1
|
Lodoso-Torrecilla I, Konka J, Kreuzer M, Jimenez-Pique E, Espanol M, Ginebra MP. Quality assessment of regenerated bone in intraosseous and intramuscular scaffolds by spectroscopy and nanoindentation. BIOMATERIALS ADVANCES 2024; 164:213982. [PMID: 39098081 DOI: 10.1016/j.bioadv.2024.213982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 07/12/2024] [Accepted: 07/31/2024] [Indexed: 08/06/2024]
Abstract
The efficiency of synthetic bone grafts can be evaluated either in osseous sites, to analyze osteoconduction or ectopically, in intramuscular or subcutaneous sites, to assess osteoinduction. Bone regeneration is usually evaluated in terms of the presence and quantity of newly formed bone, but little information is normally provided on the quality of this bone. Here, we propose a novel approach to evaluate bone quality by the combined use of spectroscopy techniques and nanoindentation. Calcium phosphate scaffolds with different architectures, either foamed or 3D-printed, that were implanted in osseous or intramuscular defects in Beagle dogs for 6 or 12 weeks were analyzed. ATR-FTIR and Raman spectroscopy were performed, and mineral-to-matrix ratio, crystallinity, and mineral and collagen maturity were calculated and mapped for the newly regenerated bone and the mature cortical bone from the same specimen. For all the parameters studied, the newly-formed bone showed lower values than the mature host bone. Hardness and elastic modulus were determined by nanoindentation and, in line with what was observed by spectroscopy, lower values were observed in the regenerated bone than in the cortical bone. While, as expected, all techniques pointed to an increase in the maturity of the newly-formed bone between 6 and 12 weeks, the bone found in the intramuscular samples after 12 weeks presented lower mineralization than the intraosseous counterparts. Moreover, scaffold architecture also played a role in bone maturity, with the foamed scaffolds showing higher mineralization and crystallinity than the 3D-printed scaffolds after 12 weeks.
Collapse
Affiliation(s)
- Irene Lodoso-Torrecilla
- Department of Materials Science and Engineering, Group of Biomaterials, Biomechanics and Tissue Engineering, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain; Barcelona Research Centre in Multiscale Science and Engineering, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Joanna Konka
- Department of Materials Science and Engineering, Group of Biomaterials, Biomechanics and Tissue Engineering, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain; Barcelona Research Centre in Multiscale Science and Engineering, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Martin Kreuzer
- CELLS-ALBA, Carrer de la Llum 2-26, 08290, Cerdanyola del Valles, Barcelona, Spain
| | - Emilio Jimenez-Pique
- Barcelona Research Centre in Multiscale Science and Engineering, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain; Department of Materials Science and Engineering, CIEFMA Group, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Montserrat Espanol
- Department of Materials Science and Engineering, Group of Biomaterials, Biomechanics and Tissue Engineering, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain; Barcelona Research Centre in Multiscale Science and Engineering, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain; Centro de Investigación Biomédica en Red-Bioingeniería, Biomedicina y Nanomedicina (CIBER-BBN), Spain
| | - Maria-Pau Ginebra
- Department of Materials Science and Engineering, Group of Biomaterials, Biomechanics and Tissue Engineering, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain; Barcelona Research Centre in Multiscale Science and Engineering, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain; Centro de Investigación Biomédica en Red-Bioingeniería, Biomedicina y Nanomedicina (CIBER-BBN), Spain; Institute for Bioengineering of Catalonia (IBEC), Barcelona Institute of Science and Technology, Carrer Baldiri Reixac 10-12, 08028 Barcelona, Spain.
| |
Collapse
|
2
|
Xu H, Ke W, Zhang D, Miao J, Wang B, Yang C. Biomechanical Effects of Different Prosthesis Types and Fixation Ranges in Multisegmental Total En Bloc Spondylectomy: A Finite Element Study. Orthop Surg 2024; 16:2488-2498. [PMID: 39101231 PMCID: PMC11456706 DOI: 10.1111/os.14171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/29/2024] [Accepted: 07/02/2024] [Indexed: 08/06/2024] Open
Abstract
OBJECTIVE Multi-segmental total en bloc spondylectomy (TES) gradually became more commonly used by clinicians. However, the choice of surgical strategy is unclear. This study aims to investigate the biomechanical performance of different prosthesis types and fixation ranges in multisegmental TES. METHODS In this study, a validated finite element model of T12-L2 post-spondylectomy operations were carried out. The prostheses of these models used either 3D-printed artificial vertebrae or titanium mesh cages. The fixed range was two or three segment levels. Range of motion, stress distribution of the endplate and internal fixation system, intervertebral disc pressure, and facet joint surface force of four postoperative models and intact model in flexion and extension, as well as lateral bending and rotation were analyzed and compared. RESULTS The type of prosthesis used in the anterior column reconstruction mainly affected the stress of the adjacent endplate and the prosthesis itself. The posterior fixation range had a greater influence on the overall range of motion (ROM), the ROM of the adjacent segment, the stress of the screw-rod system, and adjacent facet joint surface force. For the model of the same prosthesis, the increase of fixed length resulted in an obvious reduction of ROM. The maximal decrease was 70.23% during extension, and the minimal decrease was 30.19% during rotation. CONCLUSION In three-segment TES, the surgical strategy of using 3D-printed artificial prosthesis for anterior column support and pedicle screws for posterior fixation at both two upper and lower levels respectively can reduce the stress on internal fixation system, endplates, and adjacent intervertebral discs, resulting in a reduced risk of internal fixation failure, and ASD development.
Collapse
Affiliation(s)
- Hanpeng Xu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wencan Ke
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dongzhe Zhang
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Jun Miao
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Bingjin Wang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cao Yang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
3
|
Micheletti C, Shah FA. Bone hierarchical organization through the lens of materials science: Present opportunities and future challenges. Bone Rep 2024; 22:101783. [PMID: 39100913 PMCID: PMC11295937 DOI: 10.1016/j.bonr.2024.101783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 06/20/2024] [Accepted: 06/22/2024] [Indexed: 08/06/2024] Open
Abstract
Multiscale characterization is essential to better understand the hierarchical architecture of bone and an array of analytical methods contributes to exploring the various structural and compositional aspects. Incorporating X-ray tomography, X-ray scattering, vibrational spectroscopy, and atom probe tomography alongside electron microscopy provides a comprehensive approach, offering insights into the diverse levels of organization within bone. X-ray scattering techniques reveal information about collagen-mineral spatial relationships, while X-ray tomography captures 3D structural details, especially at the microscale. Electron microscopy, such as scanning and transmission electron microscopy, extends resolution to the nanoscale, showcasing intricate features such as collagen fibril organization. Additionally, atom probe tomography achieves sub-nanoscale resolution and high chemical sensitivity, enabling detailed examination of bone composition. Despite various technical challenges, a correlative approach allows for a comprehensive understanding of bone material properties. Real-time investigations through in situ and in operando approaches shed light on the dynamic processes in bone. Recently developed techniques such as liquid, in situ transmission electron microscopy provide insights into calcium phosphate formation and collagen mineralization. Mechanical models developed in the effort to link structure, composition, and function currently remain oversimplified but can be improved. In conclusion, correlative analytical platforms provide a holistic perspective of bone extracellular matrix and are essential for unraveling the intricate interplay between structure and composition within bone.
Collapse
Affiliation(s)
- Chiara Micheletti
- Department of Biomaterials, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Furqan A. Shah
- Department of Biomaterials, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
4
|
Iqbal J, Zafar Z, Skandalakis G, Kuruba V, Madan S, Kazim SF, A Bowers C. Recent advances of 3D-printing in spine surgery. Surg Neurol Int 2024; 15:297. [PMID: 39246777 PMCID: PMC11380890 DOI: 10.25259/sni_460_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 07/27/2024] [Indexed: 09/10/2024] Open
Abstract
Background The emerging use of three-dimensional printing (3DP) offers improved surgical planning and personalized care. The use of 3DP technology in spinal surgery has several common applications, including models for preoperative planning, biomodels, surgical guides, implants, and teaching tools. Methods A literature review was conducted to examine the current use of 3DP technology in spinal surgery and identify the challenges and limitations associated with its adoption. Results The review reveals that while 3DP technology offers the benefits of enhanced stability, improved surgical outcomes, and the feasibility of patient-specific solutions in spinal surgeries, several challenges remain significant impediments to widespread adoption. The obvious expected limitation is the high cost associated with implementing and maintaining a 3DP facility and creating customized patient-specific implants. Technological limitations, including the variability between medical imaging and en vivo surgical anatomy, along with the reproduction of intricate high-fidelity anatomical detail, pose additional challenges. Finally, the lack of comprehensive clinical monitoring, inadequate sample sizes, and high-quality scientific evidence all limit our understanding of the full scope of 3DP's utility in spinal surgery and preclude widespread adoption and implementation. Conclusion Despite the obvious challenges and limitations, ongoing research and development efforts are expected to address these issues, improving the accessibility and efficacy of 3DP technology in spinal surgeries. With further advancements, 3DP technology has the potential to revolutionize spinal surgery by providing personalized implants and precise surgical planning, ultimately improving patient outcomes and surgical efficiency.
