Customized Knee Prosthesis in Treatment of Giant Cell Tumors of the Proximal Tibia: Application of 3-Dimensional Printing Technology in Surgical Design

Wenbin Luo, Lanfeng Huang, He Liu, Wenrui Qu, Xin Zhao, Chenyu Wang, Chen Li, Tao Yu, Qing Han, Jincheng Wang, Yanguo Qin, Wenbin Luo, Lanfeng Huang, He Liu, Wenrui Qu, Xin Zhao, Chenyu Wang, Chen Li, Tao Yu, Qing Han, Jincheng Wang, Yanguo Qin

Abstract

BACKGROUND We explored the application of 3-dimensional (3D) printing technology in treating giant cell tumors (GCT) of the proximal tibia. A tibia block was designed and produced through 3D printing technology. We expected that this 3D-printed block would fill the bone defect after en-bloc resection. Importantly, the block, combined with a standard knee joint prosthesis, provided attachments for collateral ligaments of the knee, which can maintain knee stability. MATERIAL AND METHODS A computed tomography (CT) scan was taken of both knee joints in 4 patients with GCT of the proximal tibia. We developed a novel technique - the real-size 3D-printed proximal tibia model - to design preoperative treatment plans. Hence, with the application of 3D printing technology, a customized proximal tibia block could be designed for each patient individually, which fixed the bone defect, combined with standard knee prosthesis. RESULTS In all 4 cases, the 3D-printed block fitted the bone defect precisely. The motion range of the affected knee was 90 degrees on average, and the soft tissue balance and stability of the knee were good. After an average 7-month follow-up, the MSTS score was 19 on average. No sign of prosthesis fracture, loosening, or other relevant complications were detected. CONCLUSIONS This technique can be used to treat GCT of the proximal tibia when it is hard to achieve soft tissue balance after tumor resection. 3D printing technology simplified the design and manufacturing progress of custom-made orthopedic medical instruments. This new surgical technique could be much more widely applied because of 3D printing technology.

Figures

Figure 1
Figure 1
Antero-posterior and lateral radiographs showing GCT lesions in these 4 cases (A–D), and Case3 (B) had an internal fixation after curettage of the lesion (arrow shows the lesion).
Figure 2
Figure 2
A brief flow chart of this study (EBM: Electron Beam Melting).
Figure 3
Figure 3
GCT lesion located in the MRI and CT scan) The range of resection was recorded and then used as a parameter in design of the proximal tibia block. (A, B) Lesion and its boundary located in the MRI. (B1–B3) The lesion boundary located in CT.
Figure 4
Figure 4
Design of the block. (A) The modified proximal tibia block. (B) 3D-printed model for surgical simulation. (C) Difference between the original case (C1) and the modified one (C2).
Figure 5
Figure 5
Surgical simulation using 3D-printed model. (A, B) Models of the knee prosthesis and the block. (C) Internal structure of the block.
Figure 6
Figure 6
The final product made of titanium alloy. (A) The reticular porous structure on the surface. (B) Comparing with model made of photosensitive resin.
Figure 7
Figure 7
(A–D) Intraoperatively, the proximal tibia prosthesis was highly consistent with the block.
Figure 8
Figure 8
(A–D) The ligaments were preserved and sutured to the proximal tibia space through reticular porous structure.
Figure 9
Figure 9
(A–F) A 40-year-old female (case 1) suffered a local recurrence in 2015. The MRI and CT scan showed that the lesion breached the bone cortex. Resection of tumor and reconstruction of the knee joint with prosthesis were applied. Antero-posterior and lateral radiographs taken postoperative, one month and 3 months after discharge shows no sign of prosthesis fracture and loosening. The flexion of the affected knee was 90 degrees at 6 months after surgery.

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