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Case Report Open Access

3D‑Printed prosthesis for recurrent femoral metastasis with periprosthetic infection: A case report

  • Authors:
    • Jiangbi Li
    • Yangjie Zhang
    • Jianping Kang
    • Changping Tian
    • Suolin Chen
    • Ya Ning
    • Haixia Li
    • Yanbin Xiao
  • View Affiliations / Copyright

    Affiliations: Department of Orthopaedics, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650118, P.R. China, Department of Neurology, The First People's Hospital of Yunnan Province, Kunming, Yunnan 650118, P.R. China
    Copyright: © Li et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 189
    |
    Published online on: May 14, 2026
       https://doi.org/10.3892/etm.2026.13185
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Abstract

3D‑printed prosthesis replacement is increasingly applied for reconstruction following resection of malignant bone tumors. However, the management of postoperative tumor recurrence with periprosthetic infection following surgery remains challenging, as clinical manifestations and imaging features can be obscured by or mimic tumor recurrence, periprosthetic biofilms render conventional antibiotics ineffective and large segmental bone defects limit reconstructive options. The present study reports the case of a 53‑year‑old female patient with cervical cancer who developed femoral metastasis and tumor recurrence with periprosthetic infection. A customized anatomically matched femoral prosthesis was designed using 3D printing technology. The patient underwent tumor resection, debridement and implantation of the custom prosthesis, followed by prolonged antibiotic therapy. The infection was effectively controlled and limb salvage was achieved. At 1 year postoperative follow‑up, the patient was able to ambulate without assistance and reported no notable pain. Personalized 3D‑printed prosthesis combined with appropriate antibiotic therapy may offer an effective treatment option for recurrent bone tumors complicated by infection and large segmental bone defects.
View Figures

Figure 1

Preoperative imaging findings (June
2024). (A) X-ray showed osteolytic destruction of the distal femur
around the primary prosthesis. (B) Coronal 3D CT reconstruction
demonstrating distal femoral bone destruction (arrow). (C) Sagittal
3D CT reconstruction confirming prosthetic loosening and
periprosthetic bone resorption (arrow). (D) Coronal 3D CT with
segmented blue-colored prosthesis visualizing prosthetic loosening
(arrow). (E) Sagittal 3D CT with segmented blue-colored prosthesis
demonstrating prosthetic migration (arrow). (F) Sagittal MRI
showing abnormal signal intensity in the distal femur and
periprosthetic soft tissue (arrow). (G) Axial MRI revealing
periprosthetic fluid collection and soft tissue edema (arrow). (H)
Single photon emission computed tomography bone scan revealing
abnormal radionuclide uptake in the left femoral stump (arrows), as
well as in T2, T5 and T7 vertebrae.

Figure 2

Design and fabrication of the
3D-printed customized femoral prosthesis. (A) 3D bone model
reconstructed from CT data. (B) Surgical planning: The distal femur
osteotomy was performed at 96 mm above the lateral condyle, with a
total osteotomy length of 143 mm. (C) Complete assembly design of
the modular prosthesis and 3D-printed implant with marked
dimensional parameters. (D) 3D design of the distal femoral
3D-printed prosthesis, showing the integrated structure matching
the residual femur. (E) Assembly diagram of the 3D-printed distal
femoral prosthesis and residual femur mold, demonstrating the
implant-bone fitting relationship. (F) The prosthesis-bone
interface adopts a porous trabecular structure to promote
osseointegration, with bilateral plates for distal fixation.

Figure 3

Postoperative imaging at day 3. (A)
X-rays showed satisfactory positioning of the 3D-printed distal
femoral prosthesis and modular tumor-type hemi-hip prosthesis. (B)
Coronal 3D CT reconstruction shows stable fixation of the
prosthesis to the residual femur. (C) Sagittal 3D CT reconstruction
confirms excellent apposition and stable fixation between the
implant and residual femur. (D) Coronal 3D CT with segmented
blue-colored prosthesis visualizes satisfactory prosthesis position
and stability. (E) Sagittal 3D CT with segmented blue-colored
prosthesis visualizes secure fixation of the implant.

