Pilot study of patient-specific 3D-printed titanium prosthesis/autograft composite reconstruction for large osteoarticular defect of metacarpal: A novel surgical technique

PurposeTo provide preliminary evidence of the effectiveness of a novel surgical technique using patient-specific 3D-printed titanium prosthesis/autograft composite (3D-PAC) in reconstruction of a large osteoarticular metacarpal defect.Material and methodsSeven patients (4 women, 3 men; mean age, 30 years; mean follow-up duration, 37.4 months (range, 12-73 months)) with large osteoarticular metacarpal defect who were treated with 3D-PAC reconstruction between January 2018 and November 2024 were included in the study. The etiologies were bone tumors in 4 patients, and open fracture in 3 patients.ResultsAt the final follow-up, mean metacarpophalangeal (MCP) extension was 2.1° (range, 0°-10°), and flexion was 52.9° (range, 30°-90°). Mean total active motion of the involved digit was 185.7 (range, 110°-270°) with 3 excellent cases, 3 good cases, and 1 fair case. Mean grip strength was 71.3 % (range, 40%-91%), and key pinch strength was 84.7% (range, 50%-128%) of the contralateral side. Mean visual analog scale score was 0.6 (range, 0-2), Michigan Hand Outcomes Questionnaire score was 70.3 (range, 52.4-83.1), and Disabilities of the Arm, Shoulder and Hand score was 12.9 (range, 4.2-21.7). One patient developed persistent periprosthetic joint infection which required prosthetic removal and converted to arthrodesis. No mechanical complications including aseptic loosening, and implant breakage was revealed. All were satisfied with the function and cosmesis of reconstructive hands.ConclusionPatient-specific 3D-printed titanium prosthesis/autograft composite reconstruction appears to be effective in treatment of large osteoarticular defect of metacarpal in a pilot study. Although suboptimal MCP flexion and decreased hand strength were revealed, such joint motion-sparing procedure was useful to achieve satisfactory hand function and cosmesis. Further studies with a larger sample size compared with the conventional treatments are required to validate the benefits of 3D-PAC reconstruction.