Additive technologies in the management of patients with extensive lower limb bone defects

Introduction. Implant instability with the formation of bone defects is one of the complications after primary osteosynthesis and joint arthroplasties. Augments and reinforcing constructs made of titanium with a porous coating have been used for bone defect management in addition to osteoplastic materials. Additive technologies in traumatology and orthopedics for extensive defects in bones and joints have been applied when it is impossible to use standard designs.

The purpose of the study was to evaluate short-term results and perspectives of using additive technologies for bone defects after failed joint arthroplasties and osteosynthesis.

Materials and methods. In 2018 to November 2019, seven patients with lower extremity bone defects underwent treatment at the Department of Traumatology and Orthopedics of the Moscow Regional Research and Clinical Institute with custom-made implants fabricated with additive technologies. The operations were carefully planned using CT scans, 3D modeling, and implant printing. Particular attention was paid to clean the implant from residual metal powder. Patients were distributed depending on the type of defect and the operation performed (arthroplasty, revision arthroplasty).

Results. The short-term results of using customized implants were analyzed in this study. The average Harris hip score before surgery was 37.8 points, and after the surgery it was 80.2 points. Pain after surgery in all patients was also evaluated by Harris scale and was 37.1 points; the functionality of patients after surgery was 38.4 points. The custom-made designs have a number of distinguishing advantages against the standard ones. A customized anatomical design provides easier fixation; ergonomic design allows implant retention without removing metal fixators if exist; there is less soft tissue injury during surgery (allinside principle); and convenient bone grafting around the implant.

Conclusions. The use of additive technologies for bone defects improves the functional results and life quality of the patient. At the moment, practical application of 3D designs has a number of limitations in financial and legal support in practical health care. Further implementation of additive technologies in traumatology and orthopedics will be supported by the grant from the President of the Russian Federation.

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