Figure 4

Histopathological and
immunohistochemical findings. (A) Hematoxylin and eosin (H&E)
staining (original magnification, x40) shows heterotypic tumor cell
nests within fibrous stroma, consistent with metastatic poorly
differentiated carcinoma (arrow). (B) Hematoxylin and eosin
(H&E) staining (original magnification, x100) demonstrates
malignant heterotypic cells in fibrous tissue, confirming
metastatic poorly differentiated carcinoma (arrow). (C)
Immunohistochemical staining (original magnification, x40) shows
positive expression of squamous differentiation markers in tumor
cells, supporting squamous differentiation (arrow). (D)
Immunohistochemical staining (original magnification, x100)
confirms strong positive expression of squamous differentiation
markers in tumor cell nests (arrow).

Figure 5

Perioperative changes in infection
indicators. (A) WBC, (B) PCT, (C) ESR and (D) CRP peaked on
postoperative days 2-3 and gradually returned to normal levels
within 1 month after surgery. WBC, white blood cell; PCT,
procalcitonin; CRP, C-reactive protein; ESR, erythrocyte
sedimentation rate.

Figure 6

Postoperative imaging and functional
outcome after 1 year. (A) Coronal X-ray showing stable prosthesis
position without loosening or fracture. (B) Sagittal X-ray
demonstrating satisfactory prosthesis alignment and fixation. (C)
Clinical photograph of the patient walking independently without
assistive devices. (D) Clinical photograph showing well-healed
surgical wound at the operative site. (E) Coronal 3D CT
reconstruction revealing good prosthesis-residual femur interface
fitting, no bone resorption or prosthesis loosening. (F) Sagittal
3D CT reconstruction confirming satisfactory prosthesis position,
secure fixation and close contact with the residual femur. (G)
Coronal 3D CT with segmented blue-colored prosthesis visualizes
satisfactory prosthesis position and stability. (H) Sagittal 3D CT
with segmented blue-colored prosthesis visualizes secure fixation
of the implant.
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Copy and paste a formatted citation
Spandidos Publications style
Li J, Zhang Y, Kang J, Tian C, Chen S, Ning Y, Li H and Xiao Y: 3D‑Printed prosthesis for recurrent femoral metastasis with periprosthetic infection: A case report. Exp Ther Med 32: 189, 2026.
APA
Li, J., Zhang, Y., Kang, J., Tian, C., Chen, S., Ning, Y. ... Xiao, Y. (2026). 3D‑Printed prosthesis for recurrent femoral metastasis with periprosthetic infection: A case report. Experimental and Therapeutic Medicine, 32, 189. https://doi.org/10.3892/etm.2026.13185
MLA
Li, J., Zhang, Y., Kang, J., Tian, C., Chen, S., Ning, Y., Li, H., Xiao, Y."3D‑Printed prosthesis for recurrent femoral metastasis with periprosthetic infection: A case report". Experimental and Therapeutic Medicine 32.1 (2026): 189.
Chicago
Li, J., Zhang, Y., Kang, J., Tian, C., Chen, S., Ning, Y., Li, H., Xiao, Y."3D‑Printed prosthesis for recurrent femoral metastasis with periprosthetic infection: A case report". Experimental and Therapeutic Medicine 32, no. 1 (2026): 189. https://doi.org/10.3892/etm.2026.13185
Copy and paste a formatted citation
x
Spandidos Publications style
Li J, Zhang Y, Kang J, Tian C, Chen S, Ning Y, Li H and Xiao Y: 3D‑Printed prosthesis for recurrent femoral metastasis with periprosthetic infection: A case report. Exp Ther Med 32: 189, 2026.
APA
Li, J., Zhang, Y., Kang, J., Tian, C., Chen, S., Ning, Y. ... Xiao, Y. (2026). 3D‑Printed prosthesis for recurrent femoral metastasis with periprosthetic infection: A case report. Experimental and Therapeutic Medicine, 32, 189. https://doi.org/10.3892/etm.2026.13185
MLA
Li, J., Zhang, Y., Kang, J., Tian, C., Chen, S., Ning, Y., Li, H., Xiao, Y."3D‑Printed prosthesis for recurrent femoral metastasis with periprosthetic infection: A case report". Experimental and Therapeutic Medicine 32.1 (2026): 189.
Chicago
Li, J., Zhang, Y., Kang, J., Tian, C., Chen, S., Ning, Y., Li, H., Xiao, Y."3D‑Printed prosthesis for recurrent femoral metastasis with periprosthetic infection: A case report". Experimental and Therapeutic Medicine 32, no. 1 (2026): 189. https://doi.org/10.3892/etm.2026.13185
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