3D printed personalized titanium plates improve clinical outcome in microwave ablation of bone tumors around the knee

Limin Ma,Hong Xia,Lingling Chen,Chuanbin Mao,Ye Zhou,Yu Zhang,Ye Zhu,Zefeng Lin

doi:10.1038/s41598-017-07243-3

Abstract

Microwave ablation has been widely accepted in treating bone tumor. However, its procedure is time-consuming and usually results in postoperative fractures. To solve this problem, we designed and fabricated titanium plates customized to the patients’ bone structures. The personalized titanium plates were then used for fixation after the removal of tumorous tissue. Specifically, 3D models of tumor-bearing bone segments were constructed by using computed tomography (CT) and magnetic resonance imaging (MRI). The 3D models were used to design the personalized titanium plates. The plate model was transferred into a numerical control machine for manufacturing the personalized titanium plates by 3D printing. The plates were then surgically implanted for reconstruction assistance following microwave-induced hyperthermia to remove the bone tumor. Implementation parameters and knee functions were then evaluated. No postoperative fractures, implant failures or loosening problems occurred; mean Musculoskeletal Tumor Society score was 27.17 from the latest follow-up. Mean maximum flexion of affected knees was 114.08°. The results of knee gait analysis were comparable with normal population data. Our work suggests that personalized titanium plates can significantly improve the clinical outcomes in the surgical removal of bone tumor. This study represents the first-time effort in using personalized titanium plates for such surgery.

Highlights

Due to the progress made in chemotherapy, imaging technology and biomaterials over the past few decades, limb-salvage surgery has become a standard procedure for most bone tumor and has obtained numerous encouraging outcomes
They showed that prophylactic fixation, grafting, and partial weight bearing could reduce the fracture rate to some extent
In the cases of limb tumors treated with other methods such as irradiation and autoclave[11,12,13,14], the fracture rate ranged from 3.7% to 29%

Summary

Introduction

Due to the progress made in chemotherapy, imaging technology and biomaterials over the past few decades, limb-salvage surgery has become a standard procedure for most bone tumor and has obtained numerous encouraging outcomes. Fan et al.[4, 5] reported the use of microwave ablation to remove malignant bone tumor of the extremities and pelvis They found that the microwave ablation could improve the function of the salvaged limbs and reduce complication rates[4, 5]. Optimizing the plate system used for fixing the bone after microwave ablation is necessary to improve the effectiveness of bone reconstruction Toward this goal, the utility and encouraging clinical outcomes of computer-aided design (CAD)/computer-aided manufacture (CAM) techniques in the orthopedic fields have been reported[15,16,17,18]. To reduce the postoperative fracture rate of internal fixation following microwave ablation and improve the efficiency of reconstruction, in the current study, we used CAD/CAM techniques to design and manufacture personalized (i.e. customized) plates to assist with bone reconstruction following microwave ablation of bone tumors. We used the personalized titanium plates, which are made aligned well with the anatomical bone surface of the specific patient, to achieve excellent internal fixation after bone tumor resection

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Conclusion