Giovanni Beltrami1, Gabriele Ristori2, Alberto Galeotti3, Guido Scoccianti4, Angela Tamburini5, Domenico Campanacci6, Rodolfo Capanna7, Marco Innocenti8. 1. Department of Orthopedic, Traumatology and Paediatric Orthopaedic Oncology, Azienda Ospedaliero Universitaria, Meyer Children Hospital, Florence, Italy. Electronic address: gbeltrami663@gmail.com. 2. Department of Orthopedic, Traumatology and Paediatric Orthopaedic Oncology, Azienda Ospedaliero Universitaria, Meyer Children Hospital, Florence, Italy. Electronic address: gabrieleristori@gmail.com. 3. Department of Orthopedic, Traumatology and Paediatric Orthopaedic Oncology, Azienda Ospedaliero Universitaria, Meyer Children Hospital, Florence, Italy. Electronic address: albertogaleotti91@gmail.com. 4. Department of Reconstructive and Oncologic Orthopaedics, Azienda Ospedaliero Universitaria Careggi, Florence, Italy. Electronic address: scocciantig@aou-careggi.toscana.it. 5. Department of Paediatric Onco-Hematology, Azienda Ospedaliero Universitaria, Meyer Children Hospital, Florence, Italy. Electronic address: angela.tamburini@meyer.it. 6. Department of Reconstructive and Oncologic Orthopaedics, Azienda Ospedaliero Universitaria Careggi, Florence, Italy. Electronic address: campanaccid@gmail.com. 7. Department of Ortopaedics and Traumatology, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy. Electronic address: rodolfo.capanna@unipi.it. 8. Department of Plastic Surgery and Microsurgery, Azienda Ospedaliero Universitaria Careggi, Florence, Italy. Electronic address: marcoinnocenti1212@gmail.com.
Abstract
PURPOSE: While limb-sparing surgery is now possible for more than 80% of patients with bone tumours, wide resection is often required, necessitating bone reconstruction. This paper aims to present a surgical technique that combines the advantages of a hollow, titanium, custom-made prosthesis and the biological aspects of microsurgical flaps and bone graft. PATIENTS AND METHODS: From June 2016 to September 2017 at our institution, six consecutive patients with skeletal tumours underwent one-stage reconstructive surgery with concomitant implantation of a 3D-printed prosthesis. RESULTS: At an average follow-up of 30 months (range: 18-45), no early complications were observed, and no implant removals were needed. One patient experienced a delayed haematogenous deep infection, which healed after surgical debridement. Three patients died of their underlying disease 18, 22, and 23 months after surgery, respectively. All flaps and custom reconstructions were successful, with primary osseointegration at a mean of four months (range: 2-7). Patients' average Musculoskeletal Tumour Society score was 23.2 (range: 18-28). CONCLUSION: A hollow, custom-made, titanium prosthesis filled with bone graft, used in conjunction with a microsurgical flap, may offer good osseointegration in different anatomic locations among a patient population with a high risk of infection, pseudarthrosis, and long-term mechanical complications. The surgical technique's advantages are preliminarily demonstrated. Further studies with longer follow-up periods and larger sample sizes are required to confirm our findings.
PURPOSE: While limb-sparing surgery is now possible for more than 80% of patients with bone tumours, wide resection is often required, necessitating bone reconstruction. This paper aims to present a surgical technique that combines the advantages of a hollow, titanium, custom-made prosthesis and the biological aspects of microsurgical flaps and bone graft. PATIENTS AND METHODS: From June 2016 to September 2017 at our institution, six consecutive patients with skeletal tumours underwent one-stage reconstructive surgery with concomitant implantation of a 3D-printed prosthesis. RESULTS: At an average follow-up of 30 months (range: 18-45), no early complications were observed, and no implant removals were needed. One patient experienced a delayed haematogenous deep infection, which healed after surgical debridement. Three patientsdied of their underlying disease 18, 22, and 23 months after surgery, respectively. All flaps and custom reconstructions were successful, with primary osseointegration at a mean of four months (range: 2-7). Patients' average Musculoskeletal Tumour Society score was 23.2 (range: 18-28). CONCLUSION: A hollow, custom-made, titanium prosthesis filled with bone graft, used in conjunction with a microsurgical flap, may offer good osseointegration in different anatomic locations among a patient population with a high risk of infection, pseudarthrosis, and long-term mechanical complications. The surgical technique's advantages are preliminarily demonstrated. Further studies with longer follow-up periods and larger sample sizes are required to confirm our findings.