Three-dimensional printed calcaneal prosthesis following total calcanectomy

Jungo Imanishi, Peter F M Choong, Jungo Imanishi, Peter F M Choong

Abstract

Introduction: The majority of patients with extremity sarcoma can be surgically treated without amputation. However, limb-salvage surgery for foot sarcomas including the calcaneus remains challenging.

Presentation of case: A 71-year-old man presented with a 5-year history of right heel persistent pain. Imaging studies revealed an osteolytic, destructive and highly metabolic lesion in the right calcaneus. Computed tomography guided core needle biopsy confirmed the diagnosis of grade 2 chondrosarcoma. A total calcanectomy was performed, and the defect was reconstructed with a patient matched three-dimensional printed titanium calcaneal prosthesis. Intra-operatively, ligaments including the Achilles tendon, and plantar fascia were reattached. The post-operative course was uneventful, and at the 5-month clinical follow-up, the patient was fully weightbearing, with a mobile ankle without pain.

Discussion: This case is the first to use additive manufacturing to create a prosthetic calcaneus. The complex peri-calcaneal articular surfaces and reattachment of tendinous structures facilitate efforts to stabilize the prosthesis in situ.

Conclusion: Three-dimensional-printed prosthesis of the calcaneus is a viable alternative to amputation.

Keywords: Calcaneal sarcoma; Limb-salvage surgery; Three-dimensional printed prosthesis.

Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Figures

Fig. 1
Fig. 1
Pre-operative imaging. Radiographs (A and B) show an osteolytic lesion in the right calcaneus. Computed tomography (C) shows expansion of bone remodeling of the lateral wall as well as stipple calcification and popcorn type appearance in the right calcaneus, where a high accumulation of thallium is observed (arrow) (D).
Fig. 2
Fig. 2
A prototype of the calcaneal prosthesis showing an ability to sustain a load of over 6 t.
Fig. 3
Fig. 3
(A) Transverse posterior skin incision along the skin crest. (B) Scheme illustrating intra-operative field after calcanectomy.
Fig. 4
Fig. 4
A photograph showing the resected specimen and prosthesis. The prosthesis was partially polished for the talocalcaneal and calcaneocuboidal joints. Anchor points (arrows) were used to attach ligaments to the prosthesis.
Fig. 5
Fig. 5
Post-operative lateral radiograph showing the perfect fit of calcaneal prosthesis in relation to the talus and cuboid.
Video 1
Video 1
A movie showing the patient walking on bare feet at the 5-month follow-up.
Video 2
Video 2
A movie showing almost the same active dorsiflexion and planterflexion range of motion among both ankles.

References

    1. Henshaw R., Malawer M.M. Review of endoprosthetic reconstruction in limb-sparing surgery. In: Malawer M.M., Sugarbaker P.H., editors. Musculoskeletal Cancer Surgery. Kluwer Academic Publishers; Dordrecht: 2001. pp. 384–404.
    1. Choong P.F., Qureshi A.A., Sim F.H., Unni K.K. Osteosarcoma of the foot: a review of 52 patients at the Mayo clinic. Acta Orthop. Scand. 1999;70:361–364.
    1. Chou L.B., Malawer M.M., Kollender Y., Wellborn C.C. Prosthetic replacement for intramedullary calcaneal osteosarcoma: a case report. Foot Ankle Int. 1998;19:411–415.
    1. Chou L.B., Malawer M.M. Osteosarcoma of the calcaneus treated with prosthetic replacement with twelve years of followup: a case report. Foot Ankle Int. 2007;28:841–844.
    1. Kurvin L.A., Volkering C., Kessler S.B. Calcaneus replacement after total calcanectomy via vascularized pelvis bone. Foot Ankle Surg. 2008;14:221–224.
    1. Li J., Guo Z., Pei G.X., Wang Z., Chen G.J., Wu Z.G. Limb salvage surgery for calcaneal malignancy. J. Surg. Oncol. 2010;102:48–53.
    1. Li J., Wang Z., Guo Z., Yang M., Chen G., Pei G. Composite biological reconstruction following total calcanectomy of primary calcaneal tumors. J. Surg. Oncol. 2012;105:673–678.
    1. Muscolo D.L., Ayerza M.A., Aponte-Tinao L.A. Long-term results of allograft replacement after total calcanectomy. A report of two cases. J. Bone Joint Surg. Am. 2000;82:109–112.
    1. Wozniak W., Raciborska A., Walenta T., Szafranski A., Szymborska A., Bajor M. New technique of surgical treatment of malignant calcaneal tumours. Preliminary report. Ortop. Traumatol. Rehabil. 2007;9:273–276.
    1. Ottolenghi C.E., Petracchi L.J. Chondromyxosarcoma of the calcaneus; report of a case of total replacement of involved bone with a homogenous refrigerated calcaneus. J. Bone Joint Surg. Am. 1953;35-A:211–214.
    1. Scoccianti G., Campanacci D.A., Innocenti M., Beltrami G., Capanna R. Total calcanectomy and reconstruction with vascularized iliac bone graft for osteoblastoma: a report of two cases. Foot Ankle Int. 2009;30:716–720.
    1. Fuller S.M., Butz D.R., Vevang C.B., Makhlouf M.V. Application of 3-Dimensional printing in hand surgery for production of a novel bone reduction clamp. J. Hand Surg. 2014;39:1840–1845.
    1. Delloye C., van Cauter M., Dufrane D., Francq B.G., Docquier P.L., Cornu O. Local complications of massive bone allografts: an appraisal of their prevalence in 128 patients. Acta Orthop. Belg. 2014;80:196–204.
    1. Paavola M., Orava S., Leppilahti J., Kannus P., Jarvinen M. Chronic Achilles tendon overuse injury: complications after surgical treatment. An analysis of 432 consecutive patients. Am. J. Sports Med. 2000;28:77–82.
    1. Feldbrin Z., Alexander L. Cincinnati incision approach for posterior ankle and calcaneal pathology: technique tip. Foot Ankle Int. 2011;32:92–94.
    1. Watson A.D., Anderson R.B., Davis W.H. Comparison of results of retrocalcaneal decompression for retrocalcaneal bursitis and insertional achilles tendinosis with calcific spur. Foot Ankle Int. 2000;21:638–642.
    1. Crawford A.H., Marxen J.L., Osterfeld D.L. The Cincinnati incision: a comprehensive approach for surgical procedures of the foot and ankle in childhood. J. Bone Joint Surg. Am. 1982;64:1355–1358.
    1. Carmont M.R., Maffulli N. Management of insertional Achilles tendinopathy through a Cincinnati incision. BMC Musculoskel. Disord. 2007;8:82.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren