ABSTRACT
Objective:To perform the preoperative design and operative simulation for periprosthetic femoral fractures (PFF)in one patient with complex tumor knee replacement under assistance of three-dimensional (3D) printing technology,and to explore a more accurate and feasible way to restore the normal anatomy and function of this kind of patients.Methods:The female patient aged 32 years old diagnosed with PFF after an complex tumor knee replacement was selected.The CT images of the patient’s bilateral legs were collected and reconstructed.The bilateral femurs were virtually sliced and the important parameters at each location of both sides were recorded respectively.Novel femoral stem and nail paths were specially designed on the basis of original prosthesis according to these parameters. Then vitual assemble was made with the residual femur. The prosthetic femoral stem components and navigator were customized based on the 3D simulation results when no more errors were found.The residual femoral resin model,customized components and navigator were printed with an SLA 3D printer.The bone cement was taken out and newly designed femoral stem was implanted successfully according to the steps designed preoperatively.The preconcerted allograft bone plates were applied for patch of the bone defect.The pathological results,X-ray and functional scores were included in the observation indexes. Results: With the help of successfully preoperative computer matching,successfully printed bone model-prosthesis assemble and re-customized navigator,the operation was successfully performed.The postoperative alignment shown in the X-ray image was good.The patient was able to normally walk and squat one month after operation with a crutch.MSTS93 score was improved from 0 before operation to 14 only one month after operation.Conclusion:As for PFF of complex tumor knee joint,preoperative design and simulation with 3D printing technology may provide a more accurately and effectively operative outcome than traditional methods.
ABSTRACT
Se ha descripto que los tumores de la rodilla pueden ser inicialmente mal diagnosticados como lesiones deportivas o viceversa, con consecuencias dramáticas potenciales. Otro diagnóstico aún más conflictivo puede suceder cuando ambas patologías ocurren en forma simultánea. La ruptura del ligamento cruzado anterior está dentro de las lesiones deportivas más frecuentes, con una incidencia en EEUU de 150.000 a 200.000 por año. En contraste, los tumores musculo-esqueléticos de rodilla son relativamente infrecuentes. A pesar de esto, las lesiones deportivas y las lesiones tumorales presentan una estricta relación ya que exhiben un mismo grupo etario con similar sintomatología y localización anatómica, pudiendo generar problemas en el diagnóstico. El objetivo del trabajo fue describir tres pacientes con lesiones simultáneas en la rodilla: una ruptura traumática del ligamento cruzado anterior (LCA) y un tumor musculo-esquelético que puede ser particularmente confuso para el cirujano tratante. Nivel de evidencia: IV...
It has been reported that tumors about the knee may be initially misdiagnosed as athletic injuries or vice versa, with potentially dramatic consequences. An even more conflicting diagnostic situation might happen when both pathologies occur simultaneously. Anterior cruciate ligament ruptures are among the most frequent athletic injuries, with an incidence of 150.000-200.000 per year in the USA. On the other side, musculoskeletal tumors about the knee are much less common. However, they frequently occur in the same age group with symptoms that overlap, making it difficult to have a precise diagnosis. We report three patients with simultaneous lesions about the knee: A traumatic anterior cruciate ligament (ACL) rupture and a musculoskeletal tumor, which may be confusing for the treating surgeon. Level of evidence: IV...