Elbow hemiarthroplasty with a 3D-printed megaprosthesis for distal humeral bone defects after tumor excision: A cases report

Abstract

Abstract Background: The distal humerus is a rare site for primary and metastatic bone tumors. The therapeutic reconstruction modality of bone defects after tumor resection around the elbow remains extremely challenging at present. Therefore, due to the scarcity of cases and lack of standardized surgical strategies, it is often difficult for surgeons to choose the right choice. The application of 3D-printed megaprosthesis with hemiarthroplasty for the treatment of the distal humerus after tumor resection can be a very effective option. Case presentation: We present a clinical case of a 3D-printed distal humeral megaprosthesis for treatment of bone defects caused by metastatic bone tumors. The patient suffered a pathological fracture due to metastatic tumor invading the distal humerus, which affected daily life because of significantly limited pain activity. Preoperative evaluation was aggressively performed, and the decision was made to distal humeral hemi-arthroplasty (DHH) after wide resection of the tumor segment bone. Processing of the Digital Imaging and Communications in Medicine (DICOM) data from CT scans performed after mirror conversion using CT data of the contralateral humerus, we designed a 3D-printed distal humeral megaprosthesis with hemiarthroplasty. After reconstruction of bone and surrounding soft tissue by the 3D-printed megaprosthesis combined with the LARS ligament and regular follow-up for 12 months, the patient had an MSTS-93 score of 29 and an MEPs of 100, which reached a good level, and the patient was fully competent in normal daily activities. Conclusions: Our results show that the 3D-printed modular megaprosthesis with hemiarthroplasty is a very effective option for cases large elbow bone defects due to primary bone tumors or metastatic disease. However, careful preoperative preparation is required for the best outcome. Careful preoperative preparation and long-term follow-up are essential for the best outcome.