When the cells in a person’s bone divide uncontrollably, a mass of invasive tissue, better known as a tumor, develops. While most bone tumors are benign, malignant forms occur most frequently in adolescent/young adult populations. Osteosarcoma is most often sited in the knee or upper arm, and tumors have a high potential to spread, potentially requiring removal of bone segments or full limbs.
3D printing has really helped open up the possibilities for treatment when it comes to bone replacements. Surgery is the most common option for treating bone tumors, and is followed up with reconstruction of bony defects with methods like prosthetic replacement, distraction osteogenesis, intercalary allografting, and fibular grafting. While conventional rigid prosthetics can lead to inflammation, infection, dislocation, and even rejection due to poor surface bioactivity, patient-specific 3D printed prosthetics can offer a much better prognosis.
Recently, a team of medical experts from West China Hospital at Sichuan University published a study, titled “Uncemented three-dimensional-printed prosthetic reconstruction for massive bone defects of the proximal tibia,” in the World Journal of Surgical Oncology about their use of 3D printing to develop a custom knee joint replacement prosthesis for a teenager with metaphyseal osteosarcoma of the tibia.
According to the paper, “Currently, it is challenging to treat massive bone defects of proximal tibia. Although numerous methods are available for reconstruction with epiphysis preservation, limitations in knee function and complications are noted with these methods. Our paper describes our attempt to reconstruct a marked defect in the proximal tibia with an uncemented three-dimensional (3D)-printed prosthesis and to evaluate the prosthesis design and short-term outcomes.
“A 15-year-old boy with metaphyseal osteosarcoma of the tibia underwent intercalary allograft reconstruction following wide tumour resection with epiphysis preservation. However, chronic allograft rejection and/or infection occurred after the surgery and a sinus tract was formed.”
Things turned around for the patient once the initial graft was removed and an antibiotic-loaded cement spacer was implanted, but his limb function still wasn’t up to par.
Due to the odd shape of the defect, and how short the residual proximal tibia was, the team turned to 3D printing to fabricate a custom prosthesis in order to reconstruct the defect and preserve the knee joint. The team learned that a porous structure, with 600μm pore size and 65% porosity, would be able to simulate the real properties of trabecular structures in humans.
Image Credit: West China Hospital, Sichuan University
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