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Hip reconstruction using a customized intercalary prosthesis with the rhino horn-designed uncemented stem for ultrashort proximal femur segments following tumor resection: a combined biomechanical and clinical study

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机构: [1]Department of Orthopedics, Orthopedic Research Institute, West ChinaHospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu 610041, Sichuan,People’s Republic of China [2]Department of Model Worker and InnovativeCraftsman, West China Hospital, Sichuan University, No.37 Guo Xue Xiang,Chengdu 610041, Sichuan, People’s Republic of China
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关键词: Intercalary endoprosthesis Ultrashort femur segments 3D-printed prosthesis Finite element analysis Bone tumor

摘要:
Hip-preserved reconstruction for patients with ultrashort proximal femur segments following extensive femoral diaphyseal tumor resection is a formidable undertaking. A customized intercalary prosthesis with a rhino horn-designed uncemented stem was developed for the reconstruction of these extensive skeletal defects.This study was designed to analyze and compare the differences in the biomechanical behavior between the normal femur and the femur with diaphyseal defects reconstructed by an intercalary prosthesis with different stems. The biomechanical behavior under physiological loading conditions is analyzed using the healthy femur as the reference. Five three-dimensional finite element models (healthy, customized intercalary prosthesis with four different stems implemented, respectively) were developed, together with a clinical follow-up of 12 patients who underwent intercalary femoral replacement.The biomechanical results showed that normal-like stress and displacement distribution patterns were observed in the remaining proximal femur segments after reconstructions with the rhino horn-designed uncemented stems, compared with the straight stem. Stem A showed better biomechanical performance, whereas the fixation system with Stem B was relatively unstable. The clinical results were consistent with the FEA results. After a mean follow-up period of 32.33 ± 9.12 months, osteointegration and satisfactory clinical outcomes were observed in all patients. Aseptic loosening (asymptomatic) occurred in one patient reconstructed by Stem B; there were no other postoperative complications in the remaining 11 patients.The rhino horn-designed uncemented stem is outstanding in precise shape matching and osseointegration. This novel prosthesis design may be beneficial in decreasing the risk of mechanical failure and aseptic loosening, especially when Stem A is used. Therefore, the customized intercalary prosthesis with this rhino horn-designed uncemented stem might be a reasonable alternative for the reconstruction of SSPF following extensive tumor resection.© 2022. The Author(s).

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出版当年[2022]版:
大类 | 3 区 医学
小类 | 4 区 骨科 4 区 风湿病学
最新[2023]版:
大类 | 3 区 医学
小类 | 3 区 骨科 3 区 风湿病学
第一作者:
第一作者机构: [1]Department of Orthopedics, Orthopedic Research Institute, West ChinaHospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu 610041, Sichuan,People’s Republic of China [2]Department of Model Worker and InnovativeCraftsman, West China Hospital, Sichuan University, No.37 Guo Xue Xiang,Chengdu 610041, Sichuan, People’s Republic of China
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通讯作者:
通讯机构: [1]Department of Orthopedics, Orthopedic Research Institute, West ChinaHospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu 610041, Sichuan,People’s Republic of China [2]Department of Model Worker and InnovativeCraftsman, West China Hospital, Sichuan University, No.37 Guo Xue Xiang,Chengdu 610041, Sichuan, People’s Republic of China
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