SynthesisBone & joint research2026
Patient-specific implants for joint-sparing reconstruction of segmental tibial and femoral defects : systematic literature review and introduction of a classification framework.
Synthesis in Bone & joint research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
6 authors.
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Abstract
Aims: Segmental bone defects of the femur and tibia present a major challenge for reconstructive surgery, especially in joint-sparing oncological and post-traumatic cases. Patient-specific implants (PSIs), enabled by 3D imaging and additive manufacturing, offer tailored solutions. This review aimed to systematically evaluate clinical applications of PSIs for femoral and tibial shaft reconstruction in terms of mechanical survival rate, and introduce a classification framework to guide implant design and fixation, as well as communication. Methods: A systematic search of PubMed and Embase identified studies reporting joint-sparing reconstructions using PSIs for segmental femoral or tibial defects. Data were extracted on implant design, fixation method, material, biological augmentation, and clinical outcomes. A novel classification system was developed to categorize implants by defect location (unicortical, diaphyseal, meta-extended) and fixation type (screws, plates, nails, stems, hybrid). Kaplan-Meier survival analysis was used to assess five-year implant survival across subgroups. Results: A total of 53 studies involving 299 patients were included. Titanium was the predominant material, often featuring lattice structures to support bone ingrowth or grafting. Fixation methods varied, with hybrid fixation showing the highest five-year implant survival rate (97%), followed by stems (95%) and plate- or nail-only fixation (each 90%). Most implants remained failure-free at final follow-up; structural failure was the most common complication. The classification system enabled structured comparison across implant types. A notable concentration of studies (27/53) originated from China, suggesting regional leadership in PSI innovation, potentially linked to regulatory flexibility compared to the European Union. Conclusion: This review provides a structured overview of PSI design and fixation, and outcomes for joint-sparing femoral and tibial reconstruction. The proposed classification framework facilitates standardized reporting and interdisciplinary communication. Hybrid fixation methods demonstrated superior mechanical survival, supporting their use in future PSI designs.
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Registered trials
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