printed porous Ti6Al4V implants by ultraviolet photofunctionalization for improved osseointegration. Bioact Mater. 2022, 7, 26-38.
25. Zhang, T.; Wei, Q.; Zhou, H.; Zhou, W.; Fan, D.; Lin, X.; Jing, Z.; Cai, H.; Cheng, Y.; Liu, X.; Li, W.; Song, C.; Tian, Y.; Xu, N.; Zheng, Y.; Liu, Z. Sustainable release of vancomycin from micro-arc oxidised 3D-printed porous Ti6Al4V for treating methicillin-resistant Staphylococcus aureus bone infection and enhancing osteogenesis in a rabbit tibia osteomyelitis model. Biomater Sci. 2020, 8, 3106-3115.
26. Xu, L.; Qin, H.; Cheng, Z.; Jiang, W. B.; Tan, J.; Luo, X.; Huang, W. 3D-printed personalised prostheses for bone defect repair and reconstruction following resection of metacarpal giant cell tumours. Ann Transl Med. 2021, 9, 1421.
27. Xu, L.; Qin, H.; Tan, J.; Cheng, Z.; Luo, X.; Tan, H.; Huang, W. Clinical study of 3D printed personalized prosthesis in the treatment of bone defect after pelvic tumor resection. J Orthop Translat. 2021, 29, 163-169.
28. Beltrami, G.; Ristori, G.; Nucci, A. M.; Galeotti, A.; Tamburini, A.; Scoccianti, G.; Campanacci, D.; Innocenti, M.; Capanna, R. Custom-made 3D-printed implants as novel approach to reconstructive surgery after oncologic resection in pediatric patients. J Clin Med. 2021, 10, 1056.

Conflict of interest
The authors declare they have no competing interests.
Share
Back to top
We use cookies on our website to ensure you get the best experience.
Read more about our cookies here
Accept