Objective: Aseptic loosening (AL) is a common mechanical complication following reconstruction of the distal femoral cemented prosthesis (DFCP), often resulting in severe bone loss, which complicates prosthesis revision. 3D-printed personalized implants represent an emerging solution for the reconstruction of complex bone defects. This study aimed to investigate the early therapeutic effects of using a 3D-printed, customized, uncemented stem prosthesis for revising aseptic AL in DFCP.
Methods: From June 2021 to December 2022, a retrospective review was conducted on six consecutive patients who underwent revision surgery due to AL of the DFCP with a 3D-printed customized uncemented stem prosthesis. The study included four male and two female patients, with an average age of 58 ± 11 (range: 46–75) years. All six patients had previously undergone limb salvage surgery using a cemented megaprosthesis after tumor resection. Preoperative imaging evaluation was performed for all patients, and the personalized design of the prostheses was achieved through 3D printing based on CT imaging data. Regular clinical and radiographic follow-up was conducted postoperatively, with the main outcome measures being oncological outcomes, prosthesis survival, osseointegration, complications, and lower limb function.
Results: All patients successfully underwent surgery and were followed up for a mean duration of 30.33 ± 6.15 (range: 24–38) months. All patients were alive at the last follow-up, with no tumor recurrence or distant metastasis. No complications such as infection, loosening, or fracture of the prosthesis occurred. Osseointegration was satisfactory, with a mean MSTS score of 26 (range: 20–28) points.
Conclusion: 3D-printed, customized, uncemented stem prosthesis exhibit immediate initial stability and reliable biocompatibility. Early clinical outcomes are satisfactory, making them an effective method for revision AL of DFCP.
| [1] |
W. Guo, T. Ji, R. Yang, X. Tang, and Y. Yang, “Endoprosthetic Replacement for Primary Tumours Around the Knee: Experience From Peking University,” Journal of Bone and Joint Surgery. British Volume (London) 90, no. 8 (2008): 1084–1089.
|
| [2] |
F. Mittermayer, R. Windhager, M. Dominkus, et al., “Revision of the Kotz Type of Tumour Endoprosthesis for the Lower Limb,” Journal of Bone and Joint Surgery. British Volume (London) 84, no. 3 (2002): 401–406.
|
| [3] |
P. S. Unwin, S. R. Cannon, R. J. Grimer, H. B. Kemp, R. S. Sneath, and P. S. Walker, “Aseptic Loosening in Cemented Custom-Made Prosthetic Replacements for Bone Tumours of the Lower Limb,” Journal of Bone and Joint Surgery. British Volume (London) 78, no. 1 (1996): 5–13.
|
| [4] |
W. S. Song, C. B. Kong, D. G. Jeon, et al., “The Impact of Amount of Bone Resection on Uncemented Prosthesis Failure in Patients With a Distal Femoral Tumor,” Journal of Surgical Oncology 104, no. 2 (2011): 192–197.
|
| [5] |
P. F. Bergin, J. B. Noveau, J. S. Jelinek, and R. M. Henshaw, “Aseptic Loosening Rates in Distal Femoral Endoprostheses: Does Stem Size Matter?,” Clinical Orthopaedics and Related Research 470, no. 3 (2012): 743–750.
|
| [6] |
K. Ogura, T. Fujiwara, C. D. Morris, P. J. Boland, and J. H. Healey, “Long-Term Competing Risks for Overall and Cause-Specific Failure of Rotating-Hinge Distal Femoral Arthroplasty for Tumour Reconstruction,” Bone Joint Surgery 103, no. 8 (2021): 1405–1413.
|
| [7] |
N. M. Bernthal, V. Hegde, S. D. Zoller, et al., “Long-Term Outcomes of Cement in Cement Technique for Revision Endoprosthesis Surgery,” Journal of Surgical Oncology 117, no. 3 (2018): 443–450.
|
| [8] |
V. Batta, M. J. Coathup, M. T. Parratt, et al., “Uncemented, Custom-Made, Hydroxyapatite-Coated Collared Distal Femoral Endoprostheses: Up to 18 years’ Follow-Up,” Bone & Joint Journal 96, no. 2 (2014): 263–269.
|
| [9] |
J. D. Stevenson, C. Wigley, H. Burton, et al., “Minimising Aseptic Loosening in Extreme Bone Resections: Custom-Made Tumour Endoprostheses With Short Medullary Stems and Extra-Cortical Plates,” Bone & Joint Surgery 99, no. 12 (2017): 1689–1695.
|
| [10] |
B. S. Moon, N. F. Gilbert, C. P. Cannon, P. P. Lin, and V. O. Lewis, “Distal Femur Allograft Prosthetic Composite Reconstruction for Short Proximal Femur Segments Following Tumor Resection,” Advances in Orthopedics 2013 (2013): 397456.
