3D-Printed Titanium Custom-Made Prostheses in Reconstruction after Pelvic Tumor Resection: Indications and Results in a Series of 14 Patients at 42 Months of Average Follow-Up.

Carmine Zoccali,Alessandro Luzzati,Alessandra Scotto Di Uccio,Jacopo Baldi,Dario Attala,Gennaro Scotto,Luca Cannavò

doi:10.3390/jcm10163539

Abstract

Wide resection is currently considered the mainstay treatment for primary bone tumors. When the tumor is located in anatomically complex segments, 3D-Printed Titanium Custom-Made Prostheses (3DPTCMP) are possible reconstructive solutions. The aim of the present paper is to analyze indications, results and complications of a series of 14 patients who underwent pelvis reconstruction with 3DPTCMP after tumor removal from January 2015 to December 2019. Chondrosarcoma was the main histology; indications were tumors located in the acetabular area without enough residual bone to support a cup with an iliac stem, and tumors located near the sacrum-iliac joint. The margins were wide in 12 cases, and marginal and intralesional in one case each. In three cases, resection also included the sacrum-iliac joint, so a spine stabilization was performed and linked to the pelvic prosthesis; The average MSTS score was 46.3%; the 5-year local recurrence-free survival was 85.7%. Wound dehiscences were the main complication, resolved with multiple debridements; nevertheless, prosthesis removal was necessary in one case. Currently, the 3DPTCMP is an effective resource for reconstruction after resection of tumors located in the pelvis. Further studies are necessary to value long-term results; more strategies are necessary to try to reduce the infection rate and improve osteointegration.

Highlights

Wide resection is currently considered the mainstay treatment for primary bone tumors [1,2,3]; it is suitable for metastatic patients with long survival, obviously taking the invasiveness of the tumor into account [4,5]
At the latest follow-up, no signs of 3D-Printed Titanium Custom-Made Prostheses (3DPTCMP) loosening are reported; no case of femoral prosthesis dislocation occurred both in the constrained cup and the dual-mobility cup groups
Reconstruction is usually performed using massive composite allografts, composed by an alloplastic hemipelvis segment which is cut intraoperatively to adapt to the gap and stabilized by a plate and screws plus a standard total hip prosthesis [21]

Summary

Introduction

Wide resection is currently considered the mainstay treatment for primary bone tumors [1,2,3]; it is suitable for metastatic patients with long survival, obviously taking the invasiveness of the tumor into account [4,5].When the tumor is located in limbs, reconstruction after resection is usually performed with modular prostheses which are able to reconstruct the joint and restore limb length [6,7].When the tumor is located in anatomically complex segments, such as in the pelvis or the scapula, no efficient modular prostheses are commercially available.Several reconstruction methods have been proposed: massive autograft, which is still considered the gold standard, autoclaved autograft, arthrodesis or pseudoarthrosis [8,9,10,11].these possibilities present several complications and poor results, so custommade implants, that potentially have better results, must be considered [12].In the past, the technology used to produce a custom implant was based on subtraction techniques. Several reconstruction methods have been proposed: massive autograft, which is still considered the gold standard, autoclaved autograft, arthrodesis or pseudoarthrosis [8,9,10,11]. These possibilities present several complications and poor results, so custommade implants, that potentially have better results, must be considered [12]. The technology used to produce a custom implant was based on subtraction techniques. This meant high manufacturing costs, long production times and small distribution, limited to just some centers

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