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Objectives Pelvic reconstruction with conventional 3D‐printed prostheses faces a critical trade‐off, where achieving sufficient porosity for optimal bone ingrowth often compromises essential mechanical stability. To address this challenge, this study evaluates the clinical outcomes of 3D‐printed hemipelvic prostheses incorporating re‐entrant chiral structure (RCS), a novel negative Poisson's ratio design, in patients undergoing pelvic reconstruction following tumor resection. Methods A retrospective analysis was conducted on 15 patients (eight females and seven males; mean age: 39.3 ± 11.7 years) with pelvic malignancies who underwent reconstruction using 3D‐printed hemipelvic prostheses incorporating RCS between March 2018 and June 2023. The diagnoses included osteosarcoma (n = 8), Ewing's sarcoma (n = 3), chondrosarcoma (n = 2), and high‐grade soft tissue sarcoma (n = 2). All patients were staged as IIB according to the Enneking system, except for one case of Ewing's sarcoma (stage III). Neoadjuvant chemotherapy (four cycles) was administered to six osteosarcoma patients, and one Ewing's sarcoma patient received six cycles, while other patients proceeded directly to surgery. Patient outcomes were systematically evaluated through oncological status, functional performance (MSTS‐93 score), pain assessment (VAS score), surgical parameters, complications, and radiographic analysis using Tomosynthesis Shimadzu Metal Artifact Reduction Technology (T‐SMART). Results At the latest follow‐up (44.5 ± 9.4 months), 13 patients (86.7%) remained disease‐free; one patient (6.7%) experienced local recurrence requiring revision surgery, and one patient (6.7%) died of metastatic complications at 32 months post‐surgery. Functional outcomes showed significant improvement, with mean MSTS‐93 scores increasing from 14.5 ± 1.1 preoperatively to 25.8 ± 1.3 at final follow‐up (p < 0.001). Pain control was satisfactory, with VAS scores decreasing from 5.5 ± 0.6 to 1.5 ± 0.5 (p < 0.001). The mean surgical duration was 289.3 ± 30.4 min, with an average intraoperative blood loss of 3540 ± 621.5 mL. Early complications included delayed wound healing in three cases (20%), successfully managed with wound care protocols and VAC therapy. One patient (6.7%) developed deep prosthetic infection at 14 months post‐surgery, necessitating a two‐stage revision procedure. No mechanical failures, aseptic loosening, or prosthesis fractures were observed during the follow‐up period. Radiographic analysis demonstrated progressive bone ingrowth into the RCS porous regions in all cases, with no signs of osteolysis or implant migration in the remaining prostheses. Conclusion D‐printed custom hemipelvic prostheses with RCS offer an effective solution for pelvic reconstruction by achieving an optimal balance between mechanical stability and biological integration, leading to promising clinical outcomes. Novel 3D‐printed hemipelvic prostheses incorporating re‐entrant chiral structure achieved 75% porosity while maintaining structural integrity. Clinical outcomes demonstrated 86.7% disease‐free survival and significant functional improvement (MSTS‐93: 14.4→25.7) in pelvic malignancy reconstruction.

Objective Osteosarcoma at the first metacarpal is extremely rare. Reconstructing the metacarpal after tumor resection is essential, as the thumb accounts for approximately 40%–50% of hand function. Although autografts, arthroplasty, and transposition have been reported as reconstruction options, their use is limited by complications such as secondary injury, nonunion, and displacement. In this study, we present a case of a patient with first metacarpal osteosarcoma who underwent tumor resection followed by reconstruction with a 3D‐printed metacarpal prosthesis. We tend to introduce a novel strategy to reconstruct the first metacarpal and restore the hand function. Methods A 30‐year‐old male with 5‐month history of first metacarpal swelling in the left hand was admitted to our center. Imaging examinations and incision biopsy confirmed a diagnosis of intramedullary well‐differentiated osteosarcoma. A 3D‐printed metacarpal prosthesis was then designed to achieve carpometacarpal (CMC) joint fusion and thumb metacarpophalangeal (MCP) joint reconstruction. Postoperative evaluations included X‐ray and tomosynthesis‐shimadzu metal artifact reduction technology (T‐SMART) imaging to assess bone‐prosthesis integration. Hand function was measured using the Musculoskeletal Tumor Society (MSTS) score and the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Results The tumor was completely resected, and a 3D‐printed metacarpal prosthesis was performed to reconstruct the tumor defect. Postoperative imaging showed that the interface between bone and prosthesis was integrated and that there was no loose, displacement, or fracture of the implant. At the last follow‐up, the patient had an MSTS score of 25/30 and a DASH score of 8/100. The range of motion on thumb MCP joint was 30° of flexion and 0° of extension. The Kapandji thumb opposition score was 4 points. The grip strength was 9 kg (compared to 30 kg on the contralateral side) and the key‐pinch strength was 3 kg (compared to 8 kg on the contralateral side). Conclusion 3D‐printed metacarpal prosthesis could be an effective reconstruction option for patients with low‐grade malignant tumors. Themulti‐planar fixation achieved through 3D surgical planning helps maintain thumb function and restore overall hand function. In this study, we reported the first metacarpal osteosarcoma patient received tumor resection and 3D‐printed metacarpal prosthesis reconstruction. We tend to introduce a novel strategy to reconstruct the first metacarpal and restore the hand function. During the follow‐up, patients had considerable hand function.

