A Novel Invention of a 3D Printed Mould for Calcaneum Replacement Post Total Calcanectomy for a Recurrent Aggressive GCT of the Calcaneum

Abstract

Advances in image processing have led to the clinical use of 3D printing technology, providing surgeons with realistic physical models of anatomy that enable them to recreate accurate bone structures. 3D-printed molds can play a central role in surgical replacements, offering both efficiency and cost-effectiveness. This case report describes the innovative creation of an anatomical calcaneum using a 3D printer. A patient presented with a recurrent aggressive stage of calcaneal giant cell tumor, which necessitated a complete resection, leaving a large void that required reconstruction. This paper outlines the 3D printing methodology used from pre-operative printing of the prototype, through the surgical procedure, to post-operative care. 3D images of the calcaneum were extracted from a CT scan and edited using 3D modelling software to print a hollow-shelled calcaneum. The printed prototype was created in two halves and sent for gas sterilization. After resecting the diseased calcaneum, the mold was filled with bone cement and clasped together with a proline mesh in between, for soft tissue attachment. Once the cement set, the shell was removed, and the shaped bone cement calcaneum was implanted into the patient with screws. The surrounding soft tissues and Achilles tendon were sutured to the mesh. Post-operatively, the patient was kept in a plaster dorsal slab for six weeks to allow for soft tissue incorporation. Six weeks after surgery, the patient began weight-bearing activities with an aesthetically shaped foot. This method for bone reconstruction is efficient, economical, and reproducible.

Resumo

Avanços no processamento de imagens levaram ao uso clínico da tecnologia de impressão tridimensional (3D), dando aos cirurgiões modelos físicos anatômicos realistas para recriação precisa de estruturas ósseas. Moldes impressos em 3D podem desempenhar um papel essencial em substituições cirúrgicas, oferecendo eficiência e boa relação custo-benefício. Este relato de caso descreve a criação inovadora de um calcâneo anatômico usando uma impressora 3D. Um paciente apresentou uma recidiva de tumor de células gigantes do calcâneo em estágio agressivo, com necessidade de ressecção completa, deixando um grande espaço vazio que exigia reconstrução. Este artigo descreve a metodologia utilizada desde a impressão 3D pré-operatória do protótipo, passando pelo procedimento cirúrgico, até os cuidados pós-operatórios. As imagens 3D do calcâneo foram extraídas de uma tomografia computadorizada e editadas usando um software de modelagem 3D para impressão do osso como uma concha oca. O protótipo impresso foi criado em duas metades e enviado para esterilização a gás. Após a ressecção do calcâneo acometido, o molde foi preenchido com cimento ósseo e as duas metades foram unidas, com uma tela de prolene entre elas, para fixação nos tecidos moles. Após a cura do cimento ósseo, a concha foi removida e o calcâneo moldado foi implantado no paciente com parafusos. Os tecidos moles circundantes e o tendão calcâneo foram suturados à tela. No pós-operatório, o paciente utilizou uma placa dorsal de gesso por 6 semanas para permitir a incorporação dos tecidos moles. Seis semanas após a cirurgia, o paciente iniciou atividades com suporte de peso no pé esteticamente moldado. Este método de reconstrução óssea é eficiente, econômico e reprodutível.

Keywords

calcaneum - giant cell tumors - oncology - printing, three-dimensional

Palavras-chave

calcâneo - impressão tridimensional - oncologia - tumores de células gigantes

Authors' Contributions

Each author contributed individually and significantly to the development of this article: GBHE, conceptualization, formal initiator, research, methodology, validation, visualization, writing of original draft, primary author, revision intrasubmission for publication. TKK, validation, editing, revision, 2nd read correction. AGP, validation, mentor, supervisor-trainer, editing, revision.

Work developed at the Orthopedic Oncology Unit, Orthopedic and Traumatology Hospital Queen Elizabeth I & II Sabah Malaysia.

Publikationsverlauf

Eingereicht: 28. Juli 2024

Angenommen: 27. März 2025

Artikel online veröffentlicht:
01. Juli 2025

• References

• 1 Wixted CM, Peterson JR, Kadakia RJ, Adams SB. Three-dimensional Printing in Orthopaedic Surgery: Current Applications and Future Developments. J Am Acad Orthop Surg Glob Res Rev 2021; 5 (04) 00230-11
• 2 Alemayehu DG, Zhang Z, Tahir E, Gateau D, Zhang DF, Ma X. Preoperative Planning Using 3D Printing Technology in Orthopedic Surgery. BioMed Res Int 2021; 2021: 7940242
• 3 Fritz J, Fishman EK, Corl F, Carrino JA, Weber KL, Fayad LM. Imaging of limb salvage surgery. AJR Am J Roentgenol 2012; 198 (03) 647-660
• 4 Luijkx T, Elthokapy M, Gregory L. et al. Calcaneus. Reference article, Radiopaedia.org (Accessed on 10 Mar 2024). Available from: https://doi.org/10.53347/rID-31905
• 5 Heidkamp J, Scholte M, Rosman C, Manohar S, Fütterer JJ, Rovers MM. Novel imaging techniques for intraoperative margin assessment in surgical oncology: A systematic review. Int J Cancer 2021; 149 (03) 635-645
• 6 Wang J, Yu X, Zheng K, Xu M. Limb salvage surgery for calcaneal chondrosarcoma: A case report. Medicine (Baltimore) 2022; 101 (51) e31578
• 7 Rizzo A, Paderno M, Saccomanno MF, Milano F, Milano G. The Musculoskeletal Tumor Society Scoring system is a valid subjective and objective tool to evaluate outcomes of surgical treatment of patients affected by upper and lower extremity tumors. Musculoskelet Surg 2024; 108 (02) 201-214
• 8 Kacl GM, Zanetti M, Amgwerd M. et al. Rapid prototyping (stereolithography) in the management of intra-articular calcaneal fractures. Eur Radiol 1997; 7 (02) 187-191
• 9 Lee JY, Tan BM, Png W, Too CW, Yeo NEM. Novel Utilization of 3D Printing Technology for a Chronic Malunited Calcaneum Fracture- A Case Report. Foot & Ankle Surgery Techniques, Reports & Cases 2021; 1 (03) 100051