|
| [11] |
J. H. Healey, A. Abdeen, C. D. Morris, E. A. Athanasian, and P. J. Boland, “Telescope Allograft Method to Reconstitute the Diaphysis in Limb Salvage Surgery,” Clinical Orthopaedics and Related Research 467, no. 7 (2009): 1813–1819.
|
| [12] |
S. Hindiskere, E. Staals, D. M. Donati, and M. Manfrini, “What Is the Survival of the Telescope Allograft Technique to Augment a Short Proximal Femur Segment in Children After Resection and Distal Femur Endoprosthesis Reconstruction for a Bone Sarcoma?,” Clinical Orthopaedics and Related Research 479, no. 8 (2021): 1780–1790.
|
| [13] |
J. H. Healey, C. D. Morris, E. A. Athanasian, and P. J. Boland, “Compress Knee Arthroplasty Has 80% 10-Year Survivorship and Novel Forms of Bone Failure,” Clinical Orthopaedics and Related Research 471, no. 3 (2013): 774–783.
|
| [14] |
G. T. Calvert, J. E. Cummings, A. J. Bowles, K. B. Jones, L. D. Wurtz, and R. L. Randall, “A Dual-Center Review of Compressive Osseointegration for Fixation of Massive Endoprosthetics: 2-to 9-Year Followup,” Clinical Orthopaedics and Related Research 472, no. 3 (2014): 822–829.
|
| [15] |
M. N. Zimel, G. L. Farfalli, A. M. Zindman, et al., “Revision Distal Femoral Arthroplasty With the Compress(®) Prosthesis Has a Low Rate of Mechanical Failure at 10 Years,” Clinical Orthopaedics and Related Research 474, no. 2 (2016): 528–536.
|
| [16] |
C. A. Cipriano, I. S. Gruzinova, R. M. Frank, S. Gitelis, and W. W. Virkus, “Frequent Complications and Severe Bone Loss Associated With the Repiphysis Expandable Distal Femoral Prosthesis,” Clinical Orthopaedics and Related Research 473, no. 3 (2015): 831–838.
|
| [17] |
Z. Du, S. Tang, R. Yang, X. Tang, T. Ji, and W. Guo, “Use of an Artificial Ligament Decreases Hip Dislocation and Improves Limb Function After Total Femoral Prosthetic Replacement Following Femoral Tumor Resection,” Journal of Arthroplasty 33, no. 5 (2018): 1507–1514.
|
| [18] |
W. K. Guder, J. Hardes, G. Gosheger, M. Nottrott, and A. Streitbürger, “Ultra-Short Stem Anchorage in the Proximal Tibial Epiphysis After Intercalary Tumor Resections: Analysis of Reconstruction Survival in Four Patients at a Mean Follow-Up of 56 Months,” Archives of Orthopaedic and Trauma Surgery 137, no. 4 (2017): 481–488.
|
| [19] |
A. Angelini, G. Trovarelli, A. Berizzi, E. Pala, A. Breda, and P. Ruggieri, “Three-Dimension-Printed Custom-Made Prosthetic Reconstructions: From Revision Surgery to Oncologic Reconstructions,” International Orthopaedics 43, no. 1 (2019): 123–132.
|
| [20] |
T. Gong, M. Lu, L. Min, Y. Luo, and C. Tu, “Reconstruction of a 3D-Printed Endoprosthesis After Joint-Preserving Surgery With Intraoperative Physeal Distraction for Childhood Malignancies of the Distal Femur,” Journal of Orthopaedic Surgery and Research 18, no. 1 (2023): 534.
|
| [21] |
M. Lu, Y. Li, Y. Luo, W. Zhang, Y. Zhou, and C. Tu, “Uncemented Three-Dimensional-Printed Prosthetic Reconstruction for Massive Bone Defects of the Proximal Tibia,” World Journal of Surgical Oncology 16, no. 1 (2018): 47.
|
| [22] |
W. Liu, Z. Shao, S. Rai, et al., “Three-Dimensional-Printed Intercalary Prosthesis for the Reconstruction of Large Bone Defect After Joint-Preserving Tumor Resection,” Journal of Surgical Oncology 121, no. 3 (2020): 570–577.
|
| [23] |
J. Wang, J. An, M. Lu, 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 Journal of Surgical Oncology 19, no. 1 (2021): 235.
|
| [24] |
X. Shao, M. Dou, Q. Yang, et al., “Reconstruction of Massive Bone Defects After Femoral Tumor Resection Using Two New-Designed 3D-Printed Intercalary Prostheses: A Clinical Analytic Study With the Cooperative Utilization of Multiple Technologies,” BMC Musculoskeletal Disorders 24, no. 1 (2023): 67.