Collapse
Affiliation(s)
- Javed Iqbal
- Department of Neurosurgery, King Edward Medical University, Lahore, Pakistan
| | - Zaitoon Zafar
- Department of Biotechnology, University of San Francisco, San Francisco, California, United States
| | - Georgios Skandalakis
- Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, United States
| | | | - Shreya Madan
- Department of Neurosurgery, Desert Mountain High School, Scottsdale, Arizona, United States
| | - Syed Faraz Kazim
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, New Mexico, United States
| | - Christian A Bowers
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, New Mexico, United States
| |
Collapse
|
5
|
Chu JH, Zhang Y, Jiang Y, Wu HF, Wang WY, Wang M, Zhang JH, Yan K, Yao XM. Research trends of bone tumor treatment with 3D printing technology from 2013 to 2022: a bibliometric analysis. Discov Oncol 2024; 15:359. [PMID: 39160379 PMCID: PMC11333674 DOI: 10.1007/s12672-024-01207-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 07/30/2024] [Indexed: 08/21/2024] Open
Abstract
OBJECTIVE Bibliometrics was employed in this study to determine the research trends in the worldwide application of 3D printing technology to treat bone tumors over the previous 10 years. METHODS Published from 2013 to 2022, the papers related to bone tumors treated with 3D printing were located in Web of Science Core Collection (WoSCC), PubMed, and Scopus. The screened articles were included in this bibliometric study. From these papers in WoSCC, information on annual publications, journals, keywords, countries, authors, institutions, and cited references were extracted and visualized with CiteSpace (version 6.1.R6) software to investigate the state of bone tumor treatment using 3D printing as well as research hotspots. The Carrot2 online visualization tool and Vosviewer software (version 1.6.20) were employed to visualize the publications from PubMed and Scopus, respectively, in order to ascertain the most popular research topics from both databases. RESULTS A total of 606, 233, and 364 publications were obtained from WoSCC, PubMed, and Scopus, respectively, between the years 2013 and 2022. In WoSCC, the peak number of publications was found in 2021, with 145 publications published. Acta Biomaterialia (11 publications) and World Neurosurgery (10 publications) were the most prolific journals, and Biomaterials was the journal cited the most (244 times). Yong Zhou was the most productive author with 14 publications, while Kwok-Chuen Wong (69 citations) and William F Enneking, (69 citations) possessed the most citations. The country with the largest quantity of publications was China (207). Among all institutions, Shanghai Jiao Tong University produced the most publications (29). Rapid prototyping was the keyword with the strongest citation burst (4.73). 'Reconstruction', 'surgery', 'resection', and 'design' caught the significant attention of researchers. 3D-printed materials, pelvic reconstruction, mandibular reconstruction, computer-assisted surgical techniques, photothermal therapy, and in vitro experiments were recognized as hot subjects and trends in current research. The most frequently occurring topics in Scopus are not significantly different from those found in WoSCC. The most prevalent research areas in PubMed encompass implant, patient-specific, bioceramic, models, and pelvic.
Collapse
Affiliation(s)
- Jia-Hao Chu
- Third Clinical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yang Zhang
- Third Clinical College, Zhejiang Chinese Medical University, Hangzhou, China
- Zhejiang Chinese Medical University's Third Affiliated Hospital, Hangzhou, China
| | - Yi Jiang
- Third Clinical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Hai-Fan Wu
- Third Clinical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Wen-Yi Wang
- Third Clinical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Min Wang
- Third Clinical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jia-Hui Zhang
- Third Clinical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Kun Yan
- Zhejiang Chinese Medical University's Third Affiliated Hospital, Hangzhou, China
| | - Xin-Miao Yao
- Third Clinical College, Zhejiang Chinese Medical University, Hangzhou, China.
- Zhejiang Chinese Medical University's Third Affiliated Hospital, Hangzhou, China.
| |
Collapse
|
6
|
Vahidi M, Rizkalla AS, Mequanint K. Extracellular Matrix-Surrogate Advanced Functional Composite Biomaterials for Tissue Repair and Regeneration. Adv Healthc Mater 2024:e2401218. [PMID: 39036851 DOI: 10.1002/adhm.202401218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 06/13/2024] [Indexed: 07/23/2024]
Abstract
Native tissues, comprising multiple cell types and extracellular matrix components, are inherently composites. Mimicking the intricate structure, functionality, and dynamic properties of native composite tissues represents a significant frontier in biomaterials science and tissue engineering research. Biomimetic composite biomaterials combine the benefits of different components, such as polymers, ceramics, metals, and biomolecules, to create tissue-template materials that closely simulate the structure and functionality of native tissues. While the design of composite biomaterials and their in vitro testing are frequently reviewed, there is a considerable gap in whole animal studies that provides insight into the progress toward clinical translation. Herein, we provide an insightful critical review of advanced composite biomaterials applicable in several tissues. The incorporation of bioactive cues and signaling molecules into composite biomaterials to mimic the native microenvironment is discussed. Strategies for the spatiotemporal release of growth factors, cytokines, and extracellular matrix proteins are elucidated, highlighting their role in guiding cellular behavior, promoting tissue regeneration, and modulating immune responses. Advanced composite biomaterials design challenges, such as achieving optimal mechanical properties, improving long-term stability, and integrating multifunctionality into composite biomaterials and future directions, are discussed. We believe that this manuscript provides the reader with a timely perspective on composite biomaterials.
Collapse
Affiliation(s)
- Milad Vahidi
- Department of Chemical and Biochemical Engineering, The University of Western Ontario, London, N6A5B9, Canada
| | - Amin S Rizkalla
- Department of Chemical and Biochemical Engineering, The University of Western Ontario, London, N6A5B9, Canada
- School of Biomedical Engineering, The University of Western Ontario, London, N6A5B9, Canada
| | - Kibret Mequanint
- Department of Chemical and Biochemical Engineering, The University of Western Ontario, London, N6A5B9, Canada
- School of Biomedical Engineering, The University of Western Ontario, London, N6A5B9, Canada
| |
Collapse
|
7
|
Zhai WJ, Liu L, Gao YH, Qin SL, Han PF, Xu YF. Application of 3D‑printed porous titanium interbody fusion cage vs. polyether ether ketone interbody fusion cage in anterior cervical discectomy and fusion: A systematic review and meta‑analysis update. Exp Ther Med 2024; 28:290. [PMID: 38827472 PMCID: PMC11140292 DOI: 10.3892/etm.2024.12579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 04/18/2024] [Indexed: 06/04/2024] Open
Abstract
The present study aimed to compare the differences between 3D-printed porous titanium and polyether ether ketone (PEEK) interbody fusion cages for anterior cervical discectomy and fusion (ACDF). Literature on the application of 3D-printed porous titanium and PEEK interbody fusion cages for ACDF was searched in the PubMed, Web of Science, Embase, China National Knowledge Infrastructure, Wanfang and VIP databases. A total of 1,181 articles were retrieved and 12 were finally included. The Cochrane bias risk assessment criteria and Newcastle-Ottawa scale were used for quality evaluation and Review Manager 5.4 was used for data analysis. The 3D cage group was superior to the PEEK cage group in terms of operative time [mean difference (MD): -7.68; 95% confidence interval (CI): -11.08, -4.29; P<0.00001], intraoperative blood loss (MD: -6.17; 95%CI: -10.56, -1.78; P=0.006), hospitalization time (MD: -0.57; 95%CI: -0.86, -0.28: P=0.0001), postoperative complications [odds ratio (OR): 0.35; 95%CI: 0.15, 0.80; P=0.01], C2-7 Cobb angle (MD: 2.85; 95%CI: 1.45, 4.24; P<0.0001), intervertebral space height (MD: 1.20; 95%CI: 0.54, 1.87; P=0.0004), Japanese Orthopaedic Association Assessment of Treatment (MD: 0.69; 95%CI: 0.24, 1.15; P=0.003) and visual analogue scale score (MD: -0.43; 95%CI: -0.78, -0.07; P=0.02). The difference was statistically significant, while there was no significant difference between the two groups in terms of fusion rate (OR: 1.74; 95%CI: 0.71, 4.27; P=0.23). The use of 3D-printed porous titanium interbody fusion cage in ACDF has the advantages of short operation time, less bleeding loss, shorter hospitalization time and fewer postoperative complications. It can better maintain the cervical curvature and intervertebral height, relieve pain and accelerate postoperative functional recovery.
