Additive manufacturing in orthopaedics: Clinical implications

Abstract

Background: The reconstruction of complex pelvic trauma or developmental bone abnormalities is challenging as it involves in-depth understanding of a complex three-dimensional structure. Advances in medical imaging and rapid prototyping allow for detailed pre-operative planning and manufacture of planning models, custom jigs and prostheses to make this type of surgery manageable with good results. Methods:We report the reconstruction of a hip and proximal femur using planning models, jigs and custom prostheses produced by rapid prototyping methods. These tools helped to solve a complex problem and produced a good functional result for the patient. Results:In this case report the patient underwent the reconstruction of her right hip joint. She was unable to mobilise well independently prior to the surgery. The surgery provided her with a stable and functional hip joint. This allows her to mobilise independently with an external prosthesis. One year down the line she has a Fair MSTS score (14 of 30). Conclusion:Advances in medical imagining and rapid prototyping have produced planning and operative tools with which surgeons are able to solve complex problems safely and with good result. This technology has widespread use not only in orthopaedics but other surgical disciplines, and with increasing availability and improved cost effectiveness will be used more frequently in the future. Level of evidence: Level V (case report)

Active Materials for 3D Printing in Small Animals: Current Modalities and Future Directions for Orthopedic Applications

“…Three-dimensional printing refers to the process of creating physical objects from digital models [14,15]. A virtual 3D design file is created by computer-aided design (CAD) software using a 3D modeling program, a 3D scanner, or medical scanning techniques.…”

“…The receivers' post-operative prognosis, recovery, and implant-related failures will also be expected to improve [12]. Three-dimensional printing is a valuable technique in human medicine for guiding bone tumor resection and designing custom-made implants for bone reconstruction in tumor surgeries [14,15,61]. In veterinary, a personalized AM titanium implant was used in four large-breed dogs with appendicular OSA.…”

Reporting fidelity in the literature for computer aided design and additive manufacture of implants and guides

“…• Report results openly, both negative and positive, to ensure that mistakes are not repeated Open porous scaffold with rectangular strut: width 400 µm and height 800 µm Bone formation Triangular, hexagonal and rectangular pore shapes; 500 and 1000 µm pore size; strut size 200 µm; stiffness from 0.45 to 11 GPa Small pores -initial cell attachment; large non-circular pores -avoid pore occlusion *not strictly an AM porosity, but an AM feature that creates a non-solid area to improve implant stability. 1 2 Ti-6Al-4V 8, 11, 14, 15, 22, 27, 36, 40, 42-44, 48, 49, 55, 57, 58, 67, 70 Ti-6Al-4V ELI 10,19,20,25,35,37,39,52 Co-28Cr-6Mo…”

“…Lack of reporting on economics has similarly been reported by Fera et al for AM in the industrial field [122]. Hilton et al claimed that 'low cost' was an aim of their study, however they neglected to report costs in their work [20]. Further, contradictory statements such as "complicated fabrication with no cost increase" [27], yet the process being an "expensive procedure" [23] was reported, with little evidence to support claims.…”

“…Case study [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] Clinical animal study 2 27,28 Applied non-clinical 10 [29][30][31][32][33][34][35][36][37][38] Animal study 14 [39][40][41][42][43][44][45][46][47][48][49][50][51][52] Fundamental science 19 53…”