Bony ingrowth potential of 3D-printed porous titanium alloy: a direct comparison of interbody cage materials in an in vivo ovine lumbar fusion model

McGilvray, Kirk C.; Easley, Jeremiah T.; Seim, Howard B.; Regan, Daniel P.; Berven, Sigurd; Hsu, Wellington K.; Mroz, Thomas E.; Puttlitz, Christian M.

doi:10.1016/j.spinee.2018.02.018

Cited by 186 publications

(158 citation statements)

References 38 publications

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“…We observed that osteointegration with such small gaps was achieved at segments containing the mesh structure but not at those not containing the mesh structure. A few animal studies have previously focused on the osteointegration of a 3D-printed titanium implant [11,12,15,20,21,27], and three of these specifically focused on using vertebral cages for flat bones [12,15,20]. However, it is difficult to compare the results of these studies with those of the present study, which used the long tubular bone.…”

Section: Discussionmentioning

confidence: 89%

“…Because 3D printing is an additive manufacturing technique, the porosity and roughness of a surface can be appropriately adjusted using this technique. Previous studies have reported that a titanium alloy implant with appropriate porosity or roughness can enhance tissue integration [11,12,15,[17][18][19][20][21]. However, to our knowledge, this potential has not yet been evaluated in a clinical application in humans.…”

Section: Discussionmentioning

confidence: 96%

“…In orthopedic surgery, 3D printing is now widely performed to customize implants [6][7][8][9][10]. This novel additive manufacturing method facilitates the rapid and cost-effective fabrication of customized implants [3,[11][12][13][14][15][16]. Unlike the traditional metal casting method, 3D printing technology facilitates the production of implants with a constant internal pore.…”

Section: Introductionmentioning

confidence: 99%

“…Unlike the traditional metal casting method, 3D printing technology facilitates the production of implants with a constant internal pore. A few in vitro studies and in vivo animal experiments have demonstrated the potential of a titanium alloy implant with appropriate porosity to enhance the osseointegration of implants [11,12,15,[17][18][19][20][21]. Some studies have developed titanium alloy implants with a bioactive coating-however, animal and in vitro studies on these implants are still underway [22][23][24].…”

Section: Introductionmentioning

confidence: 99%

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Integration of a Three-Dimensional-Printed Titanium Implant in Human Tissues: Case Study

et al. 2020

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A titanium alloy implant of appropriate pore size can potentially enhance osseointegration and soft tissue integration. However, the human clinical application of such implants has not been reported. Here, we present a case of limb salvage surgery for a bone tumor using customized three-dimensional (3D)-printed Ti6Al4V radius and ulna implants. The patient presented with local recurrence at the proximal junction of the ulna and underwent a re-wide excision. Single forearm bone surgery was performed using another 3D-printed implant after resection of the recurrent tumor with an ulnar implant. Host osseointegration and soft tissue integration of the retrieved implant were quantified through histological evaluation. The total tissue integration rates of the implant at the proximal and distal bone junctions were 45.96% and 15.03%, respectively. The mesh structure enhanced bone integration by up to 10.81% in the proximal and by up to 8.91% in the distal bone junction. Furthermore, the soft tissue adhesion rates of the implant shaft were 59.50% and 50.26% in the axial and longitudinal cuts, respectively. No area was left unoccupied throughout the shaft of the implant. Overall, these results indicate that the 3D-printed Ti6Al4V titanium alloy implant with a rough surface has considerable tissue integration ability.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Integration of a Three-Dimensional-Printed Titanium Implant in Human Tissues: Case Study

et al. 2020

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“…Whilst an ideal pore structure has yet to be evidenced, in vivo research has demonstrated improved osseointegration of porous metallic implants compared to conventional materials. Multiple studies of porous Ti lumbar fusion cages in an ovine model have demonstrated significantly higher osseointegration than both conventional polymer, and titanium coated polymer alternatives [90,91]. Several manufacturers now utilise AM in the production of spinal fusion implants, as identified in Table 1, both in Ti and CoCr based alloys.…”

Section: Mesoscale Design For Osseointegrationmentioning

confidence: 99%

Clinical, industrial, and research perspectives on powder bed fusion additively manufactured metal implants

Lowther

Louth

Davey

et al. 2019

Additive Manufacturing

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A B S T R A C TFor over ten years, metallic skeletal endoprostheses have been produced in select cases by additive manufacturing (AM) and increasing awareness is driving demand for wider access to the technology. This review brings together key stakeholder perspectives on the translation of AM research; clinical application, ongoing research in the field of powder bed fusion, and the current regulatory framework. The current clinical use of AM is assessed, both on a mass-manufactured scale and bespoke application for patient specific implants. To illuminate the benefits to clinicians, a case study on the provision of custom cranioplasty is provided based on prosthetist testimony. Current progress in research is discussed, with immediate gains to be made through increased design freedom described at both meso-and macro-scale, as well as long-term goals in alloy development including bioactive materials. In all cases, focus is given to specific clinical challenges such as stress shielding and osseointegration. Outstanding challenges in industrialisation of AM are openly raised, with possible solutions assessed. Finally, overarching context is given with a review of the regulatory framework involved in translating AM implants, with particular emphasis placed on customisation within an orthopaedic remit. A viable future for AM of metal implants is presented, and it is suggested that continuing collaboration between all stakeholders will enable acceleration of the translation process. fection or surgical complications [11][12][13].Currently, the majority of skeletal endoprostheses are produced from titanium (Ti) or cobalt chromium (CoCr) based alloys, which meet the criteria of durability, strength, corrosion resistance and a low immune response [14,15]. These characteristics however come at the cost of the high stiffness of these alloys in comparison to bone. Mismatch between the mechanical properties of bone and orthopaedic materials

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Additive Manufacturing of Material Scaffolds for Bone Regeneration: Toward Application in the Clinics

Garot

Bettega

Picart

2020

Adv Funct Materials

138

105

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Additive manufacturing (AM) allows the fabrication of customized bone scaffolds in terms of shape, pore size, material type, and mechanical properties. Combined with the possibility to obtain a precise 3D image of the bone defects using computed tomography or magnetic resonance imaging, it is now possible to manufacture implants for patient‐specific bone regeneration. This paper reviews the state‐of‐the‐art of the different materials and AM techniques used for the fabrication of 3D‐printed scaffolds in the field of bone tissue engineering. Their advantages and drawbacks are highlighted. For materials, specific criteria, are extracted from a literature study: biomimetism to native bone, mechanical properties, biodegradability, ability to be imaged (implantation and follow‐up period), histological performances, and sterilization process. AM techniques can be classified in three major categories: extrusion‐based, powder‐based, and vat photopolymerization. Their price, ease of use, and space requirement are analyzed. Different combinations of materials/AM techniques appear to be the most relevant depending on the targeted clinical applications (implantation site, presence of mechanical constraints, temporary or permanent implant). Finally, some barriers impeding the translation to human clinics are identified, notably the sterilization process.

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Bony ingrowth potential of 3D-printed porous titanium alloy: a direct comparison of interbody cage materials in an in vivo ovine lumbar fusion model

Cited by 186 publications

References 38 publications

Integration of a Three-Dimensional-Printed Titanium Implant in Human Tissues: Case Study

Integration of a Three-Dimensional-Printed Titanium Implant in Human Tissues: Case Study

Clinical, industrial, and research perspectives on powder bed fusion additively manufactured metal implants

Additive Manufacturing of Material Scaffolds for Bone Regeneration: Toward Application in the Clinics

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