Collapse
Affiliation(s)
- Wan-Jing Zhai
- Graduate School, The First Clinical College of Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
- Department of Orthopedics, Changzhi Yunfeng Hospital, Changzhi, Shanxi 046000, P.R. China
| | - Lun Liu
- Graduate School, The First Clinical College of Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
| | - Yu-Hao Gao
- Graduate School, The First Clinical College of Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
- Department of Orthopedics, Changzhi Yunfeng Hospital, Changzhi, Shanxi 046000, P.R. China
| | - Shi-Lei Qin
- Department of Orthopedics, Changzhi Yunfeng Hospital, Changzhi, Shanxi 046000, P.R. China
- Department of Orthopedics, Changzhi Institution of Spinal Disease, Changzhi, Shanxi 046000, P.R. China
| | - Peng-Fei Han
- Department of Orthopedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
| | - Yun-Feng Xu
- Department of Orthopedics, Changzhi Yunfeng Hospital, Changzhi, Shanxi 046000, P.R. China
- Department of Orthopedics, Changzhi Institution of Spinal Disease, Changzhi, Shanxi 046000, P.R. China
| |
Collapse
|
8
|
Hu X, Lu M, Wang Y, Luo Y, Zhou Y, Yang X, Min L, Tu C. 3D-Printed custom-made hemipelvic endoprosthetic reconstruction following periacetabular tumor resection: utilizing a novel classification system. BMC Musculoskelet Disord 2024; 25:384. [PMID: 38755628 PMCID: PMC11097426 DOI: 10.1186/s12891-024-07509-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 05/08/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Customized 3D-printed pelvic implants with a porous structure have revolutionized periacetabular pelvic defect reconstruction after tumor resection, offering improved osteointegration, long-term stability, and anatomical fit. However, the lack of an established classification system hampers implementation and progress. METHODS We formulated a novel classification system based on pelvic defect morphology and 3D-printed hemipelvis endoprostheses. It integrates surgical approach, osteotomy guide plate and prosthesis design, postoperative rehabilitation plans, and perioperative processes. RESULTS Retrospectively analyzing 60 patients (31 males, 29 females), we classified them into Type A (15 patients: Aa = 6, Ab = 9), Type B (27 patients: Ba = 15, Bb = 12), Type C (17 patients). All underwent customized osteotomy guide plate-assisted tumor resection and 3D-printed hemipelvic endoprosthesis reconstruction. Follow-up duration was median 36.5 ± 15.0 months (range, 6 to 74 months). The mean operating time was 430.0 ± 106.7 min, intraoperative blood loss 2018.3 ± 1305.6 ml, transfusion volume 2510.0 ± 1778.1 ml. Complications occurred in 13 patients (21.7%), including poor wound healing (10.0%), deep prosthesis infection (6.7%), hip dislocation (3.3%), screw fracture (1.7%), and interface loosening (1.7%). VAS score improved from 5.5 ± 1.4 to 1.7 ± 1.3, MSTS-93 score from 14.8 ± 2.5 to 23.0 ± 5.6. Implant osseointegration success rate was 98.5% (128/130), with one Type Ba patient experiencing distal prosthesis loosening. CONCLUSION The West China classification may supplement the Enneking and Dunham classification, enhancing interdisciplinary communication and surgical outcomes. However, further validation and wider adoption are required to confirm clinical effectiveness.
Collapse
Affiliation(s)
- Xin Hu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, Sichuan, 610041, China
| | - Minxun Lu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, Sichuan, 610041, China
| | - Yitian Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, Sichuan, 610041, China
| | - Yi Luo
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, Sichuan, 610041, China
| | - Yong Zhou
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, Sichuan, 610041, China
| | - Xiao Yang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, Sichuan, 610064, People's Republic of China.
- Provincial Engineering Research Center for Biomaterials Genome of Sichuan, Sichuan University, Chengdu, 610064, China.
| | - Li Min
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China.
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, Sichuan, 610041, China.
| | - Chongqi Tu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, Sichuan, 610041, China
| |
Collapse
|
9
|
Lee MC, Pan CT, Chen WF, Lin MC, Shiue YL. Design, Manufacture, and Characterization of a Critical-Sized Gradient Porosity Dual-Material Tibial Defect Scaffold. Bioengineering (Basel) 2024; 11:308. [PMID: 38671730 PMCID: PMC11047886 DOI: 10.3390/bioengineering11040308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/12/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
This study proposed a composite tibia defect scaffold with radial gradient porosity, utilizing finite element analysis to assess stress in the tibial region with significant critical-sized defects. Simulations for scaffolds with different porosities were conducted, designing an optimal tibia defect scaffold with radial gradient porosity for repairing and replacing critical bone defects. Radial gradient porosity scaffolds resulted in a more uniform stress distribution, reducing titanium alloy stiffness and alleviating stress shielding effects. The scaffold was manufactured using selective laser melting (SLM) technology with stress relief annealing to simplify porous structure fabrication. The study used New Zealand white rabbits' tibia defect sites as simulation parameters, reconstructing the 3D model and implanting the composite scaffold. Finite element analysis in ANSYS-Workbench simulated forces under high-activity conditions, analyzing stress distribution and strain. In the simulation, the titanium alloy scaffold bore a maximum stress of 122.8626 MPa, while the centrally encapsulated HAp material delivered 27.92 MPa. The design demonstrated superior structural strength, thereby reducing stress concentration. The scaffold was manufactured using SLM, and the uniform design method was used to determine a collection of optimum annealing parameters. Nanoindentation and compression tests were used to determine the influence of annealing on the elastic modulus, hardness, and strain energy of the scaffold.
Collapse
Affiliation(s)
- Ming-Chan Lee
- Department of Electrical Engineering, National Kaohsiung University of Science and Technology, Kaohsiung 807, Taiwan;
- Institute of Advanced Semiconductor Packaging and Testing, College of Semiconductor and Advanced Technology Research, National Sun Yat-Sen University, Kaohsiung 804, Taiwan;
| | - Cheng-Tang Pan
- Institute of Advanced Semiconductor Packaging and Testing, College of Semiconductor and Advanced Technology Research, National Sun Yat-Sen University, Kaohsiung 804, Taiwan;
- Department of Mechanical and Electro-Mechanical Engineering, National Sun Yat-Sen University, Kaohsiung 804, Taiwan
- Institute of Precision Medicine, National Sun Yat-Sen University, Kaohsiung 804, Taiwan
- Taiwan Instrument Research Institute, National Applied Research Laboratories, Hsinchu City 300, Taiwan
| | - Wen-Fan Chen
- Institute of Medical Science and Technology, National Sun Yat-Sen University, Kaohsiung 804, Taiwan;
| | - Meng-Chi Lin
- Department of Surgery, Zuoying Armed Forces General Hospital, Kaohsiung 813, Taiwan
| | - Yow-Ling Shiue
- Institute of Precision Medicine, National Sun Yat-Sen University, Kaohsiung 804, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung 804, Taiwan
| |
Collapse
|
10
|
Mao C, Yu W, Li G, Xu Z, Gong Y, Jin M, Lu E. Effects of immediate loading directionality on the mechanical sensing protein PIEZO1 expression and early-stage healing process of peri-implant bone. Biomed Eng Online 2024; 23:36. [PMID: 38504231 PMCID: PMC10953093 DOI: 10.1186/s12938-024-01223-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/23/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND The reduced treatment time of dental implants with immediate loading protocol is an appealing solution for dentists and patients. However, there remains a significant risk of early peri-implant bone response following the placement of immediately loaded implants, and limited information is available regarding loading directions and the associated in vivo characteristics of peri-implant bone during the early stages. This study aimed to investigate the effects of immediate loading directionality on the expression of mechanical sensing protein PIEZO1 and the healing process of peri-implant bone in the early stage. METHODS Thirty-two implants were inserted into the goat iliac crest models with 10 N static lateral immediate loading applied, followed by histological, histomorphological, immunohistochemical, X-ray microscopy and energy dispersive X-ray spectroscopy evaluations conducted after 10 days. RESULTS From evaluations at the cellular, tissue, and organ levels, it was observed that the expression of mechanical sensing protein PIEZO1 in peri-implant bone was significantly higher in the compressive side compared to the tensile side. This finding coincided with trends observed in interfacial bone extracellular matrix (ECM) contact percentage, bone mass, and new bone formation. CONCLUSIONS This study provides a novel insight into the immediate loading directionality as a potential influence factor for dental implant treatments by demonstrating differential effects on the mechanical sensing protein PIEZO1 expression and related early-stage healing processes of peri-implant bone. Immediate loading directions serve as potential therapeutic influence factors for peri-implant bone during its early healing stage.
Collapse
Affiliation(s)
- Chuanyuan Mao
- Department of Stomatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China
| | - Weijun Yu
- Department of Stomatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China
| | - Guanglong Li
- Department of Stomatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China
| | - Ziyuan Xu
- Department of Stomatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China
| | - Yuhua Gong
- Department of Stomatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China.
| | - Min Jin
- Department of Stomatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China.
| | - Eryi Lu
- Department of Stomatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China.
| |
Collapse
|
11
|
Wu J, Miao J, Chen G, Xu H, Wen W, Xu H, Liu L. Finite element biomechanical analysis of 3D printed intervertebral fusion cage in osteoporotic population. BMC Musculoskelet Disord 2024; 25:129. [PMID: 38347518 PMCID: PMC10860281 DOI: 10.1186/s12891-024-07221-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/21/2024] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVE To study the biomechanical characteristics of each tissue structure when using different 3D printing Cage in osteoporotic patients undergoing interbody fusion. METHODS A finite element model of the lumbar spine was reconstructed and validated with regarding a range of motion and intervertebral disc pressure from previous in vitro studies. Cage and pedicle screws were implanted and part of the lamina, spinous process, and facet joints were removed in the L4/5 segment of the validated mode to simulate interbody fusion. A 280 N follower load and 7.5 N·m moment were applied to different postoperative models and intact osteoporotic model to simulate lumbar motion. The biomechanical characteristics of different models were evaluated by calculating and analyzing the range of motion of the fixed and cephalic adjacent segment, the stress of the screw-rod system, the stress at the interface between cage and L5 endplate, and intervertebral disc pressure of the adjacent segment. RESULTS After rigid fixation, the range of motion of the fixed segment of model A-C decreased significantly, which was much smaller than that of the osteoporotic model. And with the increase of the axial area of the interbody fusion cages, the fixed segment of model A-C tended to be more stable. The range of motion and intradiscal pressure of the spinal models with different interbody fusion cages were higher than those of the complete osteoporosis model, but there was no significant difference between the postoperative models. On the other hand, the L5 upper endplate stress and screw-rod system stress of model A-C show a decreasing trend in different directions of motion. The stress of the endplate is the highest during flexion, which can reach 40.5 MPa (model A). The difference in endplate stress between models A-C was the largest during lateral bending. The endplate stress of models A and B was 150.5% and 140.9% of that of model C, respectively. The stress of the screw-rod system was the highest during lateral bending (model A, 102.0 MPa), which was 108.4%, 102.4%, 110.4%, 114.2% of model B and 158.5%, 110.1%, 115.8%, 125.4% of model C in flexion, extension, lateral bending, and rotation, respectively. CONCLUSIONS For people with osteoporosis, no matter what type of cage is used, good immediate stability can be achieved after surgery. Larger cage sizes provide better fixation without significantly increasing ROM and IDP in adjacent segments, which may contribute to the development of ASD. In addition, larger cage sizes can disperse endplate stress and reduce stress concentration, which is of positive significance in preventing cage subsidence after operation. The cage and screw rod system establish a stress conduction pathway on the spine, and a larger cage greatly enhances the stress-bearing capacity of the front column, which can better distribute the stress of the posterior spine structure and the stress borne by the posterior screw rod system, reduce the stress concentration phenomenon of the nail rod system, and avoid exceeding the yield strength of the material, resulting in the risk of future instrument failure.
