Fortifying the Bone-Implant Interface Part 2: An In Vivo Evaluation of 3D-Printed and TPS-Coated Triangular Implants

Curr Rev Musculoskelet Med

2019

Purpose of Review To summarize the recent advances in 3D printing technology as it relates to spine surgery and how it can be applied to minimally invasive spine surgery. Recent Findings Most early literature about 3D printing in spine surgery was focused on reconstructing biomodels based on patient imaging. These biomodels were used to simulate complex pathology preoperatively. The focus has shifted to guides, templates, and implants that can be used during surgery and are specific to patient anatomy. However, there continues to be a lack of long-term outcomes or cost-effectiveness analyses. 3D printing also has the potential to revolutionize tissue engineering applications in the search for the optimal scaffold material and structure to improve bone regeneration without the use of other grafting materials. Summary 3D printing has many potential applications to minimally invasive spine surgery requiring more data for widespread adoption.

Section: Implantsmentioning

confidence: 79%

Section: Implantsmentioning

confidence: 99%

Section: Tissue Engineeringmentioning

confidence: 99%

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Three-Dimensional Printing in Minimally Invasive Spine Surgery

Yamaguchi

Curr Rev Musculoskelet Med

2019

“…They found that AM implants displayed significantly more bony ingrowth into the device's core versus superficial ingrowth with the TPS coated implant. Authors suggest the increased porosity of AM implants more closely mimics native bone and may enhance the biomechanical stability in MIS SI joint fusion [ 32 ].…”

Section: Implantsmentioning

confidence: 99%

“…In addition to its uses to develop custom, patient-specific implants, 3DP technology is also being used to optimize the geometric properties of premade “Off-the-Shelf” (OTS) implants [ 37 ]. As described previously by McGilvray et al, the customizable porosity and stiffness of 3DP materials can more closely mimic native bone and facilitate bony ingrowth [ 30 – 32 ]. OTS products are created by premanufacturing implants with a wide variety of sizes and fits, thus reducing the additional time required for additional imaging studies and custom implant printing [ 37 ].…”

Section: Implantsmentioning

confidence: 99%

3D Printing Applications in Minimally Invasive Spine Surgery

Haleem

Minimally Invasive Surgery

2018

3D printing (3DP) technology continues to gain popularity among medical specialties as a useful tool to improve patient care. The field of spine surgery is one discipline that has utilized this; however, information regarding the use of 3DP in minimally invasive spine surgery (MISS) is limited. 3D printing is currently being utilized in spine surgery to create biomodels, hardware templates and guides, and implants. Minimally invasive spine surgeons have begun to adopt 3DP technology, specifically with the use of biomodeling to optimize preoperative planning. Factors limiting widespread adoption of 3DP include increased time, cost, and the limited range of diagnoses in which 3DP has thus far been utilized. 3DP technology has become a valuable tool utilized by spine surgeons, and there are limitless directions in which this technology can be applied to minimally invasive spine surgery.

A systematic review of preclinical in vivo testing of 3D printed porous Ti6Al4V for orthopedic applications, part I: Animal models and bone ingrowth outcome measures

et al. 2021

For Ti6Al4V orthopedic and spinal implants, osseointegration is often achieved using complex porous geometries created via additive manufacturing (AM). While AM porous titanium (pTi) has shown clinical success, concerns regarding metallic implants have spurred interest in alternative AM biomaterials for osseointegration. Insights regarding the evaluation of these new materials may be supported by better understanding the role of preclinical testing for AM pTi. We therefore asked: (a) What animal models have been most commonly used to evaluate AM porous Ti6Al4V for orthopedic bone ingrowth; (b) What were the primary reported quantitative outcome measures for these models; and (c) What were the bone ingrowth outcomes associated with the most frequently used models? We performed a systematic literature search and identified 58 articles meeting our inclusion criteria. We found that AM pTi was evaluated most often using rabbit and sheep femoral condyle defect (FCD) models. Additional ingrowth models including transcortical and segmental defects, spinal fusions, and calvarial defects were also used with various animals based on the study goals. Quantitative outcome measures determined via histomorphometry including ''bone ingrowth'' (range: 3.92–53.4% for rabbit/sheep FCD) and bone‐implant contact (range: 9.9–59.7% for rabbit/sheep FCD) were the most common. Studies also used 3D imaging to report outcomes such as bone volume fraction (BV/TV, range: 4.4–61.1% for rabbit/sheep FCD), and push‐out testing for outcomes such as maximum removal force (range: 46.6–3092 N for rabbit/sheep FCD). Though there were many commonalities among the study methods, we also found significant heterogeneity in the outcome terms and definitions. The considerable diversity in testing and reporting may no longer be necessary considering the reported success of AM pTi across all model types and the ample literature supporting the rabbit and sheep as suitable small and large animal models, respectively. Ultimately, more standardized animal models and reporting of bone ingrowth for porous AM materials will be useful for future studies.