Using 3D Printing Technology to Design Split-Piece Sleeve Prosthesis in the Revision Surgery of Tumor-Type Total Elbow Prosthetic Fractures: A Case Report

Abstract

Background: Revision of tumor-type prosthetic fractures is very challenging in clinical work. Traditional repair methods may not be able to meet the needs of complex cases or cause greater bone damage. Therefore, more effective and reliable solutions need to be found.

Case Presentation: This study presents a novel revision technique for managing fractures of tumor-type total elbow prostheses. A 57-year-old female patient was diagnosed with a left distal humeral bone tumor accompanied by pathological fracture and underwent customized tumor-type total elbow prosthesis arthroplasty. After 5 years, she experienced pain and encountered difficulty in flexing the left elbow while lifting heavy objects. The X-ray examination revealed a fracture of the distal humeral prosthesis. As a response, the elbow joint was initially explored, and the damaged component of the prosthesis was extracted. Subsequently, we utilized 3D printing technology to design a split-piece sleeve prosthesis and effectively restored the fractured left distal humerus implant. During the 2-year follow-up, The X-ray demonstrated satisfactory positioning of the prosthesis, which remained securely affixed without any indications of loosening. The Mayo Elbow Performance Score (MEPS) reached 80 points, the Musculoskeletal Tumor Society (MSTS) attained a score of 28 points, and the range of motion of the elbow was measured between 25° and 110°, revealing favorable functional outcomes.

Conclusion: The utilization of a 3D printed split-piece sleeve prosthesis presents a viable clinical treatment strategy for addressing fractures in tumor-type elbow prostheses.

Keywords

3D Printing / Elbow joint tumor / Limited revision / Prosthesis fracture / Split-piece sleeve prosthesis

References

[1] SperlingJ, Pritchard D, MorreyB. Total elbow arthroplasty after resection of tumors at the elbow. Clin Orthop Rel Res. 1999;367:256–261.

[2] ZhangD, ChenN. Total elbow arthroplasty. J Hand Surg Am. 2019;44(6):487–495.

[3] ManoharanG, JordanR, OrfanosG, Cheruvu M, CoolP, HayS. Joint replacement surgery for elbow tumours: a systematic review of outcomes. Shoulder & Elbow. 2021;13(6):656–670.

[4] CasadeiR, De Paolis M, DragoG, RomagnoliC, DonatiD. Total elbow arthroplasty for primary and metastatic tumor. Orthop Traumatol Surg Res. 2016;102(4):459–465.

[5] KruckebergB, LeeD, BarlowJ, Morrey M, RoseP, Sanchez-SoteloJ, et al. Total elbow arthroplasty for tumors of the distal humerus and elbow. J Surg Oncol. 2021;124(8):1508–1514.

[6] GuptaP, MarigiEM, Sanchez-SoteloJ. Research on artificial intelligence in shoulder and elbow surgery is increasing. JSES Int. 2022;7(1):158–161.

[7] LiZ. Digital orthopedics: the future developments of orthopedic surgery. J Pers Med. 2023;13(2):292.

[8] IwamotoT, SuzukiT, OkiS, Matsumura N, NakamuraM, MatsumotoM, et al. Computed tomography-based 3-dimensional preoperative planning for unlinked total elbow arthroplasty. J Shoulder Elbow Surg. 2018;27(10):1792–1799.

[9] LiangH, YangY, GuoW, YanL, TangX, Li D, et al. Elbow hemiarthroplasty with a 3D-printed megaprosthesis for defects of the distal humerus or proximal ulna after tumour resection: a preliminary report. Bone Joint J. 2022;104:747–757.

[10] ToulemondeJ, Ancelin D, AzoulayV, BonnevialleN, Rongières M, MansatP. Complications and revisions after semi-constrained total elbow arthroplasty: a mono-centre analysis of one hundred cases. Int Orthop. 2016;40(1):73–80.

[11] MohammedA, Frostick S. Intramedullary humeral replacement: an evolving design. SICOT J. 2016;2:3.

[12] PhamTT, Bonnevialle N, RongièresM, BonnevialleP, MansatP. Mechanical failure of the Coonrad-Morrey linked total elbow arthroplasty: a case report. Orthop Traumatol Surg Res. 2014;100(7):831–834.

[13] SeitzWH, BismarH, EvansPJ. Failure of the hinge mechanism in total elbow arthroplasty. J Shoulder Elbow Surg. 2010;19(3):368–375.

[14] XiaoR, ModelZ, KimJ, ChenN. Revision arthroplasty in the challenging elbow. Hand Clin. 2023;39(3):341–351.

RIGHTS & PERMISSIONS

2024 2024 The Authors. Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.