Amit Benady1,2,3, J Sam Meyer4, Yuval Ran5,6, Yaron Mor2,3, Ron Gurel2,3, Netta Rumack1, Eran Golden1, Yair Gortzak2,7, Ortal Segal2,7, Omri Merose2,7, Amir Sternheim2,7, Solomon Dadia1,2,7. 1. Levin Center for 3D Printing and Surgical Innovation, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. 2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. 3. Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel. 4. Department of Biomedical Engineering, Ben-Gurion University of the Negev, Beer Sheva, Israel. 5. The Military Track of Medicine, The Hebrew University-Hadassah Medical School, Jerusalem, Israel. 6. Office of the Deputy Medical Manager, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. 7. National Unit of Orthopedic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Abstract
Background: Primary bone sarcomas are associated with critically sized bone defects and require complete resection with negative margins. Recent advancements in health care have pioneered novel approaches such as the implementation of 3D surgical technologies. This study presents oncological and functional outcomes following tumor resections of long bones with the use of customized 3D-printed Patient Specific Instruments (PSIs). Methods: This single-center retrospective study is comprised of seventeen patients who underwent either intercalary (N = 12) or geographic (N = 5) resections with various reconstruction methods including allograft (N = 8), vascularized fibula (Capanna) (N = 7), and 3D printed customized titanium implants (N = 2), between the years 2016-2020. All patients were operated on with a 3D surgical workflow, including intraoperative PSIs, and were followed up postoperatively for at least 12 months (average 31.40 ± 12.13 months) to assess oncological and functional outcomes. Results: All patients demonstrated negative surgical margins, apart from one patient who had planned positive margins. Three patients suffered from short-term complications, and three patients underwent revision surgery due to graft non-union or pathological fracture. One patient suffered from local recurrence and underwent above-knee amputation. Three patients suffered from lung metastasis. MSTS at 12-month follow-up was 26.9.±5.87. Conclusion: Customized 3D-printed osteotomy PSIs provide surgeons with a novel tool for optimizing bone resection and reconstruction in long bones surgeries, thus minimizing overall tissue trauma and reducing the risk of damage to nervous and vascular structures. This study demonstrates that the use of PSIs has the potential to improve functional and oncological outcomes. We believe that this technique will become increasingly popular in the future as a widely applicable, highly accurate, cost-effective optimization tool.
Background: Primary bone sarcomas are associated with critically sized bone defects and require complete resection with negative margins. Recent advancements in health care have pioneered novel approaches such as the implementation of 3D surgical technologies. This study presents oncological and functional outcomes following tumor resections of long bones with the use of customized 3D-printed Patient Specific Instruments (PSIs). Methods: This single-center retrospective study is comprised of seventeen patients who underwent either intercalary (N = 12) or geographic (N = 5) resections with various reconstruction methods including allograft (N = 8), vascularized fibula (Capanna) (N = 7), and 3D printed customized titanium implants (N = 2), between the years 2016-2020. All patients were operated on with a 3D surgical workflow, including intraoperative PSIs, and were followed up postoperatively for at least 12 months (average 31.40 ± 12.13 months) to assess oncological and functional outcomes. Results: All patients demonstrated negative surgical margins, apart from one patient who had planned positive margins. Three patients suffered from short-term complications, and three patients underwent revision surgery due to graft non-union or pathological fracture. One patient suffered from local recurrence and underwent above-knee amputation. Three patients suffered from lung metastasis. MSTS at 12-month follow-up was 26.9.±5.87. Conclusion: Customized 3D-printed osteotomy PSIs provide surgeons with a novel tool for optimizing bone resection and reconstruction in long bones surgeries, thus minimizing overall tissue trauma and reducing the risk of damage to nervous and vascular structures. This study demonstrates that the use of PSIs has the potential to improve functional and oncological outcomes. We believe that this technique will become increasingly popular in the future as a widely applicable, highly accurate, cost-effective optimization tool.
Authors: Roby C Thompson; Edward Y Cheng; Denis R Clohisy; John Perentesis; Carlos Manivel; Chap T Le Journal: Clin Orthop Relat Res Date: 2002-04 Impact factor: 4.176
Authors: Thorsten Jentzsch; Lazaros Vlachopoulos; Philipp Fürnstahl; Daniel A Müller; Bruno Fuchs Journal: World J Surg Oncol Date: 2016-09-21 Impact factor: 2.754