As a consultant orthopaedic oncology surgeon, Dr Eyrique Goh Boay Heong sees all kinds of bone and soft tissue tumours in the musculoskeletal system.
His subspeciality addresses both benign (non-cancerous) and malignant (cancerous) tumours, which often require complex surgical interventions to manage the abnormal growths and reconstruct affected areas.
Bone tumour resections and reconstructions are highly individualised, and the decision to amputate or save the limb depends on several factors.
These include the level of infection, nerve and/or blood vessel damage, soft tissue availability and oncological margins, among others.
“In most cases of malignant tumours, we can’t preserve the bone, so we end up taking out parts of the bone or the entire bone.
“And whenever we take something out, there are two options.
“One is amputation, and the other is where you plug the whole space non-anatomically with bone cement to hold the limb in place, but it doesn’t emulate the original bone,” he says.
This is where 3D bone printing has emerged as a transformative technology in modern surgery.
By converting CT (computed tomography) or MRI (magnetic resonance imaging) data into physical anatomical models, surgeons can improve surgical planning, simulation and precision.
Replacing diseased bone
Neurosurgeons are already using custom cranial implants made with 3D printing to replace parts of the skull damaged by trauma or disease.
Instead of a one-size-fits-all plate, a patient can get a tailored implant that fits like the last piece of a puzzle.
ALSO READ: Regrowing the skull bone with 3D printing technology
Maxillofacial surgeons are also using this technology for jaw reconstructions and trauma repair.
In 2024, Dr Goh was one of surgeons who successfully performed Malaysia’s first 3D-printed, moulded calcaneum (heel bone) replacement surgery on a patient with a rare, but aggressive, tumour.
Carried out at the Queen Elizabeth Hospital in Kota Kinabalu using a donated 3D printer, the team noted that this method offered “a very efficient and economical option” for patients, in view of the financial constraints faced by government hospitals in providing replacement implants.
A few weeks later, the 30-year-old patient was climbing Mount Kinabalu!
Spurred by the results and intrigued with the technology, Dr Goh, who was transferred to Hospital Kuala Lumpur (HKL) last year (2025), has since gone on to complete fellowships in Spain and Japan to further his knowledge in the area.
Today, he is saving more limbs that would otherwise be amputated.
What’s more impressive is that he prints these moulds from his little laboratory in a back room at his home in Petaling Jaya, Selangor, in his own time, using his own funds.
He considers it his way of serving humanity.
How it works
Although 3D tissue printing in the medical field has been around for a while, it’s a very untapped market because the learning curve is very steep.
“It’s a niche area and you have to be extremely interested, spend time making error after error ... I destroyed a lot of PLA (polylactic acid) before the mould finally came out right.
“We know our government is poor and they’re not going to invest in a medical 3D printer – only some university hospitals have it as they’re using it for research,” shares Dr Goh.
The basic printers cost RM4,000 and above, depending on whether they are medical-grade or commercial ones, and what material they can print.
Each filament roll – which is the material used to create the mould – costs RM50-RM100, depending on the brand, type and blend.
PLA is one of the types of material used as a filament roll.
In some countries, the technology has advanced to the point where researchers have developed methods to 3D-print both ceramic and metal implants that closely mimic natural bone.
Dr Goh explains: “To 3D-print, basically, you have to think of an idea and create a model using different software on the computer, then slice the model, i.e. put in different layers, to come up with the final version.
“Then you go to the software that is connected to the 3D printer and it will extrude your material.
“When I first started, it took me more than two hours to come up with a model whilst my Spanish mentor was doing it within 10 minutes!
“After many practice sessions, now I can do it in 10 minutes.”
Here’s how the 3D printing and bone replacement process works.
Dr Goh puts the PLA into the printer to create the mould, which can take anywhere from one to four hours, depending on the size, orientation and additional support needed.
On surgery day, the mould is taken to HKL for sterilisation before antibiotic bone cement is poured in to prevent bone and joint infections.
Within four minutes, the cement will start to thicken and this is when the mould is clasped together.
The mould has to be held in place for 12 to 14 minutes to allow the cement to harden sufficiently.
As it hardens, the cement releases heat and softens the heat-sensitive PLA mould, which is then easily peeled off.
Surgery can then begin.
The cement piece is implanted into the patient, replacing the removed bone, and the surrounding soft tissues are reconstructed.
Options for patients
As the national referral centre for orthopaedic oncology, HKL has the highest number of bone tumour cases in the country.
ALSO READ: Getting to know the bone tumour surgeon
This alternative surgery, which is a bailout option for limb salvage, definitely takes a longer time than an amputation.
“When a situation arises and it doesn’t work, modifications may be necessary and you have to think of plans B, C and D.
“Amputation is the last resort, but we would have already discussed with the patient all the risks before surgery.
“I’m very happy that I have the chance to do this at HKL because a lot of older surgeons are very reluctant to try things they are not familiar with.
“So far, I’ve done six cases – mostly replacements for the calcaneum and proximal femur bones – with good outcomes,” says Dr Goh, who gave keynote presentations on this method in Nepal and Portugal earlier this year (2025).
He’s still researching and refining options to replace other bones like the proximal radius, metatarsals, metacarpals and proximal humerus.
For patients whose cancer has metastasised to the bone and have difficulty walking, this is offered as a palliative surgery.
He says: “That means we do the surgery for symptomatic control, not to cure.
“Once you have metastasis, your cancer cells are already in the system, so even if you cure that, it is going to flood elsewhere, but we still want to give them a better quality of life.
“They can’t be living with pain, unable to walk, so for comfort, we will get their consent and proceed with the surgery.”
Further experiments
Dr Goh is also experimenting with creating 3D-printed casts (mesh scaffolds/braces) to replace the typical plaster of Paris used to hold fractures in place while they heal.
“I do a lot of surgeries for wrist fractures, and instead of using a plaster of Paris cast, which is functional, but heavy and not aesthetically pleasing, I’m working on giving them another option.
“I 3D-scan the patient’s hand, enlarge it a bit, cut off the finger portions, choose a colour and print the mould, after which I add the straps/latch.
“This is not going inside the patient, so once it’s printed, it goes directly to the patient,” he says.
Because it is made of plastic, it’s light, breathable, can get wet and is more comfortable.
The materials are also easily available online.
Dr Goh shares: “A lot of things that we do in government hospitals are modifications as we don’t have the funds.
“With bone cancer patients who end up with fractures, most of the time they are not so well off and surgery is not always recommended, so we have to think of another way to get their fractures fixed.”
Also in the works is a 3D-printed, motorised hand, something Dr Goh is hoping to produce in collaboration with engineers from a public university.
“I’m trying to expand the service from the back room in my home!
“Let’s see where it’ll go from here,” he says, laughing.