Breast reconstruction is essential for improving the appearance of patients after cancer surgery. Traditional breast prostheses are not appropriate for those undergoing partial resections and cannot detect and treat locoregional recurrence. Personalized shape prostheses that can smartly sense tumor relapse and deliver therapeutics are needed. A 3D‐printed prosthesis that contains a therapeutic hydrogel is developed. The hydrogel, which is fabricated by crosslinking the polyvinyl alcohol with N1‐(4‐boronobenzyl)‐N3‐(4‐boronophenyl)‐N1, N1, N3, N3‐tetramethylpropane‐1,3‐diaminium, is responsive to reactive oxygen species (ROS) in the tumor microenvironment. Specifically, RSL3, a ferroptosis inducer that is loaded in hydrogels, can trigger tumor ferroptosis. Intriguingly, RSL3 encapsulated in the ROS‐responsive hydrogel exerts antitumor effects by increasing the numbers of tumor‐infiltrated CD4+ T cells, CD8+ T cells, and M1 macrophages while reducing the number of M2 macrophages. Therefore, this new prosthesis not only allows personalized shape reconstruction, but also detects and inhibits tumor recurrence. This combination of aesthetic appearance and therapeutic function can be very beneficial for breast cancer patients undergoing surgery. In this study, a 3D‐printed prosthesis with good biocompatibility, stability, and elasticity is combined with an RSL3@LIPO‐loaded ROS‐responsive hydrogel, which not only optimizes the shape of the breast after surgery in a personalized manner, but also senses tumor, induces ferroptosis in tumor cells, and accumulates the tumor‐suppressive immune cells for exerting therapeutic effect upon tumor recurrence.

Objective Using a fibula autograft (FA) to reconstruct defects after en bloc resection of giant cell tumor of bone (GCTB) in the distal radius is classic but has high complication rates. We describe a novel reconstruction method employing the cooperative application of LARS® and a 3D‐printed prosthesis (L‐P) and investigate whether it improves postoperative outcomes. Methods From April 2015 to August 2022, 14 patients who underwent the cooperative L‐P reconstruction method after en bloc resection of distal radial GCTBs and 31 patients who received FA reconstruction were enrolled as two retrospective cohorts in this comparative study. The properties of the implants and critical surgical techniques were elaborated in the L‐P group. Preoperative function, intraoperative data, and postoperative clinical, functional, and radiographic outcomes of all patients were recorded and compared between the two groups. The grip strength and range of wrist motion, including extension, flexion, radial deviation, and ulnar deviation, were measured. The Mayo modified wrist and Musculoskeletal Tumor Society scores were chosen to assess wrist function and surgical functional outcomes, respectively. Kaplan–Meier curves were generated to analyze the significant differences in complication rates and implant survival between the two groups. Results In both groups, all 45 patients underwent the operation without complication with similar average osteotomy lengths and bleeding volumes, while a shorter operative duration was achieved in the L‐P group (201.43 ± 22.87 min vs. 230.16 ± 51.44 min, P = 0.015). At a mean follow‐up of 40.42 ± 18.43 months (range, 14–72 months), both reconstruction methods effectively ameliorated postoperative function. Patients who received L‐P showed higher postoperative modified Mayo wrist scores (81.43 ± 5.49 vs. 71.13 ± 16.10, P = 0.003), Musculoskeletal Tumor Society scores (27.64 ± 1.34 vs. 25.06 ± 2.95, P = 0.004), and grip strength on the normal side (68.71% ± 8.00% vs. 57.81% ± 12.31%, P = 0.005) than the FA group. Better wrist extension (63.21° ± 8.99° vs. 45.32° ± 14.53°, P < 0.001) and flexion (45.36° ± 7.90° vs. 30.48° ± 12.07°, P < 0.001) were also observed in the L‐P group. The complication rate was significantly higher in the FA group (29/31, 93.55%) than in the L‐P group (1/14 7.14%, P < 0.001). The L‐P group showed higher implant survival than the FA group, but the difference was not statistically significant. Conclusion The cooperative application of LARS® and 3D‐printed prostheses is an effective modality for reconstructing musculoskeletal defects after en bloc resection of distal radial GCTBs, which can improve functional outcomes, diminish complication rates, and promote wrist joint stability and motion. With consideration both to bone and soft tissue reconstitution, the cooperative application of LARS® and 3D‐printed prostheses is an optimized modality for reconstructing musculoskeletal defects after en bloc resection of distal radial GCTBs, which can improve functional outcomes, diminish complication rates, and promote wrist stability and motion.

