3D-Printed Bone Implant Gets Simrit Back on Her Feet for College Graduation

The tumor in Simrit’s foot wasn’t cancerous. But it was definitely causing a lot of worry.

The trouble started when Simrit was 15. “Sometimes my right foot would swell up after a soccer game or cross-country practice,” says Simrit, now 23. “For a while, I just iced it. It didn’t seem like that big of a deal.”

Her pediatrician thought otherwise and ordered X-rays, which showed a tumor on her right first metatarsal — the long bone that connects the big toe to the foot. Simrit had surgery to remove the tumor, and her biopsy results confirmed she had a condition called giant cell tumor of bone. This rare disease is known for coming back and can even spread from the bones to the lungs. Later scans showed Simrit had developed small tumors in her lungs.

Simrit’s pediatric care team recommended she start taking a targeted drug to help keep the disease under control. The hope was that within a year or two, the tumors would stop growing or even go away. She did well on the drug for about three years, and her care team discontinued it, anticipating she might not need it anymore.

Unfortunately, the foot tumor began growing fast. “My foot started to hurt a lot — sometimes just a nagging pain, but sometimes I could barely walk,” Simrit says. “I started taking the medicine again, but by then my tumor was really big. On my right foot, I could only wear a larger, wider-width tennis shoe.”

By now, Simrit was a junior in college and ready to transition to adult-care providers. She made an appointment with Shervin Oskouei, MD, an orthopaedic surgeon at Emory Healthcare who specializes in bone tumors. Dr. Oskouei was concerned by what he saw on Simrit’s imaging scans.

“The tumor had destroyed the metatarsal — there was almost no bone left,” Dr. Oskouei says. “We had two options. We could amputate part or all of her foot. Or we could remove the tumor and remaining bone and replace the metatarsal with a titanium implant.”

Amputation was a last resort. To explore the implant option, Dr. Oskouei turned to a colleague just down the hall at Emory Orthopaedics & Spine Center, Rishin Kadakia, MD.

Dr. Kadakia is a foot and ankle surgeon with extensive experience in advanced reconstruction. “I frequently use titanium implants to stabilize bone or replace joints,” Dr. Kadakia says. “Most of those are off-the-shelf devices that work well in most situations. But Simrit needed a completely new metatarsal.”

With no off-the-shelf implant available, Dr. Kadakia would need to work with a manufacturer to design and 3D-print a new metatarsal. It was a somewhat experimental approach. “I’ve only read about one or two other cases in the country,” he explains.

He met with Simrit and her parents to review the risks and benefits. The main concern was whether the implant would fit precisely. If it didn’t, Dr. Oskouei would still remove the tumor, but instead of an implant, Dr. Kadakia would graft bone from her leg — a procedure that carries risks if the transplanted bone fails to heal properly.

Simrit felt good about the 3D-print option.

“I am an active person. I love to walk in nature and go to exercise classes,” she says. “Amputation meant the tumor would be gone, but I wouldn’t be able to walk normally. I understood the risks of a custom implant, but it felt like the best route. I decided to just go for it.”

With Simrit’s decision made, Dr. Kadakia began to plan for surgery. “Patients like Simrit have already gone through so much, whether it’s trauma or disease,” he says. “It’s rewarding to collaborate with colleagues and engineers to design an innovative solution for them.”

To make the implant, Dr. Kadakia shared computed tomography (CT) images of Simrit’s healthy foot with engineers at a custom implant manufacturer. Using the CT images and other measurements, the engineers designed an implant to replace her damaged bone. After reviewing and approving the final design, Dr. Kadakia gave the go-ahead to 3D-print the titanium implant.

In the operating room, Dr. Oskouei would remove the tumor and the entire diseased metatarsal while preserving the big toe joint. Dr. Kadakia would then attach the custom implant to that joint and the foot bone behind it, restoring both structure and function.

A perfect fit

Dr. Oskouei and Dr. Kadakia prepared Simrit for a long recovery, emphasizing that she would need weeks of rest for proper healing. She planned to take the fall semester off from college to focus on getting better.

The surgery was a success. When Simrit woke up, she was thrilled to learn that the implant was a perfect fit. Next came extended bed rest, followed by physical therapy a few months later.

 “I slept a lot for the first few weeks, and as I started to feel more like myself, I passed the time doing puzzles and building LEGO sets,” Simrit says. “When I returned to campus for my last semester, I wore a boot and used crutches. I mostly just went to class, but my friends included me in things, and my parents brought food from home, which always cheered me up.”

Simrit saw Dr. Kadakia often for follow-up care. By March, she was out of the boot, and a few weeks later, she set aside her crutches. As graduation approached, Simrit could walk normally. “That’s when I realized I might be able to wear heels to my graduation,” she says. “I hadn’t worn pretty shoes in so long — I was sort of stuck with sensible styles. I tried on a pair, and they felt good! I wore them for the ceremony and for photos. It was great.”

Today, Simrit can do everything she enjoys, including high-intensity interval training classes. So far, there’s no sign of tumors in her foot. She continues to see Dr. Kadakia and William Read, MD, a medical oncologist at Winship Cancer Institute of Emory University who monitors her lungs for tumor growth related to giant cell tumor of bone.

“I missed out on a lot of activities in high school and college because of my foot, and I had a lot more doctor’s appointments than most teens,” she says. “I feel so lucky the surgery worked so well. I can walk and exercise without pain, and I don’t take any of it for granted.”

For her surgeons, it’s rewarding to know Simrit is enjoying her life again. “The day I met Simrit, I had a feeling she was going to do well,” Dr. Oskouei says. “It’s special to work at an institution like Emory Healthcare that supports surgeons who go the extra mile to find unique solutions for our patients.”