Collapse
Affiliation(s)
- Jincheng Wu
- Department of Emergency Trauma Surgery, The Second Affiliated Hospital of Hainan Medical University, Haikou City, Hainan, China, 48 Baishuitang Road, Longhua District, 571700
| | - Jun Miao
- Tianjin Hospital, Tianjin University, Tianjin, China
| | | | - Hanpeng Xu
- Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wangqiang Wen
- The First Affiliated Hospital of Hainan Medical University, Haikou City, Hainan, China
| | - Haoxiang Xu
- The Second People's Hospital of Hefei, Hefei, Anhui, China
| | - Lizhu Liu
- Department of Emergency Trauma Surgery, The Second Affiliated Hospital of Hainan Medical University, Haikou City, Hainan, China, 48 Baishuitang Road, Longhua District, 571700.
| |
Collapse
|
12
|
Hirase T, Vemu SM, Boddapati V, Ling JF, So M, Saifi C, Marco RAW, Bird JE. Customized 3-dimensional-printed Vertebral Implants for Spinal Reconstruction After Tumor Resection: A Systematic Review. Clin Spine Surg 2024; 37:31-39. [PMID: 37074792 DOI: 10.1097/bsd.0000000000001462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 03/09/2023] [Indexed: 04/20/2023]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To examine the outcomes of customized 3-dimensional (3D) printed implants for spinal reconstruction after tumor resection. SUMMARY OF BACKGROUND DATA Various techniques exist for spinal reconstruction after tumor resection. Currently, there is no consensus regarding the utility of customized 3D-printed implants for spinal reconstruction after tumor resection. MATERIALS AND METHODS A systematic review was registered with PROSPERO and performed according to "Preferred Reporting Items for Systematic Reviews and Meta-analyses" guidelines. All level I-V evidence studies reporting the use of 3D-printed implants for spinal reconstruction after tumor resection were included. RESULTS Eleven studies (65 patients; mean age, 40.9 ± 18.1 y) were included. Eleven patients (16.9%) underwent intralesional resections with positive margins and 54 patients (83.1%) underwent en bloc spondylectomy with negative margins. All patients underwent vertebral reconstruction with 3D-printed titanium implants. Tumor involvement was in the cervical spine in 21 patients (32.3%), thoracic spine in 29 patients (44.6%), thoracolumbar junction in 2 patients (3.1%), and lumbar spine in 13 patients (20.0%). Ten studies with 62 patients reported perioperative outcomes radiologic/oncologic status at final follow-up. At the mean final follow-up of 18.5 ± 9.8 months, 47 patients (75.8%) had no evidence of disease, 9 patients (14.5%) were alive with recurrence, and 6 patients (9.7%) had died of disease. One patient who underwent C3-C5 en bloc spondylectomy had an asymptomatic subsidence of 2.7 mm at the final follow-up. Twenty patients that underwent thoracic and/or lumbar reconstruction had a mean subsidence of 3.8 ± 4.7 mm at the final follow-up; however, only 1 patient had a symptomatic subsidence that required revision surgery. Eleven patients (17.7%) had one or more major complications. CONCLUSION There is some evidence to suggest that using customized 3D-printed titanium or titanium alloy implants is an effective technique for spinal reconstruction after tumor resection. There is a high incidence of asymptomatic subsidence and major complications that are similar to other methods of reconstruction. LEVEL OF EVIDENCE Level V, systematic review of level I-V studies.
Collapse
Affiliation(s)
- Takashi Hirase
- Houston Methodist Orthopedics and Sports Medicine, Houston
- Texas A&M University Health Science Center College of Medicine, Bryan, TX
| | - Sree M Vemu
- Houston Methodist Orthopedics and Sports Medicine, Houston
| | - Venkat Boddapati
- New York-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Jeremiah F Ling
- Texas A&M University Health Science Center College of Medicine, Bryan, TX
| | - Matthew So
- Houston Methodist Orthopedics and Sports Medicine, Houston
| | - Comron Saifi
- Houston Methodist Orthopedics and Sports Medicine, Houston
| | - Rex A W Marco
- Houston Methodist Orthopedics and Sports Medicine, Houston
| | - Justin E Bird
- Department of Orthopedic Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
13
|
Deering J, Mahmoud D, Rier E, Lin Y, do Nascimento Pereira AC, Titotto S, Fang Q, Wohl GR, Deng F, Grandfield K, Elbestawi MA, Chen J. Osseointegration of functionally graded Ti6Al4V porous implants: Histology of the pore network. BIOMATERIALS ADVANCES 2023; 155:213697. [PMID: 37979439 DOI: 10.1016/j.bioadv.2023.213697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 10/11/2023] [Accepted: 11/05/2023] [Indexed: 11/20/2023]
Abstract
The additive manufacturing of titanium into porous geometries offers a means to generate low-stiffness endosseous implants with a greater surface area available for osseointegration. In this work, selective laser melting was used to produce gyroid-based scaffolds with a uniform pore size of 300 μm or functionally graded pore size from 600 μm to 300 μm. Initial in vitro assessment with Saos-2 cells showed favourable cell proliferation at pore sizes of 300 and 600 μm. Following implantation into rabbit tibiae, early histological observations at four weeks indicated some residual inflammation alongside neovessel infiltration into the scaffold interior and some early apposition of mineralized bone tissue. At twelve weeks, both scaffolds were filled with a mixture of adipocyte-rich marrow, micro-capillaries, and mineralized bone tissue. X-ray microcomputed tomography showed a higher bone volume fraction (BV/TV) and percentage of bone-implant contact (BIC) in the implants with 300 μm pores than in the functionally graded specimens. In functionally graded specimens, localized BV/TV measurement was observed to be higher in the innermost region containing smaller pores (estimated at 300-400 μm) than in larger pores at the implant exterior. The unit cell topology of the porous implant was also observed to guide the direction of bone ingrowth by conducting along the implant struts. These results suggest that in vivo experimentation is necessary alongside parametric optimization of functionally graded porous implants to predict short-term and long-term bone apposition.
Collapse
Affiliation(s)
- Joseph Deering
- Department of Materials Science and Engineering, McMaster University, Hamilton, ON, Canada
| | - Dalia Mahmoud
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada; Production Engineering Department, Faculty of Engineering, Alexandria University, Alexandria 21544, Egypt
| | - Elyse Rier
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
| | - Yujing Lin
- Guanghua School of Stomatology, Hospital of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Anna Cecilia do Nascimento Pereira
- Center of Engineering, Modeling and Applied Social Sciences, Federal University of ABC (UFABC), Santo André, Brazil; 4D Printing and Biomimetics' (4DB) Research Group, Federal University of ABC (UFABC), Santo André, Brazil
| | - Silvia Titotto
- Center of Engineering, Modeling and Applied Social Sciences, Federal University of ABC (UFABC), Santo André, Brazil; 4D Printing and Biomimetics' (4DB) Research Group, Federal University of ABC (UFABC), Santo André, Brazil
| | - Qiyin Fang
- Department of Engineering Physics, McMaster University, Hamilton, ON, Canada
| | - Gregory R Wohl
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada; School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada; Brockhouse Institute for Materials Research, McMaster University, Hamilton, ON, Canada
| | - Feilong Deng
- Guanghua School of Stomatology, Hospital of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Kathryn Grandfield
- Department of Materials Science and Engineering, McMaster University, Hamilton, ON, Canada; School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada; Brockhouse Institute for Materials Research, McMaster University, Hamilton, ON, Canada.
| | - Mohamed A Elbestawi
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada.
| | - Jianyu Chen
- Guanghua School of Stomatology, Hospital of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China.
| |
Collapse
|
14
|
Sefa S, Espiritu J, Ćwieka H, Greving I, Flenner S, Will O, Beuer S, Wieland DF, Willumeit-Römer R, Zeller-Plumhoff B. Multiscale morphological analysis of bone microarchitecture around Mg-10Gd implants. Bioact Mater 2023; 30:154-168. [PMID: 37575877 PMCID: PMC10412723 DOI: 10.1016/j.bioactmat.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 07/07/2023] [Accepted: 07/20/2023] [Indexed: 08/15/2023] Open
Abstract
The utilization of biodegradable magnesium (Mg)-based implants for restoration of bone function following trauma represents a transformative approach in orthopaedic application. One such alloy, magnesium-10 weight percent gadolinium (Mg-10Gd), has been specifically developed to address the rapid degradation of Mg while enhancing its mechanical properties to promote bone healing. Previous studies have demonstrated that Mg-10Gd exhibits favorable osseointegration; however, it exhibits distinct ultrastructural adaptation in comparison to conventional implants like titanium (Ti). A crucial aspect that remains unexplored is the impact of Mg-10Gd degradation on the bone microarchitecture. To address this, we employed hierarchical three-dimensional imaging using synchrotron radiation in conjunction with image-based finite element modelling. By using the methods outlined, the vascular porosity, lacunar porosity and the lacunar-canaliculi network (LCN) morphology of bone around Mg-10Gd in comparison to Ti in a rat model from 4 weeks to 20 weeks post-implantation was investigated. Our investigation revealed that within our observation period, the degradation of Mg-10Gd implants was associated with significantly lower (p < 0.05) lacunar density in the surrounding bone, compared to Ti. Remarkably, the LCN morphology and the fluid flow analysis did not significantly differ for both implant types. In summary, a more pronounced lower lacunae distribution rather than their morphological changes was detected in the surrounding bone upon the degradation of Mg-10Gd implants. This implies potential disparities in bone remodelling rates when compared to Ti implants. Our findings shed light on the intricate relationship between Mg-10Gd degradation and bone microarchitecture, contributing to a deeper understanding of the implications for successful osseointegration.
