Yonsei Med J.  2019 Sep;60(9):882-886. 10.3349/ymj.2019.60.9.882.

3D-Printed Prosthesis Replacement for Limb Salvage after Radical Resection of an Ameloblastoma in the Tibia with 1 Year of Follow Up: A Case Report

• Feng D
• He J
• Zhang C
• Wang L
• Gu X
• Guo Y

• KMID: 2457485
• DOI: http://doi.org/10.3349/ymj.2019.60.9.882

Abstract

Ameloblastoma in the tibia is rare. Limb reconstruction after tumor resection is challenging in terms of selection of the operative method. Here, we report a case of radical resection of an ameloblastoma in the mid-distal tibia combined with limb salvage using a three-dimensional (3D)-printed prosthesis replacement, with 1-year follow-up results. After receiving local institutional review board approval, a titanium alloy prosthesis was designed using a computer and manufactured with 3D-printing technology. During the operation, the stem of the prosthesis was inserted closely into the proximal tibial medullary cavity. Then, the metal ankle mortise and the talus were compacted closely. Radiographic results at 1-year follow up showed that the prosthesis was well placed, and no loosening was observed. The Musculoskeletal Tumor Society (MSTS) 93 functional score was 26 points, and the functional recovery percentage was 86.7%. Computer-assisted 3D-printing technology allowed for more volume and structural compatibility of the prosthesis, thereby ensuring a smooth operation and initial prosthetic stabilization. During the follow up, the presence of bone ingrowths on the porous surface of some segments of the prosthesis suggested good outcomes for long-term biological integration between the prosthesis and host bone.

Keyword

3D-printing; tibia; ameloblastoma; prosthesis

MeSH Terms

Alloys
Ameloblastoma*
Ankle
Ethics Committees, Research
Extremities*
Follow-Up Studies*
Limb Salvage*
Methods
Prostheses and Implants*
Talus
Tibia*
Titanium
Alloys
Titanium

Figure

• 

  Fig. 1 Preoperative examination, design, and construction of the prosthesis using three-dimensional (3D)-printing technology. (A) Radiography of diseased tibia. (B) Magnetic resonance imaging of the diseased tibia and fibula. (C) 3D prosthesis design in a computer. (D) 3D-printing resinous model and titanium alloy prosthesis; the latter has a porous printed structure (0.25–0.40 cm thickness) of the bone trabecula on the peripheral surface of the stem, collar, and ankle mortise (red arrowheads). The prosthesis was made with 3D printing in one step with its porous coating. (E) Incision I. (F) Incision II and incision III. (G) Installation of the proximal end of the prosthesis. (H) Installation of the distal end of the prosthesis.

• 

  Fig. 2 Postoperative review. (A) Good prosthesis position and lower limb force line in full-length radiography images at 3 months after the operation. (B) At 12 months after the operation, radiography images show no obvious progressive radiolucent zones around the prosthesis stem and metal ankle mortise, as well as several new bone bridge spanning the bone-prosthesis junction outside the cortex and prosthesis (red arrowheads). (C) Computed tomography scan shows bone growth into the porous surface of the prosthetic stem and ankle mortise (red arrowheads) and into the porous surface of the prosthetic collar and the front of metal ankle mortise (from the extracortical bone bridge, green arrowheads) at 9 months after the operation. (D) Lower extremity movement of the patient at 9 months after the operation.

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