limb salvage surgery for treatment of Chondrosarcoma of Pelvic

Solution:

Dr. Manish Agarwal, India’s leading Onco Orthopedic surgeon in Mumbai, Maharashtra being a pioneer in using treated tumor bone/ECRT as a method of reconstruction aided surgeries studied medical history, imaging and histopathology reports. It was decided to proceed with ECRT line of treatment. Salvage of acetabulum with ECRT is more of challenging procedure due to complex anatomy of hip, limitation on access due to vital organs in pelvis and particularly due to functionality of load bearing joint. Hence Dr. Manish Agarwal decided to use patient specific cutting guide and patient specific anterior and posterior plate to fix radiated bone fragment back to the position to give maximum functional benefit to the patient. 3D Incredible team discussed with Dr. Agarwal, the designing and entire manufacturing process. The case was initially started with surgical planning and case stimulation with the help of US FDA & CE approved Materialise Mimics software by superimposing CT & MRI DICOM data & anatomical model. As anatomical model maintained 1:1 ratio with the anatomy, hence showed excellent detailing of the tumor, the model was also used to design jig & implant on actual bone, which helped the presurgical planning to be more accurate. Once the planning was finalized, the surgery was to be accompanied with not only customized plates but also cutting guides & jigs. Customized jig helped in precise cutting of hip bone tissue particularly useful with the narrow margins. Jigs are manufactured using biocompatible Nylon material which is autoclavable. The design was completed with valuable inputs between the doctor and the 3D Incredible design team together. The benefits of a 3D printed implant was it`s customization which resulted in an anatomically perfect fitted implant. The variable sizes help in strengthen the particular area required. Finite Element Analysis was carried out at the design which to determine the strength, stability and functionality of the plates. The specialty of the design was the screw location and direction were defined as per surgeon’s requirement to get maximum bone purchase and to achieve the same pre-defined trajectory of screws provided. Excellent combination of combi and locking holes provided to ensure strong and stable hold of bone fragment.

Quote from Doctor :

“Custom made cutting jigs allowed us to make precise bone-cuts as planned. Custom made plates further made reconstruction of the bone with anatomically contoured plates with desired screw trajectory for maximum hold, Custom plate allowed us to preserve the growth plate. We could customize the locking by predeciding the screw direction and position within bone. The custom plate fits the deformed bony contours and aids reduction.”