Revision for Solid-Body Breakage of the 3D-Printed Implant Following Joint-Sparing Surgery: A Technical Note

Abstract

Background: The advent of three-dimensional (3D)-printed custom-made implants has revolutionized orthopaedic surgery, particularly in limb- and joint-sparing surgeries. However, clinical experience in the revision for 3D-printed implant breakage is lacking, and the revision surgery remains challenging. This study reported the revision of proximal tibial prosthetic reconstruction necessitated by solid-body breakage of a 3D-printed implant, aiming to detail the surgical techniques and evaluate postoperative outcomes.

Case Presentation: A patient diagnosed with osteosarcoma underwent joint-sparing surgery with a 3D-printed implant, but implant breakage occurred during subsequent follow-up. The initial implant was broken into two parts: the proximal implant breakage part (IBP) integrated with the host bone and the distal IBP left in the prosthetic component. Four revision protocols were devised, each based on one of the four hypothesis results of taking out the initial implant. A new custom-made implant and a series of assistance devices (“positioning devices,” “drill devices,” “tap devices,” and “separator devices”) were specifically prepared for revision surgery. The proximal IBP was taken out from the host bone, but the distal IBP was not taken out from the initial prosthetic component. The patient received the new custom-made implant for reconstruction, with the knee joint preserved. The patient recovered uneventfully after revision surgery and achieved satisfactory function. The Musculoskeletal Tumor Society was 28 at the last follow-up. No complications were detected during the follow-up period.

Conclusion: Comprehensive preoperative planning and preparation, enabling the surgeon to effectively address intraoperative challenges, are crucial for the successful revision of 3D-printed implant breakage. It is feasible to re-implant a 3D-printed custom-made implant, demonstrating satisfactory clinical and functional results.

Keywords

3D-Printed Implant / Breakage / Proximal Tibia / Reconstruction / Revision

References

[1] HardesJ, GuderW, DuddaM, Nottrott M, PodleskaLE, StreitbürgerA. Current results of tumour endoprosthetics in adolescents and adults. Orthopade. 2019;48(9):744–751.

[2] BalkeM, AhrensH, StreitbürgerA, et al. Modular endoprosthetic reconstruction in malignant bone tumors: indications and limits. Recent Results Cancer Res. 2009;179:39–50.

[3] GuderWK, HardesJ, NottrottM, Podleska LE, StreitbürgerA. Highly cancellous titanium alloy (TiAl₆V₄) surfaces on three-dimensionally printed, custom-made intercalary tibia prostheses: promising short- to intermediate-term results. J Pers Med. 2021;11(5):351.

[4] ParkJ-W, KangH-G, KimJ-H, Kim HS. 3D-printed connector for revision limb salvage surgery in long bones previously using customized implants. Metals. 2021;11(5):707.

[5] WangJ, AnJ, LuM, ZhangY, LinJ, LuoY, et al. Is three-dimensional-printed custom-made ultra-short stem with a porous structure an acceptable reconstructive alternative in peri-knee metaphysis for the tumorous bone defect? World J Surg Oncol. 2021;19(1):235.

[6] LiuW, ShaoZ, RaiS, HuB, WuQ, HuH, et al. Three-dimensional-printed intercalary prosthesis for the reconstruction of large bone defect after joint-preserving tumor resection. J Surg Oncol. 2020;121(3):570–577.

[7] ZhangZ, ShiY, FuJ, LiuD, ZhuD, LiuX, et al. Customized three dimensional printed prosthesis as a novel intercalary reconstruction for resection of extremity bone tumours: a retrospective cohort study. Int Orthop. 2022;46(12):2971–2981.

[8] LuM, LiY, LuoY, ZhangW, ZhouY, Tu C. Uncemented three-dimensional-printed prosthetic reconstruction for massive bone defects of the proximal tibia. World J Surg Oncol. 2018;16(1):47.

[9] AgarwalM, GuliaA, RaviB, Ghyar R, PuriA. Revision of broken knee megaprostheses: new solution to old problems. Clin Orthop Relat Res. 2010;468:2904–2913.

[10] NasrPJ, KeeneGS. Revision of a fractured uncemented revision stem using a custom designed punch and retrograde through-knee approach. Case Rep Orthop. 2015;2015:485729.

[11] StenoB, NecasL, MelisikM, Almasi J. Minimally invasive hollow trephine technique is recommended for revision of broken uncemented and extensively porous-coated monolithic femoral stems: a review of three cases. Eklem Hastalik Cerrahisi. 2014;25(2):112–116.

[12] TanakaT, HamadaK, OshimaK, Joyama S, NakaN, ArakiN. A new strategy to remove broken femoral mega-prostheses with hollow trephine reamers. Eur J Orthop Surg Traumatol. 2013;23(3):357–360.

[13] ZhangC, WangJ, WuH, et al. Ten-year retrospect of the investigation of proximal limbs metastasis in cancer: a multi-center study on survival outcome, limb function status and surgical procedures analysis. BMC Cancer. 2023;23(1):795.

[14] LiZ, LuM, ZhangY, Gong T, MinL, ZhouY, et al. 3D-printed custom-made short stem with porous structure for fixation of massive endoprosthesis in joint-preserving reconstruction after tumor resection. J Orthop Surg Res. 2023;18(1):468.

[15] ZhangY, LuM, HuX, LiZ, WangJ, Gong T, et al. Three-dimensional-printed porous prosthesis for the joint-sparing reconstruction of the proximal humeral tumorous defect. Front Bioeng Biotechnol. 2023;10:1098973.

[16] ZhangT, WeiQ, ZhouH, Jing Z, LiuX, ZhengY, et al. Three-dimensional-printed individualized porous implants: a new “implant-bone” interface fusion concept for large bone defect treatment. Bioact Mater. 2021;6(11):3659–3670.

[17] SchwartzAJ, KaboJM, EilberFC, et al. Cemented distal femoral endoprostheses for musculoskeletal tumor: improved survival of modular versus custom implants. Clin Orthop Relat Res. 2010;468(8):2198–2210.

[18] LiuS, ShinYC. Additive manufacturing of Ti6Al4V alloy: a review. Mater Des. 2019;164:107552.

[19] SwamyGN, QuahC, BagouriE, Badhe NP. Nontraumatic fracture of the femoral condylar prosthesis in a Total knee arthroplasty leading to mechanical failure. Case Rep Orthop. 2014;2014:896348.

[20] GuoJ. Solid state welding processes in manufacturing. Handbook of manufacturing engineering and technology. London: Springer; 2015. p. 569–592.

[21] WagleDV, BakerGA. Cold welding: a phenomenon for spontaneous self-healing and shape genesis at the nanoscale. Mater Horiz. 2015;2(2):157–167.

[22] WhittakerRK, Zaghloul AM, HothiHS, SiddiquiIA, BlunnGW, SkinnerJA, et al. Clinical cold welding of the modular Total hip arthroplasty prosthesis. J Arthroplasty. 2017;32(2):610–615.

[23] ShehadehAM, IsleemU, AbdelalS, Salameh H, AbdelhalimM. Surgical technique and outcome of custom joint-sparing endoprosthesis as a reconstructive modality in juxta-articular bone sarcoma. J Oncol. 2019;2019:9417284.

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