The application of custom 3D-printed hemi-elbow prosthesis in the repair and reconstruction of bone defects following distal humeral tumor resection.

Abstract

To investigate the application value of a custom 3D-printed hemi-elbow prosthesis in the repair and reconstruction of bone defects following distal humeral tumor resection, and to analyze and evaluate the shorterm and midterm prognosis of patients who received this treatment. This is a retrospective study of 5 patients with aggressive or malignant tumors of the distal humerus treated at our center between September 2021 and August 2023. The surgical procedures for all 5 patients were completed successfully. All cases achieved either marginal or wide resection, and the prostheses were successfully implanted in each case without any intraoperative complications. The mean follow-up period was 33.4±10.8months (range: 24-46 months). Four patients remained alive without evidence of tumor recurrence, while one patient ultimately died due to lung metastasis progression. At the final follow-up, there were no signs of degenerative joint disease, aseptic loosening, or postoperative prosthetic infections. However, complications included 1 case of early ulnar nerve palsy and 1 case of ulnar nerve injury with concomitant elbow joint stiffness. At final follow-up, the mean elbow flexion was 126° ± 15° (range, 100°-140°), the mean extension deficit was 15° ± 9° (range, 5°-30°), and the mean arc of elbow motion was 111° ± 22° (range, 70°-135°). Mean forearm rotation was 161° ± 16° (range, 130°-175°). The average Musculoskeletal Tumor Society 93 score was 27.2 points, and the average Mayo Elbow Performance score was 97points. The application of a custom 3D-printed hemi-elbow prosthesis for the repair and reconstruction of bone defects following distal humeral tumor resection results in good elbow joint mobility and postoperative function. Subsequent follow-up showed no occurrence of degenerative joint disease, loosening, or infection-related complications. Additionally, the use of mesh grafts facilitates improved joint capsule reconstruction and promotes early postoperative mobilization. To reduce the risk of postoperative elbow stiffness, careful attention must be paid to the placement of mesh grafts, minimizing their contact with muscle bellies to lower the risk of adhesions. Further improvements in prosthetic design and an emphasis on postoperative elbow rehabilitation are necessary to enhance clinical outcomes.