3D-printed hemipelvic prosthesis combined with a dual mobility bearing in patients with primary malignant neoplasm involving the acetabulum: clinical outcomes and finite element analysis
Abstract Background Limb salvage reconstruction for pelvic tumors, especially periacetabular tumors, is challenging. We combined the use of dual mobility bearing and 3D-printed hemipelvic prosthesis to improve function and reduce the probability of complications after hemi-pelvic resection in patien...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-10-01
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| Series: | BMC Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12893-022-01804-8 |
| _version_ | 1797996140708233216 |
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| author | Miao Wang Tianze Liu Changli Xu Chang Liu Bo Li Qiujian Lian Tongjiang Chen Suchi Qiao Zhiwei Wang |
| author_facet | Miao Wang Tianze Liu Changli Xu Chang Liu Bo Li Qiujian Lian Tongjiang Chen Suchi Qiao Zhiwei Wang |
| author_sort | Miao Wang |
| collection | DOAJ |
| description | Abstract Background Limb salvage reconstruction for pelvic tumors, especially periacetabular tumors, is challenging. We combined the use of dual mobility bearing and 3D-printed hemipelvic prosthesis to improve function and reduce the probability of complications after hemi-pelvic resection in patients with primary acetabular malignancy. The purpose of this study was to evaluate the efficacy and safety of this combination. Methods Between October 2011 and May 2021, 11 patients with malignancies involving the acetabulum received hemipelvic replacement with a 3D-printed prosthesis and dual mobility bearing. Follow‐up of postoperative survival, complications, and Musculoskeletal Tumor Society 93 (MSTS-93) lower limb functional scores were carried out. A finite element model of the postoperative pelvis was developed and input into the finite element analysis software. The Von Mises equivalent stress formula was used to analyze the stress distribution of each part of the pelvis under one gait cycle and the stress distribution at different angles of the hip joint. Results By the last follow-up, 9 of the 11 patients (81.8%) were still alive, and 2 patients had local tumor recurrence. The complications including 1 deep infection and 1 dislocation of the artificial joint. Excluding 1 amputation patient, the average score of the remaining 8 patients at the last follow-up was 21.4/30 (71.3%) on the MSTS-93. In the reconstructed pelvis, stress distributions were concentrated on the junction between hemipelvic prosthesis and screw and iliac bone on the resected side, and between femoral prosthesis stem and femoral bulb, while the stress of polyethylene lining was small. Before impact, the polyethylene lining will rotate at a small angle, about 3°. The inner stress of polyethylene liner is greater than the outer stress in all conditions. The polyethylene liner has no tendency to slide out. Conclusion Pelvic tumor resection and reconstruction using 3D-printed hemipelvic prosthesis combined with dual mobility bearing was an effective treatment for pelvic tumors. Our patients achieved good early postoperative efficacy and functional recovery. The dual mobility bearing is beneficial to prevent dislocation, and the mechanical distribution and wear of the prosthesis are acceptable. |
| first_indexed | 2024-04-11T10:11:42Z |
| format | Article |
| id | doaj.art-4f3304e1e07c4d11bf641853430ff963 |
| institution | Directory Open Access Journal |
| issn | 1471-2482 |
| language | English |
| last_indexed | 2024-04-11T10:11:42Z |
| publishDate | 2022-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Surgery |
| spelling | doaj.art-4f3304e1e07c4d11bf641853430ff9632022-12-22T04:30:04ZengBMCBMC Surgery1471-24822022-10-0122111410.1186/s12893-022-01804-83D-printed hemipelvic prosthesis combined with a dual mobility bearing in patients with primary malignant neoplasm involving the acetabulum: clinical outcomes and finite element analysisMiao Wang0Tianze Liu1Changli Xu2Chang Liu3Bo Li4Qiujian Lian5Tongjiang Chen6Suchi Qiao7Zhiwei Wang8Department of Orthopedics, Changhai Hospital, Naval Medical University (Second Military Medical University)Department of Orthopedics, Changhai Hospital, Naval Medical University (Second Military Medical University)Department of Orthopedics, Changhai Hospital, Naval Medical University (Second Military Medical University)Department of Orthopedics, Changhai Hospital, Naval Medical University (Second Military Medical University)Department of Orthopedics, Changhai Hospital, Naval Medical University (Second Military Medical University)Department