Application of personalized spacers made with 3D-printed mold in the two-stage procedure for periarticular infection

Cement spacers treat periarticular infection after bone tumor resection in patients with bone defects. Complications such as poor joint function, poor soft tissue reconstruction, and poor postoperative daily living ability are present. We present a case of periarticular infection treated successfully after distal femoral osteosarcoma surgery with a personalized spacer made with a 3D-printed mold.

A two-stage procedure was performed on an 18-year-old patient with high-grade conventional osteosarcoma of the left distal femur. After two biopsies, the boy developed a periarticular infection of the affected limb during neoadjuvant chemotherapy. We had a microbiologically confirmed methicillin-resistant Staphylococcus aureus (MRSA) infection. Because of the infection risk associated with primary joint replacement, a two-stage procedure was planned. In the first stage of surgery, we prepared a personalized spacer using a 3D-printed mold, antibiotic-loaded polymethylmethacrylate (PMMA), and an intramedullary needle. This spacer restored the function of the knee joint and the daily activities of the affected limb, and the infection was effectively eradicated. This spacer was firmly fixed two years after the surgery, and there were no surgical or spacer-related complications. The patient underwent a second stage of surgery to replace a permanent metal mega-prosthesis, and the knee joint functions returned to near normal.

This case report describes limb-salvage surgery following distal femoral resection for periarticular infection. The personalized spacers prepared by a 3D-printed mold can be used in periarticular infection after long bone resection, mega-prosthetic infection, or limb-salvage surgery for temporary joints in small children.