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Clinical outcomes of patient-specific porous titanium endoprostheses in dogs with tumors of the mandible, radius, or tibia: 12 cases (2013–2016)

Jonathan P. BrayVeterinary Teaching Hospital, Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Palmerston North 4442, New Zealand.

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Andrew KersleyAxia Design Group Ltd, 1/87 Bridge St, Ahuriri, Napier 4110, New Zealand.

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Warwick DowningRAM Manufacturing Ltd, 50 Paerangi Pl, Tauriko, Tauranga 3171, New Zealand.

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Katherine R. CrosseVeterinary Teaching Hospital, Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Palmerston North 4442, New Zealand.

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Andrew J. WorthVeterinary Teaching Hospital, Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Palmerston North 4442, New Zealand.

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Arthur K. HouseCentre for Animal Referral & Emergency, 5 Hood St, Melbourne, VIC 3066, Australia.

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Abstract

OBJECTIVE To characterize the processes involved in and outcomes achieved with custom-designed patient-specific implants to provide functional replacement of skeletal structures in dogs with tumors of the mandible, radius, or tibia.

DESIGN Prospective case series.

ANIMALS 6 dogs with mandibular tumors, 5 with tumors of the distal aspect of the radius, and 1 with a tumor in the distal aspect of the tibia treated from June 2013 to September 2016 at 3 referral centers.

PROCEDURES After tumor staging, implants were designed from patients' CT scans by means of various computer-aided design applications and printed by means of selective laser melting in titanium-6 aluminum-4 vanadium alloy. A cutting jig was created in thermoplastic to ensure each osteotomy was performed as planned. Following ostectomy, the implant was secured into the defect with screws of appropriate size and length.

RESULTS Initial return to normal clinical function was good to excellent for 11 of the 12 dogs. However, major complications resulted in revision of the implant or amputation of the limb in 5 dogs, and at least 3 of these complications were considered a consequence of faulty implant design or manufacturing. Infection developed in 2 dogs and was successfully treated in 1 dog. The longest-surviving dog maintained good limb function for 2 years.

CONCLUSIONS AND CLINICAL RELEVANCE This is the largest reported series of dogs managed with customized 3-D-printed titanium implants. The 3-D printing allowed complex and patient-specific 3-D geometries to be fabricated, enabling function-sparing treatment of bone cancer affecting multiple anatomic sites.

Abstract

OBJECTIVE To characterize the processes involved in and outcomes achieved with custom-designed patient-specific implants to provide functional replacement of skeletal structures in dogs with tumors of the mandible, radius, or tibia.

DESIGN Prospective case series.

ANIMALS 6 dogs with mandibular tumors, 5 with tumors of the distal aspect of the radius, and 1 with a tumor in the distal aspect of the tibia treated from June 2013 to September 2016 at 3 referral centers.

PROCEDURES After tumor staging, implants were designed from patients' CT scans by means of various computer-aided design applications and printed by means of selective laser melting in titanium-6 aluminum-4 vanadium alloy. A cutting jig was created in thermoplastic to ensure each osteotomy was performed as planned. Following ostectomy, the implant was secured into the defect with screws of appropriate size and length.

RESULTS Initial return to normal clinical function was good to excellent for 11 of the 12 dogs. However, major complications resulted in revision of the implant or amputation of the limb in 5 dogs, and at least 3 of these complications were considered a consequence of faulty implant design or manufacturing. Infection developed in 2 dogs and was successfully treated in 1 dog. The longest-surviving dog maintained good limb function for 2 years.

CONCLUSIONS AND CLINICAL RELEVANCE This is the largest reported series of dogs managed with customized 3-D-printed titanium implants. The 3-D printing allowed complex and patient-specific 3-D geometries to be fabricated, enabling function-sparing treatment of bone cancer affecting multiple anatomic sites.

Contributor Notes

Dr. Bray's present address is Fitzpatrick Referral Oncology and Soft Tissue, Surrey Research Park, Guildford, Surrey GU2 7AJ, England.

Address correspondence to Dr. Bray (JonathanB@fitzpatrickreferrals.co.uk).