of Orthopedics, Changhai Hospital, Naval Medical University (Second Military Medical University)Department of Orthopedics, Changhai Hospital, Naval Medical University (Second Military Medical University)Department of Orthopedics, The Third Affiliated Hospital, Naval Medical University (Second Military Medical University)Department of Orthopedics, The Third Affiliated Hospital, Naval Medical University (Second Military Medical University)Abstract Background Limb salvage reconstruction for pelvic tumors, especially periacetabular tumors, is challenging. We combined the use of dual mobility bearing and 3D-printed hemipelvic prosthesis to improve function and reduce the probability of complications after hemi-pelvic resection in patients with primary acetabular malignancy. The purpose of this study was to evaluate the efficacy and safety of this combination. Methods Between October 2011 and May 2021, 11 patients with malignancies involving the acetabulum received hemipelvic replacement with a 3D-printed prosthesis and dual mobility bearing. Follow‐up of postoperative survival, complications, and Musculoskeletal Tumor Society 93 (MSTS-93) lower limb functional scores were carried out. A finite element model of the postoperative pelvis was developed and input into the finite element analysis software. The Von Mises equivalent stress formula was used to analyze the stress distribution of each part of the pelvis under one gait cycle and the stress distribution at different angles of the hip joint. Results By the last follow-up, 9 of the 11 patients (81.8%) were still alive, and 2 patients had local tumor recurrence. The complications including 1 deep infection and 1 dislocation of the artificial joint. Excluding 1 amputation patient, the average score of the remaining 8 patients at the last follow-up was 21.4/30 (71.3%) on the MSTS-93. In the reconstructed pelvis, stress distributions were concentrated on the junction between hemipelvic prosthesis and screw and iliac bone on the resected side, and between femoral prosthesis stem and femoral bulb, while the stress of polyethylene lining was small. Before impact, the polyethylene lining will rotate at a small angle, about 3°. The inner stress of polyethylene liner is greater than the outer stress in all conditions. The polyethylene liner has no tendency to slide out. Conclusion Pelvic tumor resection and reconstruction using 3D-printed hemipelvic prosthesis combined with dual mobility bearing was an effective treatment for pelvic tumors. Our patients achieved good early postoperative efficacy and functional recovery. The dual mobility bearing is beneficial to prevent dislocation, and the mechanical distribution and wear of the prosthesis are acceptable.https://doi.org/10.1186/s12893-022-01804-8PelvicBone neoplasmProsthesis designDual mobilityFinite element analysis |
| spellingShingle | Miao Wang Tianze Liu Changli Xu Chang Liu Bo Li Qiujian Lian Tongjiang Chen Suchi Qiao Zhiwei Wang 3D-printed hemipelvic prosthesis combined with a dual mobility bearing in patients with primary malignant neoplasm involving the acetabulum: clinical outcomes and finite element analysis BMC Surgery Pelvic Bone neoplasm Prosthesis design Dual mobility Finite element analysis |
| title | 3D-printed hemipelvic prosthesis combined with a dual mobility bearing in patients with primary malignant neoplasm involving the acetabulum: clinical outcomes and finite element analysis |
| title_full | 3D-printed hemipelvic prosthesis combined with a dual mobility bearing in patients with primary malignant neoplasm involving the acetabulum: clinical outcomes and finite element analysis |
| title_fullStr | 3D-printed hemipelvic prosthesis combined with a dual mobility bearing in patients with primary malignant neoplasm involving the acetabulum: clinical outcomes and finite element analysis |
| title_full_unstemmed | 3D-printed hemipelvic prosthesis combined with a dual mobility bearing in patients with primary malignant neoplasm involving the acetabulum: clinical outcomes and finite element analysis |
| title_short | 3D-printed hemipelvic prosthesis combined with a dual mobility bearing in patients with primary malignant neoplasm involving the acetabulum: clinical outcomes and finite element analysis |
| title_sort | 3d printed hemipelvic prosthesis combined with a dual mobility bearing in patients with primary malignant neoplasm involving the acetabulum clinical outcomes and finite element analysis |
| topic | Pelvic Bone neoplasm Prosthesis design Dual mobility Finite element analysis |
| url | https://doi.org/10.1186/s12893-022-01804-8 |
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