title: Implantation of customized 3-D printed titanium prosthesis in limb salvage surgery: a case series and review of the literature.
abstract: BACKGROUND
  Although modular prosthesis is commercially available to meet requirements in most limb salvage surgeries, customized prosthesis is still needed. In contrast to traditional complicated procedures, rapid prototyping (RP) technique can directly manufacture customized titanium prosthesis. The objectives of this study were to describe the workflow of this technique and show the follow-up results of patients.
  
  
  METHODS
  Three patients with clavicle Ewing's sarcoma (ES), scapular ES, and pelvic chondrosarcoma (CS) were scanned by computer tomography (CT). The images were segmented and reconstructed for preoperative planning and prosthesis design. Then, the data of prosthesis were imported into an electron beam melting system to manufacture implants. These three patients received prosthesis implantation after tumor excision. They were followed up to evaluate survival rate, functional outcome, and complications.
  
  
  RESULTS
  All patients were alive with no evidence of disease. The Musculoskeletal Tumor Society (MSTS) scores were 93, 73, and 90 % for patients with clavicle ES, scapular ES, and pelvic CS, respectively. No surgical complications including limb length discrepancy, screw loosening, and implant breakage were observed in current study.
  
  
  CONCLUSIONS
  Electron beam melting (EBM) is a useful method to directly manufacture customized titanium prostheses. It might improve the effectiveness of limb salvage surgery for sarcomas in unusual sites.
authors.affiliation: Department of Orthopaedic Surgery, Xi-Jing Hospital, Fourth Military Medical University, West Chang-le Road, Xi'an, 710032, China. fanhb@fmmu.edu.cn.
authors.forename: Hongbin
authors.initials: H
authors.lastname: Fan
authors.affiliation: Department of Orthopaedic Surgery, Xi-Jing Hospital, Fourth Military Medical University, West Chang-le Road, Xi'an, 710032, China. fujun@fmmu.edu.cn.
authors.forename: Jun
authors.initials: J
authors.lastname: Fu
authors.affiliation: Department of Orthopaedic Surgery, Xi-Jing Hospital, Fourth Military Medical University, West Chang-le Road, Xi'an, 710032, China. xdlimail@yahoo.com.
authors.forename: Xiangdong
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Orthopaedic Surgery, Xi-Jing Hospital, Fourth Military Medical University, West Chang-le Road, Xi'an, 710032, China. pyjman@163.com.
authors.forename: Yanjun
authors.initials: Y
authors.lastname: Pei
authors.affiliation: Department of Orthopaedic Surgery, Xi-Jing Hospital, Fourth Military Medical University, West Chang-le Road, Xi'an, 710032, China. lxkfmmu@163.com.
authors.forename: Xiaokang
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Orthopaedic Surgery, Xi-Jing Hospital, Fourth Military Medical University, West Chang-le Road, Xi'an, 710032, China. guoxianpei@yahoo.com.
authors.forename: Guoxian
authors.initials: G
authors.lastname: Pei
authors.affiliation: Department of Orthopaedic Surgery, Xi-Jing Hospital, Fourth Military Medical University, West Chang-le Road, Xi'an, 710032, China. 2903915406@qq.com.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Guo
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007720:Knee Prosthesis; D023821:Limb Salvage; D008875:Middle Aged; D011379:Prognosis; D011474:Prosthesis Design; D019919:Prosthesis Implantation; D019651:Plastic Surgery Procedures; D016879:Salvage Therapy; D012509:Sarcoma / Q000473:pathology / Q000601:surgery*; D014025:Titanium; D055815:Young Adult
chemical_list: D014025:Titanium