Long-term Outcomes of 3-dimensional-printed Cutting Guides for Long Bone Sarcoma Resection and Intercalary Allograft Reconstruction: An Updated Case Series.

Abstract

Background: The use of 3-dimensional (3D)-printed cutting guides for resection of long bone sarcoma may offer advantages over traditional free-hand or navigational osteotomy, including improved margin control and reconstruction accuracy. We evaluated long-term surgical and oncologic outcomes of limb salvage procedures using 3D-printed cutting guides, with updated follow-up from our previously published case series and the addition of new cases focusing on margin status, bony union, and local recurrence.

Materials and methods: We retrospectively reviewed 9 patients from our surgical database who underwent limb salvage surgery for long bone sarcoma using patient-specific 3D-printed cutting guides. This included extended follow-up of 6 previously reported cases and 3 new patients. Clinicopathologic, surgical, and radiographic data were collected and analyzed.

Results: All 9 patients (100%) achieved negative surgical margins (mean, 7.7 mm) with no local recurrences at a mean follow-up of 4.1 years (range, 0.5-11.6 years). Bony union was achieved at 16 of 18 (89%) osteotomy sites, comparing favorably to reported intercalary allograft nonunion rates of 6% to 43%. Two patients (22%) required revision to modular oncology devices due to nonunion. At most recent follow-up, no local recurrences were observed, while 7 grafts (78%) remained. Eight patients (89%) are continuously disease free, and 1 (11%) is alive with metastatic disease.

Conclusion: This expanded case series demonstrates excellent long-term oncologic and surgical outcomes using 3D-printed cutting guides for long bone sarcoma resection. Patient-specific guides achieved 100% negative margins with durable graft retention and no local recurrences at 4.1-year follow-up, supporting their continued use in complex limb salvage procedures.