Abstract
Recently, custom-made 3D-printed prostheses have been introduced for limb salvage surgery in adult patients, but their use has not been described in pediatric patients. A series of 11 pediatric patients (mean age 10.8 years; range 2–13) with skeletal tumors treated with custom-made implants for the reconstruction of bony defects is described. Patients were followed up every 3 months. Functional results were evaluated by the Musculoskeletal Tumor Society Score (MSTS) for upper and lower limbs. The mean follow-up was 25.7 months (range 14–44). Three patients died after a mean of 19.3 months postoperatively—two because of disease progression and the other from a previous malignancy. Three patients experienced complications related to soft tissues. One patient required device removal, debridement, and antibiotic pearls for postoperative infection. Partial osseointegration between grafts and host bone was observed within a mean of 4 months. At the final follow-up, mean MSTS score was 75%. 3D prostheses may yield biological advantages due to possible integration with the host bone and also through the use of vascularized flaps. Further research is warranted.
Highlights
In pediatric patients who are affected by malignant bone tumors, recent progress of oncologic medical therapies has made primary amputation increasingly rare [1]
Recently, custom-made 3D-printed prostheses have been introduced for limb salvage surgery in adult patients, but their use has not been described in pediatric patients
Allografts can be used in articular reconstruction, but their survival is put to the test in patients with high functional demands [7]
Summary
In pediatric patients who are affected by malignant bone tumors, recent progress of oncologic medical therapies has made primary amputation increasingly rare [1]. Allografts can be used in articular reconstruction, but their survival is put to the test in patients with high functional demands [7] They have to be manually carved to precisely fit the defects, and this process is usually time-consuming and laborious. Bone autograft has superior healing capability through osteogenesis, osteoconduction, and osteoinduction, alone or in combination [8] It requires invasive collection, and it can hardly be used in articular reconstructions [9]. Allograft prosthesis composite is a bone massive allograft resurfaced by a conventional prosthesis, which overcomes the articular collapse of conventional bone massive allograft and maintains the enthesis and mechanical properties of homologous bone [11] This solution is challenging with the ongoing growth of the patient. Each solution has its own advantages and limitations, and the choice must be carefully weighed on an individual basis
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