Clinical Atlas of 3D Printing Bone Reconstruction

433 Pages·2021·67.722 MB·English

by  Hyun-Guy Kang

Clinical Atlas of 3D
Printing Bone
Reconstruction
Hyun-Guy Kang
123
Clinical Atlas of 3D Printing Bone
Reconstruction
Hyun-Guy Kang
Clinical Atlas
of 3D Printing Bone
Reconstruction
Hyun-Guy Kang
Orthopaedic Oncology Clinic
National Cancer Center
Goyang
Republic of Korea
ISBN 978-981-16-2042-3 ISBN 978-981-16-2043-0 (eBook)
https://doi.org/10.1007/978-981-16-2043-0
© Springer Nature Singapore Pte Ltd. 2021
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Preface
The medical use of advanced 3D printing technology is being tried in various
fields. Printing the desired model using the desired material in a short period
of time is very attractive. The 3D printing technology that enables patient-
specific bone reconstruction is now becoming the key in musculoskeletal
tumor surgery. Current bone reconstruction surgery involves a ready-made
artificial joint forcibly inserted into the body. On the contrary, the use of 3D
printing technology enables customized artificial joint to be perfectly fitted in
the patient’s body.
Using the 3D printing technology requires a lot of time and effort before
the surgery, and collaboration with multiple engineering teams is required.
One must design optimal reconstruction that allows strength and function,
beyond designing structural similarity. While it is complex, I have found out
that 3D printing design has infinite possibilities, like the art of painting.
This book is composed of photos with minimum descriptions so that the
readers can develop their imaginative view. Express your freedom in the lim-
itless 3D printing design. I hope this book will give you courage in your new
challenges.

Hyun-Guy Kang, MD, PhD, National Cancer Center
Goyang-si, Republic of Korea Hyun-Guy Kang, MD, PhD
v
Acknowledgment
My teacher and mentor who guided me to walk on this path
Han-Soo Kim, MD, PhD
Professor, Seoul National University College of Medicine & Hospital
My beloved Orthopaedic colleagues
Jong-Woong Park, MD and June-Hyuk Kim, MD
Staff Surgeon, Orthopedic Oncology Clinic, National Cancer Center