Collapse
Affiliation(s)
- Sandra Sefa
- Institute of Metallic Biomaterials, Helmholtz Zentrum Hereon, Geesthacht, Germany
| | | | - Hanna Ćwieka
- Institute of Metallic Biomaterials, Helmholtz Zentrum Hereon, Geesthacht, Germany
| | - Imke Greving
- Institute of Materials Physics, Helmholtz Zentrum Hereon, Geesthacht, Germany
| | - Silja Flenner
- Institute of Materials Physics, Helmholtz Zentrum Hereon, Geesthacht, Germany
| | - Olga Will
- Molecular Imaging North Competence Center, Kiel University, Kiel, Germany
| | - Susanne Beuer
- Fraunhofer Institut für Integrierte Systeme und Bauelementetechnologie (IISB), Erlangen, Germany
| | - D.C Florian Wieland
- Institute of Metallic Biomaterials, Helmholtz Zentrum Hereon, Geesthacht, Germany
| | | | | |
Collapse
|
15
|
Hu X, Lu M, Zhang Y, Li Z, Wang J, Wang Y, Xing Z, Yang X, Tu C, Min L. Pelvic-girdle reconstruction with three-dimensional-printed endoprostheses after limb-salvage surgery for pelvic sarcomas: current landscape. Br J Surg 2023; 110:1712-1722. [PMID: 37824784 PMCID: PMC10638540 DOI: 10.1093/bjs/znad310] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/25/2023] [Accepted: 09/09/2023] [Indexed: 10/14/2023]
Abstract
Resection of pelvic bone tumors and the subsequent reconstruction of the pelvic girdle pose challenges due to complex anatomy, load-bearing demands, and significant defects. 3D-printed implants have revolutionized pelvic girdle reconstruction by offering customized solutions, porous surface structures for precise resection with custom guides, and improved integration. Many tertiary medical centers have adopted 3Dprinted hemipelvic endoprostheses, leading to enhanced outcomes. However, most studies are limited to single centers, with a small number of cases and short follow-up periods. Additionally, the design of these implants often relies heavily on individual experience, resulting in a lack of uniformity and significant variation. To provide a comprehensive assessment of this technology, we conducted an analysis of existing literature, encompassing tumor resection classification, various types of prosthesis design, reconstruction concepts, and post-reconstruction functional outcomes.
Collapse
Affiliation(s)
- Xin Hu
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Minxun Lu
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Yuqi Zhang
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Zhuangzhuang Li
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Jie Wang
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Yitian Wang
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Zhengyi Xing
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
- Provincial Engineering Research Center for Biomaterials Genome of Sichuan, Sichuan University, Chengdu, China
| | - Xiao Yang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
- Provincial Engineering Research Center for Biomaterials Genome of Sichuan, Sichuan University, Chengdu, China
| | - Chongqi Tu
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Li Min
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
16
|
Mohanadas HP, Nair V, Doctor AA, Faudzi AAM, Tucker N, Ismail AF, Ramakrishna S, Saidin S, Jaganathan SK. A Systematic Analysis of Additive Manufacturing Techniques in the Bioengineering of In Vitro Cardiovascular Models. Ann Biomed Eng 2023; 51:2365-2383. [PMID: 37466879 PMCID: PMC10598155 DOI: 10.1007/s10439-023-03322-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/13/2023] [Indexed: 07/20/2023]
Abstract
Additive Manufacturing is noted for ease of product customization and short production run cost-effectiveness. As our global population approaches 8 billion, additive manufacturing has a future in maintaining and improving average human life expectancy for the same reasons that it has advantaged general manufacturing. In recent years, additive manufacturing has been applied to tissue engineering, regenerative medicine, and drug delivery. Additive Manufacturing combined with tissue engineering and biocompatibility studies offers future opportunities for various complex cardiovascular implants and surgeries. This paper is a comprehensive overview of current technological advancements in additive manufacturing with potential for cardiovascular application. The current limitations and prospects of the technology for cardiovascular applications are explored and evaluated.
Collapse
Affiliation(s)
| | - Vivek Nair
- Computational Fluid Dynamics (CFD) Lab, Mechanical and Aerospace Engineering, University of Texas Arlington, Arlington, TX, 76010, USA
| | | | - Ahmad Athif Mohd Faudzi
- Faculty of Engineering, School of Electrical Engineering, Universiti Teknologi Malaysia, Johor Bahru, Malaysia
- Centre for Artificial Intelligence and Robotics, Universiti Teknologi Malaysia, Kuala Lumpur, Malaysia
| | - Nick Tucker
- School of Engineering, College of Science, Brayford Pool, Lincoln, LN6 7TS, UK
| | - Ahmad Fauzi Ismail
- School of Chemical and Energy Engineering, Advanced Membrane Technology Research Centre (AMTEC), Universiti Teknologi Malaysia, Skudai, Malaysia
| | - Seeram Ramakrishna
- Department of Mechanical Engineering, Center for Nanofibers & Nanotechnology Initiative, National University of Singapore, Singapore, Singapore
| | - Syafiqah Saidin
- IJNUTM Cardiovascular Engineering Centre, Universiti Teknologi Malaysia, Johor Bahru, Malaysia
| | - Saravana Kumar Jaganathan
- Faculty of Engineering, School of Electrical Engineering, Universiti Teknologi Malaysia, Johor Bahru, Malaysia.
- Centre for Artificial Intelligence and Robotics, Universiti Teknologi Malaysia, Kuala Lumpur, Malaysia.
- School of Engineering, College of Science, Brayford Pool, Lincoln, LN6 7TS, UK.
| |
Collapse
|
17
|
Ruiz-Cardozo MA, Trevino G, Pando A, Brehm S, Olufawo M, Barot K, Carey-Ewend A, Yahanda AT, Perdomo-Pantoja A, Jauregui JJ, Cadieux M, Costa M, Coenen J, Dorward I, Anolik RA, Sacks JM, Molina CA. Rapid Implementation of a 3-Dimensional-Printed Patient-Specific Titanium Sacrum Implant for Severe Neuropathic Spinal Arthropathy and Guide to Compassionate US Regulatory Approval. Oper Neurosurg (Hagerstown) 2023; 25:469-477. [PMID: 37584482 DOI: 10.1227/ons.0000000000000872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/31/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Rapid design and production of patient-specific 3-dimensional-printed implants (3DPIs) present a novel opportunity to restore the biomechanically demanding integrity of the lumbopelvic junction. We present a unique case of a 61-year-old patient with severe neuropathic spinal arthropathy (Charcot spine) who initially underwent a T4-to-sacrum spinal fusion. Massive bone destruction led to dissociation of his upper body from his pelvis and legs. Reconstruction of the spinopelvic continuity was planned with the aid of a personalized lumbosacral 3DPI. METHOD Using high-resolution computed tomography scans, the custom 3DPI was made using additive titanium manufacturing. The unique 3DPI consisted of (1) a sacral platform with iliac screws, (2) modular corpectomy device with rigid connection to the sacral platform, and (3) anterior plate connection with screws for proximal fixation. The procedures to obtain compassionate use Food and Drug Administration approval were followed. The patient underwent debridement of a chronically open wound before undertaking the 3-stage reconstructive procedure. The custom 3DPI and additional instrumentation were inserted as part of a salvage rebuilding procedure. RESULTS The chronology of the rapid implementation of the personalized sacral 3DPI from decision, design, manufacturing, Food and Drug Administration approval, and surgical execution lasted 28 days. The prosthesis was positioned in the defect according to the expected anatomic planes and secured using a screw-rod system and a vascularized fibular bone strut graft. The prosthesis provided an ideal repair of the lumbosacral junction and pelvic ring by merging spinal pelvic fixation, posterior pelvic ring fixation, and anterior spinal column fixation. CONCLUSION To the best of our knowledge, this is the first case of a multilevel lumbar, sacral, and sacropelvic neuropathic (Charcot) spine reconstruction using a 3DPI sacral prosthesis. As the prevalence of severe spine deformities continues to increase, adoption of 3DPIs is becoming more relevant to offer personalized treatment for complex deformities.
