“2 in 1” surgery to replace both the pelvis and femur for a patient with bone cancer

Patient Le Dinh Thuan walks comfortably with crutches just 1 month after major surgery.

Miraculous recovery after “2 in 1” surgery

Exactly 1 month after the major surgery, Mr. Le Dinh Thuan (63 years old, Thanh Hoa ) is trying to recover his function to quickly return home to celebrate Tet with his family. Looking at him walking comfortably with crutches, even being able to go up and down stairs without assistance, few people know that he has just undergone the most complicated major surgery in the field of bone cancer, completely replacing the pelvis and part of the femur with artificial materials.

Nearly a year ago, after discovering a tumor in his lung, Mr. Thuan had surgery to remove the tumor. But after a while, he had hip pain again and discovered a bone tumor in an extremely dangerous location. Bone cancer in the hip joint is rare (less than 0.5%) compared to other cancers. In particular, the metastasis that invades the pelvis, joint capsule and upper femur, as in Mr. Thuan's case, is much rarer.

Patient Thuan (center) was discharged from the hospital in the joy of his family and the medical team treating him.

Because of the complicated pathology, many hospitals he had previously visited had recommended surgery to remove one side of the pelvis to save his life. This meant that the patient would be almost unable to fit a prosthetic leg, and the entire abdominal structure would be at risk of falling down, requiring covering with mesh. The mortality rate on the operating table could even be up to 25%. Therefore, Mr. Thuan and his family had repeatedly refused treatment with this option.

It was not until he visited Vinmec that Mr. Thuan began to have hope that one day he would be able to walk again. On December 22, 2023, he underwent a complicated 8-hour surgery with the participation and close coordination of Vinmec multidisciplinary doctors including vascular, digestive, urological and interventional surgeons and engineers from VinUni 3D Technology Center.

The surgery to replace two pelvis bones and a part of the femur at the same time was successful without any complications, especially losing only more than 2 liters of blood during the surgery. This is a record time because normally replacing only the pelvis bone takes up to 8 - 12 hours.

“ Now, I can actually walk again, Vinmec doctors can do very difficult things that very few hospitals in Vietnam can do, ” Mr. Thuan expressed when leaving the hospital. Before that, just 2 days after surgery, he was able to sit up by himself and after 10 days, he was able to practice moving skillfully on crutches. “The artificial replacement bone can support a body weight of 73 kg without any pain , ” Mr. Thuan shared. It is known that his total recovery time has been shortened to only ⅓ of the normal time.

Prof. Dr. Tran Trung Dung, Director of Vinmec Orthopedic Trauma Center, shares the treatment process with illustrative models used directly.

3D Titanium Artificial Bone Design – A New Step in Bone Cancer Treatment in Vietnam

For this special case, doctors at Vinmec Orthopedic & Sports Medicine Center (CTCH) had to "weigh their brains" to come up with the most appropriate and safest treatment plan. Prof. Dr. Tran Trung Dung, Director of the CTCH Center, said that the key point is that after surgery to remove the bone tumor, the pelvic and femoral bone defects must also be reconstructed to help the patient move and walk.

Therefore, the most difficult problem is to choose the type of material and how to graft artificial bone to recreate the shape and function of the bone in the area that bears the greatest force in the body. Through consultation and research, doctors and engineers have agreed to choose Titanium material to meet the requirements of load and durability.

However, difficulty is compounded, the world's medical literature has never recorded a case of simultaneous replacement of both the pelvis and the upper half of the femur to treat cancer, and no equipment company has an artificial pelvis solution available to replace this case . "If we order foreign research and manufacturing, it will take at least 2 months, while the patient needs surgery as soon as possible to prevent the tumor from progressing and invading. Because for cancer patients, time is gold, " shared Prof. Dr. Tran Trung Dung.

Master, Doctor, and Associate Professor Pham Trung Hieu shares about the latest advances in 3D technology in medicine applied to complex bone tumor cases.

Therefore, the only way is for the surgical team to design their own artificial bone implant for this patient. After more than 2 weeks of racing against time, continuously testing on nearly 100 samples with simulated situations, the engineers and doctors have chosen the most optimal design for the case. "We used a structure simulating the shape of the pelvic bone with a honeycomb hollow shape to make the entire artificial bone light . With the material made from biocompatible medical titanium alloy, after 3D printing and heating, it has the ability to withstand a load of more than 10 times that of real bone." , doctor Pham Trung Hieu, Deputy Director of 3D Technology Center shared.

Doctor Hieu also said that instead of having to use about 10-12 screws or make a splint to fix the remaining pelvic wing, the engineers only used a total of 5 screws, the screw position was hidden inside so the patient had absolutely no feeling of having material in the body, and could quickly recover motor function. This is the idea of ​​Vietnamese engineers and doctors, but no facility in the world has made this model.

After the inspection process in Vietnam, the pelvic bone design was sent to Germany for production using a 3D printing system in accordance with the European CE medical implant standards. Notably, the production and import of product samples from abroad only took 1 week, much less than the minimum 2 months if the order was made from start to finish.

With the cooperation of experts from 3D printing powerhouses such as Germany, Belgium and Israel, doctors and engineers are continuing to research and perfect artificial bone implants from materials such as Titan and Peek. It is expected that in the next 1-2 years, these products will be licensed for manufacturing and commercial production so that they can be widely used and save time and costs for patients.

It can be said that the success of this “2 in 1” surgery has brought bone cancer treatment in Vietnam to a new page. Thereby affirming the expertise and solid, precise treatment strategy of the team of Vietnamese doctors and engineers, as well as the efforts and creativity in applying technology, finding new treatment options and directions for bone cancer patients.

PV