Carbon fibre/polyether ether ketone (CF/PEEK) implants in orthopaedic oncology

Background: Radiation therapy is an important therapeutic element in musculoskeletal tumours, especially when encountering multiple or painful lesions. In osteolytic lesions, a surgical stabilization with implants is often required. However, metallic implants not only complicate the CT-based planning of a subsequent radiation therapy, but also have an uncontrollable dose-modulating effect in adjuvant radiotherapy. In addition, follow-up imaging and the diagnosis of local recurrences are often obscured by metallic artefacts. Radiolucent implants consisting of carbon/polyether ether ketone (CF/PEEK) therefore facilitate adjuvant radiation therapy and follow-up imaging of bone lesions. We hereby present clinical cases with application of CF/PEEK implants in orthopaedic tumour surgery. Methods: We report a single-centre experience of three selected patients with surgical stabilization of osteolytic bone lesions using CF/PEEK implants. Detailed information about the clinical presentation, preoperative considerations, surgical procedures and postoperative results is provided for each case. Results: One spinal lesion (T12 vertebral body), one lesion of the upper extremity (humerus) and one of the lower extremities (tibia) were surgically stabilized with use of CF/PEEK implants. With a mean follow-up of 12 months (range 6-25 months), no adverse events were observed. Two patients received adjuvant radiotherapy. Follow-up imaging was obtained in all patients. Conclusion: The applicability of CF/PEEK implants in orthopaedic tumour surgery is good with respect to postoperative follow-up imaging, application of adjuvant radiotherapy and intraoperative handling. As a result of the unique material properties, oncological patients might particularly benefit from CF/PEEK implants. Keywords: Bone metastases; CF/PEEK; Imaging; Orthopaedic oncology; Polyether ether ketone; Radiation therapy