Collapse
Affiliation(s)
- Miguel A Ruiz-Cardozo
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Gabriel Trevino
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Alejandro Pando
- Department of Neurological Surgery, Rutgers New Jersey Medical School, New Jersey, New Jersey, USA
| | - Samuel Brehm
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Michael Olufawo
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Karma Barot
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Abigail Carey-Ewend
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Alexander T Yahanda
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Alexander Perdomo-Pantoja
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Julio J Jauregui
- Department of Orthopedic Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Magalie Cadieux
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Megan Costa
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Julie Coenen
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Ian Dorward
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
- Department of Orthopedic Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Rachel A Anolik
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Justin M Sacks
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Camilo A Molina
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
- Department of Orthopedic Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| |
Collapse
|
18
|
Bandyopadhyay A, Mitra I, Avila JD, Upadhyayula M, Bose S. Porous metal implants: processing, properties, and challenges. INTERNATIONAL JOURNAL OF EXTREME MANUFACTURING 2023; 5:032014. [PMID: 37476350 PMCID: PMC10355163 DOI: 10.1088/2631-7990/acdd35] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/26/2023] [Accepted: 06/09/2023] [Indexed: 07/22/2023]
Abstract
Porous and functionally graded materials have seen extensive applications in modern biomedical devices-allowing for improved site-specific performance; their appreciable mechanical, corrosive, and biocompatible properties are highly sought after for lightweight and high-strength load-bearing orthopedic and dental implants. Examples of such porous materials are metals, ceramics, and polymers. Although, easy to manufacture and lightweight, porous polymers do not inherently exhibit the required mechanical strength for hard tissue repair or replacement. Alternatively, porous ceramics are brittle and do not possess the required fatigue resistance. On the other hand, porous biocompatible metals have shown tailorable strength, fatigue resistance, and toughness. Thereby, a significant interest in investigating the manufacturing challenges of porous metals has taken place in recent years. Past research has shown that once the advantages of porous metallic structures in the orthopedic implant industry have been realized, their biological and biomechanical compatibility-with the host bone-has been followed up with extensive methodical research. Various manufacturing methods for porous or functionally graded metals are discussed and compared in this review, specifically, how the manufacturing process influences microstructure, graded composition, porosity, biocompatibility, and mechanical properties. Most of the studies discussed in this review are related to porous structures for bone implant applications; however, the understanding of these investigations may also be extended to other devices beyond the biomedical field.
Collapse
Affiliation(s)
- Amit Bandyopadhyay
- W. M. Keck Biomedical Materials Research Lab, School of Mechanical and Materials Engineering, Washington State University, Pullman, WA 99164, United States of America
| | - Indranath Mitra
- W. M. Keck Biomedical Materials Research Lab, School of Mechanical and Materials Engineering, Washington State University, Pullman, WA 99164, United States of America
| | - Jose D Avila
- W. M. Keck Biomedical Materials Research Lab, School of Mechanical and Materials Engineering, Washington State University, Pullman, WA 99164, United States of America
| | - Mahadev Upadhyayula
- W. M. Keck Biomedical Materials Research Lab, School of Mechanical and Materials Engineering, Washington State University, Pullman, WA 99164, United States of America
| | - Susmita Bose
- W. M. Keck Biomedical Materials Research Lab, School of Mechanical and Materials Engineering, Washington State University, Pullman, WA 99164, United States of America
| |
Collapse
|
19
|
Verma A, Kapil A, Klobčar D, Sharma A. A Review on Multiplicity in Multi-Material Additive Manufacturing: Process, Capability, Scale, and Structure. MATERIALS (BASEL, SWITZERLAND) 2023; 16:5246. [PMID: 37569952 PMCID: PMC10420305 DOI: 10.3390/ma16155246] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023]
Abstract
Additive manufacturing (AM) has experienced exponential growth over the past two decades and now stands on the cusp of a transformative paradigm shift into the realm of multi-functional component manufacturing, known as multi-material AM (MMAM). While progress in MMAM has been more gradual compared to single-material AM, significant strides have been made in exploring the scientific and technological possibilities of this emerging field. Researchers have conducted feasibility studies and investigated various processes for multi-material deposition, encompassing polymeric, metallic, and bio-materials. To facilitate further advancements, this review paper addresses the pressing need for a consolidated document on MMAM that can serve as a comprehensive guide to the state of the art. Previous reviews have tended to focus on specific processes or materials, overlooking the overall picture of MMAM. Thus, this pioneering review endeavors to synthesize the collective knowledge and provide a holistic understanding of the multiplicity of materials and multiscale processes employed in MMAM. The review commences with an analysis of the implications of multiplicity, delving into its advantages, applications, challenges, and issues. Subsequently, it offers a detailed examination of MMAM with respect to processes, materials, capabilities, scales, and structural aspects. Seven standard AM processes and hybrid AM processes are thoroughly scrutinized in the context of their adaptation for MMAM, accompanied by specific examples, merits, and demerits. The scope of the review encompasses material combinations in polymers, composites, metals-ceramics, metal alloys, and biomaterials. Furthermore, it explores MMAM's capabilities in fabricating bi-metallic structures and functionally/compositionally graded materials, providing insights into various scale and structural aspects. The review culminates by outlining future research directions in MMAM and offering an overall outlook on the vast potential of multiplicity in this field. By presenting a comprehensive and integrated perspective, this paper aims to catalyze further breakthroughs in MMAM, thus propelling the next generation of multi-functional component manufacturing to new heights by capitalizing on the unprecedented possibilities of MMAM.
Collapse
Affiliation(s)
- Ayush Verma
- Department of Mechanical Engineering, Netaji Subhas University of Technology, New Delhi 110078, India;
| | - Angshuman Kapil
- Department of Materials Engineering, Faculty of Engineering Technology, KU Leuven, Campus De Nayer, 2860 Sint-Katelijne Waver, Belgium
| | - Damjan Klobčar
- Faculty of Mechanical Engineering, University of Ljubljana, Aškerčeva 6, 1000 Ljubljana, Slovenia;
| | - Abhay Sharma
- Department of Materials Engineering, Faculty of Engineering Technology, KU Leuven, Campus De Nayer, 2860 Sint-Katelijne Waver, Belgium
| |
Collapse
|
20
|
Al-Shalawi FD, Mohamed Ariff AH, Jung DW, Mohd Ariffin MKA, Seng Kim CL, Brabazon D, Al-Osaimi MO. Biomaterials as Implants in the Orthopedic Field for Regenerative Medicine: Metal versus Synthetic Polymers. Polymers (Basel) 2023; 15:2601. [PMID: 37376247 PMCID: PMC10303232 DOI: 10.3390/polym15122601] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Patients suffering bone fractures in different parts of the body require implants that will enable similar function to that of the natural bone that they are replacing. Joint diseases (rheumatoid arthritis and osteoarthritis) also require surgical intervention with implants such as hip and knee joint replacement. Biomaterial implants are utilized to fix fractures or replace parts of the body. For the majority of these implant cases, either metal or polymer biomaterials are chosen in order to have a similar functional capacity to the original bone material. The biomaterials that are employed most often for implants of bone fracture are metals such as stainless steel and titanium, and polymers such as polyethene and polyetheretherketone (PEEK). This review compared metallic and synthetic polymer implant biomaterials that can be employed to secure load-bearing bone fractures due to their ability to withstand the mechanical stresses and strains of the body, with a focus on their classification, properties, and application.
Collapse
Affiliation(s)
- Faisal Dakhelallah Al-Shalawi
- Department of Mechanical and Manufacturing Engineering, Faculty of Engineering, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (F.D.A.-S.); (M.K.A.M.A.)
| | - Azmah Hanim Mohamed Ariff
- Department of Mechanical and Manufacturing Engineering, Faculty of Engineering, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (F.D.A.-S.); (M.K.A.M.A.)
- Research Center Advanced Engineering Materials and Composites (AEMC), Faculty of Engineering, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Dong-Won Jung
- Faculty of Applied Energy System, Major of Mechanical Engineering, Jeju National University, 102 Jejudaehak-ro, Jeju-si 63243, Republic of Korea
| | - Mohd Khairol Anuar Mohd Ariffin
- Department of Mechanical and Manufacturing Engineering, Faculty of Engineering, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (F.D.A.-S.); (M.K.A.M.A.)
| | - Collin Looi Seng Kim
- Department of Orthopaedic, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia;
| | - Dermot Brabazon
- Advanced Manufacturing Research Centre, and Advanced Processing Technology Research Centre, School of Mechanical and Manufacturing Engineering, Dublin City University, Glasnevin, D09 V209 Dublin 9, Ireland;
| | - Maha Obaid Al-Osaimi
- Department of Microbiology, Faculty of Agriculture, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia;
| |
Collapse
|
21
|
Valente G, Benedetti MG, De Paolis M, Donati DM, Taddei F. Differences in hip musculoskeletal loads between limbs during daily activities in patients with 3D-printed hemipelvic reconstructions following tumor surgery. Gait Posture 2023; 102:56-63. [PMID: 36924596 DOI: 10.1016/j.gaitpost.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Anatomical custom-made prostheses, thanks to computer-aided design and 3D-printing technology, help improve osseointegration and reduce mechanical complications in bone reconstructions following bone tumors. A recent quantitative analysis of long-term recovery in patients with 3D-printed reconstructions following pelvic tumor surgery showed asymmetries in ground reaction forces between limbs during different motor activities, while standing very good motor performance and quality of life. RESEARCH QUESTION We analyzed hip contact forces and muscle forces in that cohort of six patients with an innovative custom-made reconstruction of the hemipelvis, and we tested the hypothesis that asymmetries in ground reaction forces would result in more marked differences in musculoskeletal forces. METHODS State-of-the-art musculoskeletal modeling in an optimization-based inverse-dynamics workflow was used to calculate hip contact forces and muscle forces during five motor activities, and the differences between limbs were statistically evaluated across the motor activity cycles and on the force peaks. RESULTS The musculoskeletal loads were found to be not symmetric, as hip loads were generally higher in the contralateral limb. We found significant differences in considerable portions of the motor activities cycles except squat, load symmetry indices indicating a load increase (median up to 25%) on the contralateral limb, especially during stair descent and chair rise/sit, and significantly higher values in the contralateral limb at force peaks. SIGNIFICANCE We confirmed the hypothesis that residual asymmetries found in ground reaction forces were amplified when hip musculoskeletal loads were investigated, reflecting a shift of the loads toward the intact limb. Despite the general trend of higher loads found in the contralateral hip, this cannot be considered a risk of overloading, as both hips supported loads in a physiological range or lower, indicating a likely optimal recovery.
