Three-dimensional-printed porous implant combined with autograft reconstruction for giant cell tumor in proximal tibia

Yuqi Zhang,Minxun Lu,Jie Wang,Hong Duan,Yitian Wang,Li Min,Yong Zhou,Chongqi Tu,Yi Luo

doi:10.1186/s13018-021-02446-x

Abstract

BackgroundThis study is to describe the design and surgical techniques of three- dimensional-printed porous implants for proximal giant cell tumors of bone and evaluate the short-term clinical outcomes.MethodsFrom December 2016 to April 2020, 8 patients with giant cell tumor of bone in the proximal tibia underwent intralesional curettage of the tumor and reconstruction with bone grafting and three-dimensional-printed porous implant. Detailed anatomy data were measured, including the size of lesion and thickness of the subchondral bone. Prostheses were custom-made for each patient by our team. All patients were evaluated regularly and short-term clinical outcomes were recorded.ResultsThe mean follow-up period was 26 months. According to the different defect sizes, the mean size of the plate and mean length of strut were 35 × 35 mm and 20 mm, respectively. The mean affected subchondral bone percentage was 31.5%. The average preoperative and postoperative thickness of the subchondral bone was 2.1 mm and 11.1 mm, respectively. There was no wound infection, skin necrosis, peroneal nerve injury, or other surgical related complications. No degeneration of the knee joint was found. Osseointegration was observed in all patients. The MSTS improved from an average of 12 preoperatively to 28 postoperatively.ConclusionThe application of three-dimensional-printed printed porous prosthesis combined autograft could supply enough mechanical support and enhance bone ingrowth. The design and operation management lead to satisfactory subchondral bone reconstruction.

Highlights

This study is to describe the design and surgical techniques of three- dimensional-printed porous implants for proximal giant cell tumors of bone and evaluate the short-term clinical outcomes
Giant cell tumor of bone (GCTB) is a benign but aggressive tumor mostly affecting the bones around the knee [1]
The reconstruction methods for voids filling are closely related to the protection and promotion of the subchondral bone (SCB)

Summary

Introduction

This study is to describe the design and surgical techniques of three- dimensional-printed porous implants for proximal giant cell tumors of bone and evaluate the short-term clinical outcomes. The reconstruction methods for voids filling are closely related to the protection and promotion of the SCB. Bone cement and bone graft-assisted plate, Steinmann pins, or screws have all been utilized to fill the voids [5,6,7,8,9,10]. The possible thermal necrosis damage to the SCB and the lack of bone inducibility and conductibility constitute a significant disadvantage [11, 12]. The combination of bone cement and autograft was one of the most respected methods, which is famous as “sandwich technique” [7]. The complications related to the non-biological bone-cement interface and the cytotoxic of cement have still not been solved

Results

Discussion

Conclusion