Preliminary Results Using Patient Specific 3D-Printed Titanium Cages for the Reconstruction of Massive Femoral Bone Loss

Purpose: Traumatic femoral bone loss is a complex problem with many treatment options available, however, they are typically associated with high rates of complications or prolonged treatment times. We introduce here a novel strategy for treating segmental bone loss, using patient specific 3D-printed titanium cages in conjunction with the Masquelet technique.

Methods: Data was collected prospectively for 13 consecutive femoral cases. Demographics, the length of surgery, complications, rate of union, and rate of readmission were recorded.

Patients with femoral bone loss underwent two procedures under this strategy. The first involved resection of all avascular bone fragments and insertion of an antibiotic PMMA spacer, stabilized with a plate or IM nail. Approximately 10-12 weeks later, custom 3D-printed titanium cages were implanted into the defect and filled with morselized cancellous bone graft. Patients were partial weight bearing for 6 weeks, and full weight bearing by 12 weeks. Follow-up was completed at 6, 12, 26, and 52 weeks, then annually.

Results: Patient specific 3D-printed titanium cages were used to reconstruct femoral defects in 13 patients: 10 males and 3 females; mean age 43.4 years (26-73). The mean interval between stages was 12.7 weeks (10 to 16). The mean bone defect measured 12.8 cm (8.9 to 18.4), and bone defect volume 148 cc (112 to 239). The mean length of follow-up was 25 months (10 to 36). There were no infections, fractures, nerve injuries, loss of alignment, and non-unions identified during the period of follow-up. Knee range of motion was preserved, with mean of 2^o to 108^o (0-120^o). At their latest follow-up, all patients were ambulating pain free and unaided.

Conclusions: The use of custom 3D-printed titanium cages consistently resulted in successful reconstruction of femoral defects. This study demonstrates using 3D-printed custom titanium cages compares favorably to other methods of limb salvage and reconstruction.