Collapse
Affiliation(s)
- Giordano Valente
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Maria Grazia Benedetti
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Massimiliano De Paolis
- Department of Orthopaedics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Fulvia Taddei
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| |
Collapse
|
22
|
Wu J, Feng Q, Yang D, Xu H, Wen W, Xu H, Miao J. Biomechanical evaluation of different sizes of 3D printed cage in lumbar interbody fusion-a finite element analysis. BMC Musculoskelet Disord 2023; 24:85. [PMID: 36726086 PMCID: PMC9890703 DOI: 10.1186/s12891-023-06201-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/27/2023] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To study the biomechanical characteristics of various tissue structures of different sizes of 3D printed Cage in lumbar interbody fusion. METHODS A finite element model of normal spine was reconstructed and verified. Pedicle screws and Cage of different sizes were implanted in the L4/5 segment to simulate lumbar interbody fusion. The range of motion of the fixed and cephalic adjacent segment, the stress of the screw-rod system, the stress at the interface between cage and L5 endplate, and intervertebral disc pressure of the adjacent segment were calculated and analyzed. RESULTS The range of motion and intervertebral disc pressure of the adjacent segment of each postoperative model were larger than those of the intact model, but there was not much difference between them. The stress of cage-endplate interface was also larger than that of the intact model. However, the difference is that the stress of the endplate and the screw-rod system has a tendency to decrease with the increase of the axial area of cage. CONCLUSIONS Cage with larger axial area in lumbar interbody fusion can reduce the stress of internal fixation system and endplate, but will not increase the range of motion and intervertebral disc pressure of adjacent segment. It has a certain effect in preventing the cage subsidence, internal fixation system failure and screw rod fracture.
Collapse
Affiliation(s)
- Jincheng Wu
- grid.33763.320000 0004 1761 2484Department of Spine Surgery, Tianjin Hospital, Tianjin University, Jiefangnanlu 406, Hexi District, Tianjin, China
| | - Qing Feng
- grid.33763.320000 0004 1761 2484Department of Spine Surgery, Tianjin Hospital, Tianjin University, Jiefangnanlu 406, Hexi District, Tianjin, China
| | - Dongmei Yang
- grid.284723.80000 0000 8877 7471Southern Medical University, Guangzhou City, Guangdong China
| | - Hanpeng Xu
- grid.33763.320000 0004 1761 2484Department of Spine Surgery, Tianjin Hospital, Tianjin University, Jiefangnanlu 406, Hexi District, Tianjin, China
| | - Wangqiang Wen
- grid.443397.e0000 0004 0368 7493The First Affiliated Hospital of Hainan Medical University, Haikou City, Hainan China
| | - Haoxiang Xu
- The Second People’s Hospital of Hefei, Hefei, Anhui China
| | - Jun Miao
- grid.33763.320000 0004 1761 2484Department of Spine Surgery, Tianjin Hospital, Tianjin University, Jiefangnanlu 406, Hexi District, Tianjin, China
| |
Collapse
|
23
|
Lovis C, Seidel A, Matvieieva N, Neupetsch C, Teicher U, Lemme G, Ben Achour A, Barth M, Ihlenfeldt S, Drossel WG. Unique Device Identification-Based Linkage of Hierarchically Accessible Data Domains in Prospective Surgical Hospital Data Ecosystems: User-Centered Design Approach. JMIR Med Inform 2023; 11:e41614. [PMID: 36705946 PMCID: PMC9919462 DOI: 10.2196/41614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The electronic health record (EHR) targets systematized collection of patient-specific, electronically stored health data. The EHR is an evolving concept driven by ongoing developments and open or unclear legal issues concerning medical technologies, cross-domain data integration, and unclear access roles. Consequently, an interdisciplinary discourse based on representative pilot scenarios is required to connect previously unconnected domains. OBJECTIVE We address cross-domain data integration including access control using the specific example of a unique device identification (UDI)-expanded hip implant. In fact, the integration of technical focus data into the hospital information system (HIS) is considered based on surgically relevant information. Moreover, the acquisition of social focus data based on mobile health (mHealth) is addressed, covering data integration and networking with therapeutic intervention and acute diagnostics data. METHODS In addition to the additive manufacturing of a hip implant with the integration of a UDI, we built a database that combines database technology and a wrapper layer known from extract, transform, load systems and brings it into a SQL database, WEB application programming interface (API) layer (back end), interface layer (rest API), and front end. It also provides semantic integration through connection mechanisms between data elements. RESULTS A hip implant is approached by design, production, and verification while linking operation-relevant specifics like implant-bone fit by merging patient-specific image material (computed tomography, magnetic resonance imaging, or a biomodel) and the digital implant twin for well-founded selection pairing. This decision-facilitating linkage, which improves surgical planning, relates to patient-specific postoperative influencing factors during the healing phase. A unique product identification approach is presented, allowing a postoperative read-out with state-of-the-art hospital technology while enabling future access scenarios for patient and implant data. The latter was considered from the manufacturing perspective using the process manufacturing chain for a (patient-specific) implant to identify quality-relevant data for later access. In addition, sensor concepts were identified to use to monitor the patient-implant interaction during the healing phase using wearables, for example. A data aggregation and integration concept for heterogeneous data sources from the considered focus domains is also presented. Finally, a hierarchical data access concept is shown, protecting sensitive patient data from misuse using existing scenarios. CONCLUSIONS Personalized medicine requires cross-domain linkage of data, which, in turn, require an appropriate data infrastructure and adequate hierarchical data access solutions in a shared and federated data space. The hip implant is used as an example for the usefulness of cross-domain data linkage since it bundles social, medical, and technical aspects of the implantation. It is necessary to open existing databases using interfaces for secure integration of data from end devices and to assure availability through suitable access models while guaranteeing long-term, independent data persistence. A suitable strategy requires the combination of technical solutions from the areas of identity and trust, federated data storage, cryptographic procedures, and software engineering as well as organizational changes.
Collapse
Affiliation(s)
| | - André Seidel
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, Dresden, Germany
| | - Nataliia Matvieieva
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, Dresden, Germany
| | - Constanze Neupetsch
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, Dresden, Germany.,Professorship for Adaptronics and Lightweight Design in Production, Technische Universität Chemnitz, Chemnitz, Germany
| | - Uwe Teicher
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, Dresden, Germany
| | - Gordon Lemme
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, Dresden, Germany
| | - Anas Ben Achour
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, Dresden, Germany
| | - Martin Barth
- Fraunhofer Institute for Ceramic Technologies and Systems IKTS, Dresden, Germany
| | - Steffen Ihlenfeldt
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, Dresden, Germany.,Chair of Machine Tools Development and Adaptive Controls, Technische Universität Dresden, Dresden, Germany
| | - Welf-Guntram Drossel
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, Dresden, Germany.,Professorship for Adaptronics and Lightweight Design in Production, Technische Universität Chemnitz, Chemnitz, Germany
| |
Collapse
|
24
|
Palmquist A, Jolic M, Hryha E, Shah FA. Complex geometry and integrated macro-porosity: Clinical applications of electron beam melting to fabricate bespoke bone-anchored implants. Acta Biomater 2023; 156:125-145. [PMID: 35675890 DOI: 10.1016/j.actbio.2022.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/16/2022] [Accepted: 06/01/2022] [Indexed: 01/18/2023]
Abstract
The last decade has witnessed rapid advancements in manufacturing technologies for biomedical implants. Additive manufacturing (or 3D printing) has broken down major barriers in the way of producing complex 3D geometries. Electron beam melting (EBM) is one such 3D printing process applicable to metals and alloys. EBM offers build rates up to two orders of magnitude greater than comparable laser-based technologies and a high vacuum environment to prevent accumulation of trace elements. These features make EBM particularly advantageous for materials susceptible to spontaneous oxidation and nitrogen pick-up when exposed to air (e.g., titanium and titanium-based alloys). For skeletal reconstruction(s), anatomical mimickry and integrated macro-porous architecture to facilitate bone ingrowth are undoubtedly the key features of EBM manufactured implants. Using finite element modelling of physiological loading conditions, the design of a prosthesis may be further personalised. This review looks at the many unique clinical applications of EBM in skeletal repair and the ground-breaking innovations in prosthetic rehabilitation. From a simple acetabular cup to the fifth toe, from the hand-wrist complex to the shoulder, and from vertebral replacement to cranio-maxillofacial reconstruction, EBM has experienced it all. While sternocostal reconstructions might be rare, the repair of long bones using EBM manufactured implants is becoming exceedingly frequent. Despite the various merits, several challenges remain yet untackled. Nevertheless, with the capability to produce osseointegrating implants of any conceivable shape/size, and permissive of bone ingrowth and functional loading, EBM can pave the way for numerous fascinating and novel applications in skeletal repair, regeneration, and rehabilitation. STATEMENT OF SIGNIFICANCE: Electron beam melting (EBM) offers unparalleled possibilities in producing contaminant-free, complex and intricate geometries from alloys of biomedical interest, including Ti6Al4V and CoCr. We review the diverse range of clinical applications of EBM in skeletal repair, both as mass produced off-the-shelf implants and personalised, patient-specific prostheses. From replacing large volumes of disease-affected bone to complex, multi-material reconstructions, almost every part of the human skeleton has been replaced with an EBM manufactured analog to achieve macroscopic anatomical-mimickry. However, various questions regarding long-term performance of patient-specific implants remain unaddressed. Directions for further development include designing personalised implants and prostheses based on simulated loading conditions and accounting for trabecular bone microstructure with respect to physiological factors such as patient's age and disease status.
