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. 2024;31(2):372-381.
doi: 10.15388/Amed.2024.31.2.13. Epub 2024 Dec 4.

Ankle and Distal Tibia Megaprostheses in Orthopedic Oncology: A Report of Two Cases and Review of the Literature

Edoardo Ipponi  1 , Martina Cordoni  1 , Elena Bechini  1 , Fabrizia Gentili  1 , Fabio Cosseddu  1 , Antonio D'Arienzo  1 , Lorenzo Andreani  1
Affiliations

Ankle and Distal Tibia Megaprostheses in Orthopedic Oncology: A Report of Two Cases and Review of the Literature

Edoardo Ipponi et al. Acta Med Litu. 2024.

Abstract
in English, Italian

Background: The distal tibia is one of the rarest sites for the onset of malignant and locally aggressive bone tumors. When diagnosed, these lesions should undergo surgical resection with wide margins to eradicate the disease. In the era of limb-sparing surgery, several reconstructive approaches have been proposed and described in modern literature for reconstructing the distal tibia and the ankle. The 3D-printed custom-made prostheses represent an innovative and promising reconstructive option. Several authors highlighted that despite being expensive and prone to some complications such as talar collapse or loosening and soft tissue necrosis, the megaprostheses of the distal tibia could lead to good functional outcomes, also allowing a better range of motion compared to the most common arthrodesis.

Materials and methods: We report two cases who suffered from malignant bone tumors localized in the distal tibia and treated with wide resections and the implant of 3D printed custom-made megaprostheses to replace the distal tibia and the ankle.

Results: Both patients had excellent functional results (MSTS 30/30) one year after surgery. No local recurrence occurred during the patients' latest follow-up.

Conclusions: Our results support the effectiveness of custom-made implants in replacing the distal tibia and the ankle in orthopedic oncology.

Įvadas: Distalinis blauzdikaulis yra viena iš rečiausių piktybinių ir lokaliai agresyvių kaulų navikų atsiradimo vietų. Diagnozavus šiuos pakitimus, siekiant išgydyti, reikia atlikti plačią chirurginę rezekciją. Galūnes tausojančios chirurgijos eroje šiuolaikinėje literatūroje buvo pasiūlyta ir aprašyta keletas rekonstrukcinių metodų distaliniam blauzdikauliui ir čiurnai rekonstruoti. 3D spausdintuvu pagal užsakymą pagaminti protezai yra novatoriška ir daug žadanti rekonstrukcijos galimybė. Keli autoriai pabrėžė, kad, nepaisant to, jog distalinio blauzdikaulio megaprotezai yra brangūs ir juos naudojant galimos komplikacijos, tokios kaip šokikaulio griuvimas ar atsipalaidavimas ir minkštųjų audinių nekrozė, jie gali lemti gerus funkcinius rezultatus, taip pat suteikti geresnę judesių amplitudę, palyginti su dažniausiai pasitaikančiomis artrodezėmis.

Metodai: Aprašome du atvejus, kai distalinėje blauzdikaulio dalyje buvo lokalizuoti piktybiniai kaulų navikai, kurie buvo gydomi plačiomis rezekcijomis ir implantuojant 3D spausdintuvu pagal užsakymą pagamintus megaprotezus, pakeičiančius distalinę blauzdikaulio dalį ir čiurną.

Rezultatai: Praėjus metams po operacijos abiejų pacientų funkciniai rezultatai buvo puikūs (MSTS 30/30). Per paskutinį pacientų stebėjimą lokalių recidyvų nepasitaikė.

Išvados: Mūsų rezultatai patvirtina, kad pagal užsakymą pagaminti implantai yra veiksmingi pakeičiant distalinį blauzdikaulį ir čiurną ortopedinėje onkologijoje.

Keywords: 3D printed; Adamantinoma; Additive manufacturing; Custom made prosthesis; Spindle cell sarcoma.

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Figures

Figure 1
Figure 1
MRI images of Case 1’s neoplasm localized in the distal tibia, viewed on coronal (A) and transverse (B) axes.
Figure 2
Figure 2
Intraoperative images showing (A) the distal tibia surgical specimen after resection and (B) the resulting bone gap, which was later fulfilled with (C) our custom made prosthetic implant.
Figure 3
Figure 3
X-rays of the Case 1’s distal tibia and ankle megaprosthesis in an (A) anteroposterior and (B) lateral view.
Figure 4
Figure 4
X-ray (A) and CT evidence (B) of an osteolytic lesion localized in the left distal tibia.
Figure 5
Figure 5
X-rays of the Case 2’s distal tibia and ankle megaprosthesis in a (A) lateral and (B) anteroposterior view.
Figure 6
Figure 6
Reverdin skin graft procedure. After (A) a careful debridement of the necrotic area, (B) millimetric skin patches were harvested from the ipsilateral thigh, and (C) used to cover the injured area. A good grade of skin healing could already be seen within three weeks after the procedure (D).
See this image and copyright information in PMC

References

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