Emerging Technologies in Arthroplasty: Additive Manufacturing

Abstract

Additive manufacturing is an industrial technology whereby three-dimensional visual computer models are fabricated into physical components by selectively curing, depositing, or consolidating various materials in consecutive layers. Although initially developed for production of simulated models, the technology has undergone vast improvements and is currently increasingly being used for the production of end-use components in various aerospace, automotive, and biomedical specialties. The ability of this technology to be used for the manufacture of solid-mesh-foam monolithic and coated components of complex geometries previously considered unmanufacturable has attracted the attention of implant manufacturers, bioengineers, and orthopedic surgeons. Currently, there is a paucity of reports describing this fabrication method in the orthopedic literature. Therefore, we aimed to briefly describe this technology, some of the applications in other orthopedic subspecialties, its present use in hip and knee arthroplasty, and concerns with the present form of the technology. As there are few reports of clinical trials presently available, the true benefits of this technology can only be realized when studies evaluating the clinical and radiographic outcomes of cementless implants manufactured with additive manufacturing report durable fixation, less stress shielding, and better implant survivorship. Nevertheless, the authors believe that this technology holds great promise and may potentially change the conventional methods of casting, machining, and tooling for implant manufacturing in the future.

Three-dimensional Physical Modeling: Applications and Experience at Mayo Clinic

“…Incorporation of 3D modeling is becoming an essential element in orthopedic trauma surgery (47,48). Beyond orthopedic trauma, 3D modeling has been used in planning resection of scapular and pelvic tumors, in pediatric orthopedic disorders, and in fabrication of custom arthroplasty components (49)(50)(51).…”

Characterization of dimensional, morphological and morphometric features of retrieved 3D-printed acetabular cups for hip arthroplasty

“…The majority of these implants were manufactured using conventional methods such as computer numerical controlled (CNC) machining of wrought bars. However, additive manufacturing (AM) technologies, also known as three-dimensional (3D) printing, are rapidly increasing in orthopaedics, particularly in producing off-the-shelf cementless porous acetabular components for total hip arthroplasty (THA) [2][3][4][5]. According to the United Kingdom (UK) National Joint Registry (NJR) [1,6], approximately 11% and 13% of all uncemented cups for revision procedures performed in 2017 and 2018, respectively, were 3D-printed.…”

“…3D-printing enables the manufacture of complex porous structures and features that may provide enhanced fixation stability, compared to conventionally manufactured porous geometries [3]. Specifically designed pore shapes can be produced using 3D-printing, unlike traditional technologies where there is a limited control over the porous structure layout [7].The clinical rationale behind the use of 3D-printing for customized (patientmatched) implants was to overcome the limitations of conventional custom components, which could not address complex cases where the bone stock was very limited.…”

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

“…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 variables in the final product that must be understood if we are to predict the safety and performance of 3D printed implants [4][5][6][7]. The regulatory approval systems have not yet completely caught up with the change in technology [8]; surgeons prefer to use implants that have been followed up for several years and have been highly rated by systems such as the Orthopaedic Data Evaluation Panel (ODEP, UK) [9].…”