Dr. HG Kang, HS Kim, JW Park
Orthopaedic Department, National Cancer Center
Sung-Keun Kim, Ju-Yeon Han: Registered Nurse
Sung-Eun Oh, Tae-Il Um and Se-Bin Kim: Researcher
MEDYSSEY Company
Hyo-Bok Jeong and Hyun-Woo Jung: 3D printing engineer
Springer Nature Korea Limited
Jenny Chun: Editor of medicine and life sciences books
Government, Republic of Korea
The Ministry of Health and Welfare
The Ministry of Trade, Industry and Energy
Lastly, I would like to express my deepest love and gratitude to dentist
Eun-Ha Kim for giving me a lot of ideas and courage in every moment.
vii
Contents
Part I Pelvis
1 Patient Case 1: Unique Iliac Plate, Combined with
Total Hip Arthroplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.1 Patient Case 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.2 Preoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.3 Planning of Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
1.4 Design and Fabrication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
1.5 Fixation with Iliac Bone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
1.6 Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
1.7 Postoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
2 Patient Case 2: Unique Acetabulum for Easy Assembly
of Total Hip Cup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
2.1 Patient Case 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
2.2 Preoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
2.3 Planning of Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
2.4 Design and Fabrication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
2.5 Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
2.6 Postoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
3 Patient Case 3: Mesh-Style Body Without Ischium . . . . . . . . . . . 31
3.1 Patient Case 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
3.2 Preoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
3.3 Planning of Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
3.4 Design and Fabrication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
3.5 Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
3.6 Postoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
4 Patient Case 4: Omitting Pubis and Ischium . . . . . . . . . . . . . . . . 43
4.1 Patient Case 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
4.2 Preoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
4.3 Planning of Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
4.4 Design and Fabrication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
4.5 Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
4.6 Postoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
5 Patient Case 5: Iliac Wing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
5.1 Patient Case 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
ix
x Contents
5.2 Preoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
5.3 Planning of Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
5.4 Design and Fabrication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
5.5 Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
5.6 Postoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
6 Patient Case 6: Iliac Spacer with Cavitary Resection . . . . . . . . . 69
6.1 Patient Case 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
6.2 Preoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
6.3 Planning of Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
6.4 Design and Fabrication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
6.5 Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
6.6 Postoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
7 Patient Case 7: Acetabular Subchondral Block . . . . . . . . . . . . . . 81
7.1 Patient Case 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
7.2 Preoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
7.3 Planning of Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
7.4 Design and Fabrication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
7.5 Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
7.6 Postoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
8 Patient Case 8: Iliac Acetabular Block and Plate . . . . . . . . . . . . . 95
8.1 Patient Case 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
8.2 Preoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
8.3 Planning of Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
8.4 Design and Fabrication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
8.5 Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
8.6 Postoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
9 Patient Case 9: Allograft Bone Shaping Guide . . . . . . . . . . . . . . 109
9.1 Patient Case 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
9.2 Preoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
9.3 Planning of Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
9.4 Design and Fabrication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
9.5 Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
9.6 Postoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
10 Patient Case 10: Pubis Preventing Genital Deformity
and Hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
10.1 Patient Case 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
10.2 Preoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
10.3 Planning of Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
10.4 Design and Fabrication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
10.5 Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
10.6 Postoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
11 Patient Case 11: Pubis with Acetabular Preservation . . . . . . . . . 133
11.1 Patient Case 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
11.2 Preoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
11.3 Planning of Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Contents xi
11.4 Design and Fabrication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
11.5 Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
11.6 Postoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
12 Patient Case 12: Acetabular Reinforcement Cage . . . . . . . . . . . . 149
12.1 Patient Case 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
12.2 Preoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
12.3 Planning of Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
12.4 Design and Fabrication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
12.5 Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
12.6 Postoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
13 Patient Case 13: Revision: Failed Allograft
Bone Reconstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
13.1 Patient Case 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
13.2 Preoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
13.3 Planning of Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
13.4 Design and Fabrication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
13.5 Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
13.6 Postoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
14 Patient Case 14: Revision: Failed Total Hip Arthroplasty . . . . . 169
14.1 Patient Case 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
14.2 Preoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
14.3 Planning of Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
14.4 Design and Fabrication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
14.5 Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
14.6 Postoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
15 Patient Case 15: Revision: Complicated Saddle Prosthesis . . . . 183
15.1 Patient Case 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
15.2 Preoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
15.3 Planning of Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
15.4 Design and Fabrication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
15.5 Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194
15.6 Postoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196
Part II Femur
16 Patient Case 16: Allograft Bone Shaping Guide in
the Cortical Resection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
16.1 Patient 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
16.2 Preoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
16.3 Planning of Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
16.4 Design and Fabrication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
16.5 Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
16.6 Postoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
17 Patient Case 17: Plate with Reinforcement Ridge . . . . . . . . . . . . 209
17.1 Patient 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
17.2 Preoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210
xii Contents
17.3 Planning of Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212
17.4 Design and Fabrication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212
17.5 Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
17.6 Postoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
18 Patient Case 18: Posterior Intercondylar Y Plate . . . . . . . . . . . . 219
18.1 Patient Case 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
18.2 Preoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220
18.3 Planning of Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224
18.4 Design and Fabrication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224
18.5 Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228
18.6 Postoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228
19 Patient Case 19: Segmental Distal Femur Combined
with IM Nail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
19.1 Patient Case 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
19.2 Preoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
19.3 Planning of Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
19.4 Design and Fabrication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
19.5 Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240
19.6 Postoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242
20 Patient Case 20: Cortical Mesh Covering IM
Nail and Cement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245
20.1 Patient Case 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245
20.2 Preoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246
20.3 Planning of Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 248
20.4 Design and Fabrication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
20.5 Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252
20.6 Postoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254
21 Patient Case 21: Deformity Correction:
Open Wedge Spacer and Supporting Plate . . . . . . . . . . . . . . . . . . 257
21.1 Patient Case 21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257
21.2 Preoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258
21.3 Planning of Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
21.4 Design and Fabrication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
21.5 Implant design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263
21.6 Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
21.7 Postoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269
22 Patient Case 22: Segmental Femur and
Implant-Bone Connector . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
22.1 Patient Case 22 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
22.2 Preoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272
22.3 Planning of Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
22.4 Design and Fabrication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 274
22.5 Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277
22.6 Postoperative Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
22.7 Planning of Third Operation . . . . . . . . . . . . . . . . . . . . . . . . . 282