|
| [25] |
Z. Zhang, Y. Shi, J. Fu, et al., “Customized Three Dimensional Printed Prosthesis as a Novel Intercalary Reconstruction for Resection of Extremity Bone Tumours: A Retrospective Cohort Study,” International Orthopaedics 46, no. 12 (2022): 2971–2981.
|
| [26] |
R. Vitiello, M. R. Matrangolo, A. El Motassime, et al., “Three-Dimension-Printed Custom-Made Prosthetic Reconstructions in Bone Tumors: A Single Center Experience,” Current Oncology 29, no. 7 (2022): 4566–4577.
|
| [27] |
Z. W. Hou, M. Xu, K. Zheng, and X. C. Yu, “Classification and Reconstruction of Femoral Bone Defect in the Revision of Aseptic Loosening of Distal Femoral Endoprostheses: A 10-Year Multicenter Retrospective Analysis,” BMC Musculoskeletal Disorders 23, no. 1 (2022): 935.
|
| [28] |
Z. Hou, K. Zheng, M. Xu, and X. Yu, “The Primary Stability of Ultrashort Residual Proximal Femur Fixed With Triangular Fixation Stem Prosthesis: A Comparative Biomechanical Study Based on Sawbones Models,” Frontiers in Bioengineering and Biotechnology 12 (2024): 1493738.
|
| [29] |
W. F. Enneking, W. Dunham, M. C. Gebhardt, M. Malawar, and D. J. Pritchard, “A System for the Functional Evaluation of Reconstructive Procedures After Surgical Treatment of Tumors of the Musculoskeletal System,” Clinical Orthopaedics and Related Research 286 (1993): 241–246.
|
| [30] |
C. A. Engh, P. Massin, and K. E. Suthers, “Roentgenographic Assessment of the Biologic Fixation of Porous-Surfaced Femoral Components,” Clinical Orthopaedics and Related Research 257 (1990): 107–128.
|
| [31] |
L. Min, K. Yao, M. Lu, et al., “First Application of 3D Design Custom-Made Uncemented Prosthetic Stem for Distal Femoral Cemented Megaprosthesis Revision,” Precision Clinical Medicine 1, no. 2 (2018): 88–96.
|
| [32] |
L. Li, J. Shi, K. Ma, et al., “Robotic In Situ 3D Bio-Printing Technology for Repairing Large Segmental Bone Defects,” Journal of Advanced Research 30 (2021): 75–84.
|
| [33] |
A. B. Christ, T. Fujiwara, M. A. Yakoub, and J. H. Healey, “Interlocking Reconstruction-Mode Stem-Sideplates Preserve At-Risk Hips With Short Residual Proximal Femora,” Bone Joint Surgery 103, no. 2 (2021): 398–404.
|
| [34] |
P. I. Brånemark, “Osseointegration and Its Experimental Background,” Journal of Prosthetic Dentistry 50, no. 3 (1983): 399–410.
|
| [35] |
A. Bandyopadhyay, A. Shivaram, S. Tarafder, H. Sahasrabudhe, D. Banerjee, and S. Bose, “In Vivo Response of Laser Processed Porous Titanium Implants for Load-Bearing Implants,” Annals of Biomedical Engineering 45, no. 1 (2017): 249–260.
|
| [36] |
A. Palmquist, A. Snis, L. Emanuelsson, M. Browne, and P. Thomsen, “Long-Term Biocompatibility and Osseointegration of Electron Beam Melted, Free-Form-Fabricated Solid and Porous Titanium Alloy: Experimental Studies in Sheep,” Journal of Biomaterials Applications 27, no. 8 (2013): 1003–1016.
|
| [37] |
S. E. Bosma, K. C. Wong, L. Paul, J. G. Gerbers, and P. C. Jutte, “A Cadaveric Comparative Study on the Surgical Accuracy of Freehand, Computer Navigation, and Patient-Specific Instruments in Joint-Preserving Bone Tumor Resections,” Sarcoma 2018 (2018): 4065846.
|
| [38] |
L. Ma, Y. Zhou, Y. Zhu, et al., “3D-Printed Guiding Templates for Improved Osteosarcoma Resection,” Scientific Reports 6 (2016): 23335.
|
| [39] |
K. C. Wong, L. K. Y. Sze, and S. M. Kumta, “Complex Joint-Preserving Bone Tumor Resection and Reconstruction Using Computer Navigation and 3D-Printed Patient-Specific Guides: A Technical Note of Three Cases,” Journal of Orthopaedic Translation 29 (2021): 152–162.
|
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2024 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.
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