Background: 3D printing (3DP) workflow has made its entry in the upper limb prostheses (ULP) manufacturing process. Although it represents a valuable change in clinical practice, its implementation is not ubiquitous. Additional data are required to establish recommendations and unanimously accepted guidelines to facilitate clinical application. Objectives: Our study aimed to develop and validate a web-based multilingual survey investigating the sociodemographic and technical profiles and expertise of professionals and volunteers using 3DP for manufacturing ULP. Methods: We followed a multi-stage development and validation process, including item generation, experts’ review, cognitive testing and pre-testing among the population of interest (POI). Validity evidence was accumulated at each stage, with Content Validity and Face Validity measurements. The survey was available in French, English and Spanish and distributed through the REDCAP web-based platform. Results: The validated questionnaire comprised fifty-two primary questions, organized in nine sections. Experts’ evaluations demonstrated appropriate topic coverage and a high degree of relevance throughout the survey: most single item Content Validity Indexes (CVI) ranged from 0.87 to 1 and Average CVIs for survey sections reached between 0.86 to 1. The pre-test among the POI included 42 participants and led to limited questionnaire revisions. The final version of the survey was approved unanimously by all experts. Conclusions: The newly developed web-based survey demonstrated good evidence for validity. This instrument is an acceptable tool to investigate stakeholders using 3DP for manufacturing ULP and to further establish guidelines.

Introduction Pelvic reconstruction following bone sarcoma resection presents significant challenges. This study evaluates the outcomes of using 3D‐printed custom‐made prostheses and cutting guides to improve surgical precision and functional results in periacetabular reconstructions. Therefore, in this study, we asked: (1) What is the cumulative incidence of reoperation for any reason following pelvic resection and reconstruction with a custom‐made 3D‐printed prosthesis involving the acetabulum in patients with primary bone sarcoma, and what factors contribute to an increased risk of reconstruction failure? (2) Does the use of 3D custom‐made cutting guides, combined with a 3D custom‐made hemipelvis prosthesis, ensure the attainment of safe resection margins and allow for anatomical reconstruction with optimal fit at the bone‐prosthesis interface? (3) What were the observed outcome scores as measured by the Musculoskeletal Tumor Society (MSTS) Score? Additionally, how do the type of resection and the volume of the primary bone sarcoma affect the outcomes in relation to the type of reconstruction? Materials and Methods We conducted a retrospective review of 24 patients treated for primary bone sarcomas at our institution from January 2013 to December 2023. Each patient received a 3D‐printed cutting guide and a 3D‐printed custom‐made prosthesis tailored to their specific anatomical needs, based on high‐resolution imaging and computer‐aided design. Results The use of custom‐made 3D prostheses resulted in a reoperation rate of 46%, primarily due to complications such as infection and mechanical failures. Specific complications included an 8% rate of deep infections and mechanical issues like aseptic loosening. Local recurrence was observed in 5 patients (21%) at a median time of 5 months post‐surgery. Despite these challenges, the average MSTS score was 83.7%, indicating a high level of functional recovery post‐surgery. Conclusions The integration of 3D printing in pelvic reconstructions for bone sarcomas significantly enhances anatomical and functional outcomes. However, the technology demands further refinement to reduce complication rates. Continued advancements in 3D‐printing materials and techniques are crucial to maximizing the benefits of this innovative approach in orthopedic oncology. A 60‐year‐old male patient with Grade 2 chondrosarcoma. High‐intensity signals were observed in the coronal (A) and transverse (B) MRI images (T1‐fat suppression with contrast) in the left hemi‐pelvis, involving the periacetabular area but without infiltration into the hip joint. 3D computer renderings for the frontal (C) and lateral (D) views of the left hemi‐pelvis show the planned P1–P2–P3 resection highlighted [in red] and the planned 3D‐printed custom‐made cutting guide positioning and fixation [in white]. (E) 3D computer renderings post‐tumor resection depict the insertion of the 3D‐printed prosthesis and its fixation points. The actual cutting points were confirmed using a 3D‐printed bone model. The fixation points for the cancellous screws and stems were also determined, allowing for the calculation of the appropriate lengths for drilling and the sizes of the planned screws or stems. (E) Postoperative CT 3D reconstruction after the tumor resection and prosthetic reconstruction. It should be noted that the screw on the ischial branch is not included in the figure, as resection was extended intraoperatively and fixation omitted in that region, following soft tissue disease progression observed during chemotherapy.

