3D Printed Acetabular Cups for Total Hip Arthroplasty: A Review Article

Abstract

Three-dimensional (3D) printed titanium orthopaedic implants have recently revolutionized the treatment of massive bone defects in the pelvis, and we are on the verge of a change from conventional to 3D printed manufacture for the mass production of millions of off-the-shelf (non-personalized) implants. The process of 3D printing has many adjustable variables, which taken together with the possible variation in designs that can be printed, has created even more possible variables in the final product that must be understood if we are to predict the performance and safety of 3D printed implants. We critically reviewed the clinical use of 3D printing in orthopaedics, focusing on cementless acetabular components used in total hip arthroplasty. We defined the clinical and engineering rationale of 3D printed acetabular cups, summarized the key variables involved in the manufacturing process that influence the properties of the final parts, together with the main limitations of this technology, and created a classification according to end-use application to help explain the controversial and topical issues. Whilst early clinical outcomes related to 3D printed cups have been promising, in-depth robust investigations are needed, partly because regulatory approval systems have not fully adapted to the change in technology. Analysis of both pristine and retrieved cups, together with long-term clinical outcomes, will help the transition to 3D printing to be managed safely.

Combined Infection Control and Enhanced Osteogenic Differentiation Capacity on Additive Manufactured Ti‐6Al‐4V are Mediated via Titania Nanotube Delivery of Novel Biofilm Inhibitors

“…Clinicians and medical device industry have verified the successful application of AM for orthopedic implant fabrication in the fields such as maxillofacial reconstruction, [ 31,32 ] pelvic reconstruction, [ 33 ] and total joint arthroplasty. [ 34,35 ] In conjunction with further optimization in physicochemical properties including material composition, mechanical properties, and surface texture to enhance bony integration, as well as effective infection control, implant survival is expected to be largely improved. [ 1,8,28,36 ] Figure C represents the typical surface feature of a part manufactured by laser powder bed fusion system with a random distribution of micro‐spherical particles resulting from partial melting of raw Ti‐6Al‐4V spheres on the surface.…”

“…The noticeable advantages of AM for the fabrication of dental and orthopedic implants have attracted significant attention from researchers and surgeons. [ 32,33,35,80 ] However, some of the advantageous properties of AM implants, such as the increased surface area and ability to fabricate anatomic porous mesh architectures to promote osseointegration and bone‐implant fixation, can also be a double‐edged sword, offering risk for microorganism attachment as well. Additionally, unreachable internal rough surfaces of complex AM mesh architecture makes the implant cleaning and sterilization processes challenging.…”

Current Trends in Improving of Artificial Joints Design and Technologies for Their Arthroplasty

“…The methods of 3D printing of orthopedic products made of polymers by the Fused Deposition Modeling (FDM) method and metals using Direct Metal Laser Sintering (DMLS), developed in recent years, have opened up new possibilities for creating personalized implants (Wong and Scheinemann, 2018;Dall'Ava et al, 2019;Timercan et al, 2019), which, moreover, can be very effective from the point of view of drug delivery to the area of their implantation (Benmassaoud et al, 2019). Despite the fact that additive manufacturing techniques for implants are in the initial stage of development, it can be argued that in the future they will be a powerful means of creating structures with a porous structure, optimal not only in relation to mechanical properties, but also to biocompatibility, bioactivity, and, if necessary and biodegradability (Yuan et al, 2018).…”

Three-dimensional Printing Versus Conventional Machining in the Creation of a Meatal Urethral Dilator: a Cost and Mechanical Strength Analysis

“…3D printing in medicine has perhaps advanced the most in the field of orthopaedic surgery. 3D-printed acetabular cups demonstrate the strengths of 3D printing that we have discussed as they can be patient-specific but also they are highly porous to encourage bone ingrowth which conventional manufacturing cannot achieve (30), however the long term outcomes remain to be seen.…”