3D ‐Printed Cut Guides and Custom Prostheses for Pelvic Reconstruction in Bone Sarcoma Patients: Complications, Survival Rates, and Functional Outcomes

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.