Background Treating infectious bone defects combined with large soft-tissue lesions poses significant clinical challenges. Herein, we introduced a modified two-stage treatment approach involving the implantation of 3D-printed prostheses and flap repair to treat large segmental infectious tibial bone defects. Method We conducted a retrospective study of 13 patients treated at our center between April 2018 and March 2022 for tibial infections owing to posttraumatic infection and chronic osteomyelitis combined with soft tissue defects. The average defect length was 14.0 cm (range, 5.7–22.9 cm). The flap area ranged from 14 × 5 to 15 × 8 + 25 × 15 cm. Sural neurocutaneous, lesser saphenous neurocutaneous, and local fasciocutaneous flaps were used to repair the skin defects. In the second stage, 3D-printed prostheses were designed and implanted. Union rate, complications, and functional outcomes were assessed at the final follow-up. Result The average follow-up period was 31.1 months (range, 17–47 months), with an average interval of 208.1 days (range, 139–359 days) between the two stages. According to our criteria, 7 of the 13 patients achieved radiographic healing without intervention. Two patients developed prosthesis-related complications and underwent revision surgery. Two patients experienced recurrent infections leading to prosthesis removal and debridement surgery, with the infection ultimately eradicated in one and the other undergoing amputation. Three patients experienced noninfectious flap-related complications, however, all eventually healed through surgical intervention. Conclusion The use of 3D-printed porous titanium prostheses combined with flap soft-tissue repair for the treatment of infectious tibial bone defects did not increase the rate of infection recurrence and provided good functional recovery, offering more options for the treatment of infectious bone defects.

Background Total en bloc spondylectomy (TES) is a recognized surgical approach for managing spinal tumors. With advancements in three-dimensional (3D) printing technology, the use of 3D-printed prosthetics for vertebral reconstruction post-tumor resection has gained traction. However, research on the clinical implications of these prosthetics remains limited. Methods This retrospective study evaluated patients who underwent TES for primary and metastatic thoracolumbar tumors at the Department of Spinal Surgery, Tianjin Hospital, between October 2017 and September 2020. These patients received anterior reconstruction with 3D-printed artificial vertebral bodies. Results 14 patients completed the surgery, with intraoperative blood loss ranging from 1,400 to 4,200 ml (mean 2,767 ± 790 ml) and operative duration between 240 and 520 min (mean 382 ± 75.9 min). The follow-up period extended from 7 to 43 months, with an average of 19.9 ± 9.5 months. Standardized prefabricated prosthetics were utilized in nine patients, while five received customized prosthetics. Throughout the follow-up, there were no reports of posterior connecting rod, 3D-printed prosthetic, or pedicle screw failures. Notably, one patient presented with significant prosthetic subsidence resulting in screw loosening, and three cases of prosthetic subsidence were observed. Conclusion The incorporation of 3D-printed prosthetics in TES procedures yielded favorable clinical outcomes. Further research is warranted to optimize these prosthetics for enhanced postoperative stability and patient-specific applications.

Objective To analyse and compare the biomechanical differences between 3D-printed prostheses, titanium mesh cages and poorly matched titanium mesh cages in total en bloc spondylectomy (TES). Methods The finite element model of T10-L2 for healthy adults was modified to make three models after T12 total spondylectomy. These models were a 3D-printed prosthesis, titanium mesh cage and prosthesis-endplate mismatched titanium mesh cage for reconstruction. The range of motion (ROM), stress distribution of the endplate and internal fixation system of three models in flexion and extension, lateral bending and axial rotation were simulated and analysed by ABAQUS. Result In flexion, due to the support of the anterior prosthesis, the fixation system showed the maximum fixation strength. The fixation strength of the 3D-printed prosthesis model was 26.73 N·m /°, that of the TMC support model was 27.20 N·m /°, and that of the poorly matched TMC model was 24.16 N·m /°. In flexion, the L1 upper endplate stress of the poorly matched TMC model was 35.5% and 49.6% higher than that of the TMC and 3D-printed prosthesis, respectively. It was 17% and 28.1% higher in extension, 39.3% and 42.5% higher in lateral bending, and 82.9% and 91.2% higher in axial rotation, respectively. The lower endplate of T11 showed a similar trend, but the magnitude of the stress change was reduced. In the stress analysis of the 3D-printed prosthesis and TMC, it was found that the maximum stress was in flexion and axial rotation, followed by left and right bending, and the least stress was in extension. However, the mismatched TMC withstood the maximum von Mises stress of 418.7 MPa (almost twice as much as the buckling state) in rotation, 3 times and 5.83 times in extension, and 1.29 and 2.85 times in lateral bending, respectively. Conclusion Different prostheses with good endplate matching after total spondylectomy can obtain effective postoperative stable support, and the reduction in contact area caused by mismatch will affect the biomechanical properties and increase the probability of internal fixation failure.

[This corrects the article DOI: 10.3389/fbioe.2025.1642787.].