Collapse
Affiliation(s)
- Anders Palmquist
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Martina Jolic
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eduard Hryha
- Department of Materials and Manufacturing Technologies, Chalmers University of Technology, Gothenburg, Sweden
| | - Furqan A Shah
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| |
Collapse
|
25
|
Sato M, Shah FA. Contributions of Resin Cast Etching to Visualising the Osteocyte Lacuno-Canalicular Network Architecture in Bone Biology and Tissue Engineering. Calcif Tissue Int 2023; 112:525-542. [PMID: 36611094 PMCID: PMC10106349 DOI: 10.1007/s00223-022-01058-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/21/2022] [Indexed: 01/09/2023]
Abstract
Recent years have witnessed an evolution of imaging technologies towards sophisticated approaches for visualising cells within their natural environment(s) and for investigating their interactions with other cells, with adjacent anatomical structures, and with implanted biomaterials. Resin cast etching (RCE) is an uncomplicated technique involving sequential acid etching and alkali digestion of resin embedded bone to observe the osteocyte lacuno-canalicular network using scanning electron microscopy. This review summarises the applicability of RCE to bone and the bone-implant interface. Quantitative parameters such as osteocyte size, osteocyte density, and number of canaliculi per osteocyte, and qualitative metrics including osteocyte shape, disturbances in the arrangement of osteocytes and canaliculi, and physical communication between osteocytes and implant surfaces can be investigated. Ageing, osteoporosis, long-term immobilisation, spinal cord injury, osteoarthritis, irradiation, and chronic kidney disease have been shown to impact osteocyte lacuno-canalicular network morphology. In addition to titanium, calcium phosphates, and bioactive glass, observation of direct connectivity between osteocytes and cobalt chromium provides new insights into the osseointegration potential of materials conventionally viewed as non-osseointegrating. Other applications include in vivo and in vitro testing of polymer-based tissue engineering scaffolds and tissue-engineered ossicles, validation of ectopic osteochondral defect models, ex vivo organ culture of whole bones, and observing the effects of gene dysfunction/deletion on the osteocyte lacuno-canalicular network. Without additional contrast staining, any resin embedded specimen (including clinical biopsies) can be used for RCE. The multitude of applications described here attest to the versatility of RCE for routine use within correlative analytical workflows, particularly in biomaterials science.
Collapse
Affiliation(s)
- Mari Sato
- Oral Biochemistry and Molecular Biology, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Furqan A Shah
- Department of Biomaterials, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| |
Collapse
|
26
|
Li J, Wang J, Lv J, Bai J, Meng S, Li J, Wu H. The application of additive manufacturing technology in pelvic surgery: A bibliometrics analysis. Front Bioeng Biotechnol 2023; 11:1123459. [PMID: 37091335 PMCID: PMC10117774 DOI: 10.3389/fbioe.2023.1123459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/28/2023] [Indexed: 04/25/2023] Open
Abstract
With the development of material science, additive manufacturing technology has been employed for pelvic surgery, addressing the challenges, such as the complex structure of the pelvis, difficulty in exposing the operative area, and poor visibility, of the traditional pelvic surgery. However, only limited studies have been done to review the research hotspots and trends of the additive manufacturing technology applied for pelvic surgery. In this study, we comprehensively analyzed the literatures related to additive manufacturing technology in pelvic surgery by a bibliometrics analysis and found that additive manufacturing technology is widely used in several aspects of preoperative diagnosis, preoperative planning, intraoperative navigation, and personalized implants for pelvic surgery. Firstly, we searched and screened 856 publications from the Web of Science Core Collection (WoSCC) with TS = (3D printing OR 3D printed OR three-dimensional printing OR additive manufacturing OR rapid prototyping) AND TS = (pelvis OR sacrum OR ilium OR pubis OR ischium OR ischia OR acetabulum OR hip) as the search strategy. Then, 565 of these were eliminated by evaluating the titles and abstracts, leaving 291 pieces of research literature whose relevant information was visually displayed using VOSviewer. Furthermore, 10 publications with high citations were selected by reading all publications extensively for carefully evaluating their Titles, Purposes, Results, Limitations, Journal of affiliation, and Citations. Our results of bibliometric analysis demonstrated that additive manufacturing technology is increasingly applied in pelvic surgery, providing readers with a valuable reference for fully comprehending the research hotspots and trends in the application of additive manufacturing technology in pelvic surgery.
Collapse
Affiliation(s)
- Jian Li
- Department of Orthopaedics, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Jiani Wang
- Department of Paediatric Medicine, Shanxi Medical University, Taiyuan, China
| | - Jia Lv
- Department of Orthopaedics, The Second Affiliated Hospital of Shanxi Medical University, Taiyuan, China
| | - Junjun Bai
- Department of Orthopaedics, The Second Affiliated Hospital of Shanxi Medical University, Taiyuan, China
| | - Shichao Meng
- Department of Orthopaedics, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Jinxuan Li
- Department of Orthopaedics, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Hua Wu
- Department of Orthopaedics, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
- Department of Orthopaedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Hua Wu,
| |
Collapse
|
27
|
Liang H, Wang J, Yang Y, Niu T, Du Z, Zang J, Wei R, Yan T, Tang X, Guo W. Reconstruction With a 3D-Printed Megaprosthesis With Ankle Arthrodesis After Distal Tibial Tumor Resection. Foot Ankle Int 2022; 43:1450-1459. [PMID: 35932107 DOI: 10.1177/10711007221115188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reconstruction after en bloc resection of the distal tibia has remained an unsettled issue despite many attempts with bone grafts or prostheses in the past. Failures of the previous methods have been attributed to inadequate mechanical strength, poor articular stability, failed osseointegration, and poor soft tissue coverage. To overcome these shortcomings, we designed and applied a 3D-printed megaprosthesis with ankle arthrodesis. METHODS A total of 13 patients underwent resection of a distal tibial tumor and reconstruction with a 3D-printed distal tibial megaprosthesis between January 2017 and November 2020. Mean age was 14.9±6.5 years. Diagnoses included 11 cases of osteosarcoma and 1 case each of low-grade phosphaturic mesenchymal tumor and rhabdomyosarcoma. Baseline characteristics, operative data, complication profiles, and oncologic, and functional outcomes were reviewed and analyzed. RESULTS All 13 cases attained a wide or marginal resection. During a mean follow-up of 26.8±10.6 months, 1 patient experienced local recurrence and distant metastasis, whereas 3 other patients only developed distant metastasis. Periprosthetic infection subsequent to paronychia occurred in 1 patient 24 months after the operation. No other complications were observed. By the last follow-up, the mean MSTS-93 score was 28.0±1.5. CONCLUSION In this relatively small cohort with short-term follow-up, reconstruction with the 3D-printed megaprosthesis with ankle arthrodesis was found to be a safe and efficacious method after resection of a distal tibial malignancy.
Collapse
Affiliation(s)
- Haijie Liang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Xicheng District, Beijing, China
| | - Jichuan Wang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Xicheng District, Beijing, China
| | - Yi Yang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Xicheng District, Beijing, China
| | - Tianli Niu
- Musculoskeletal Tumor Center, Peking University People's Hospital, Xicheng District, Beijing, China
| | - Zhiye Du
- Musculoskeletal Tumor Center, Peking University People's Hospital, Xicheng District, Beijing, China
| | - Jie Zang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Xicheng District, Beijing, China
| | - Ran Wei
- Musculoskeletal Tumor Center, Peking University People's Hospital, Xicheng District, Beijing, China
| | - Taiqiang Yan
- Musculoskeletal Tumor Center, Peking University People's Hospital, Xicheng District, Beijing, China
| | - Xiaodong Tang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Xicheng District, Beijing, China
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, Xicheng District, Beijing, China
| |
Collapse
|
28
|
Park JW, Park H, Kim JH, Kim HM, Yoo CH, Kang HG. Fabrication of a lattice structure with periodic open pores through three-dimensional printing for bone ingrowth. Sci Rep 2022; 12:17223. [PMID: 36241776 PMCID: PMC9568544 DOI: 10.1038/s41598-022-22292-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/12/2022] [Indexed: 01/06/2023] Open
Abstract
Lattice structures for implants can be printed using metal three-dimensional (3D)-printing and used as a porous microstructures to enhance bone ingrowth as orthopedic implants. However, designs and 3D-printed products can vary. Thus, we aimed to investigate whether targeted pores can be consistently obtained despite printing errors. The cube-shaped specimen was printed with one side 15 mm long and a full lattice with a dode-thin structure of 1.15, 1.5, and 2.0 mm made using selective laser melting. Beam compensation was applied, increasing it until the vector was lost. For each specimen, the actual unit size and strut thickness were measured 50 times. Pore size was calculated from unit size and strut thickness, and porosity was determined from the specimen's weight. The actual average pore sizes for 1.15, 1.5, and 2.0 mm outputs were 257.9, 406.2, and 633.6 μm, and volume porosity was 62, 70, and 80%, respectively. No strut breakage or gross deformation was observed in any 3D-printed specimens, and the pores were uniformly fabricated with < 10% standard deviation. The actual micrometer-scaled printed structures were significantly different to the design, but this error was not random. Although the accuracy was low, precision was high for pore cells, so reproducibility was confirmed.
Collapse
Affiliation(s)
- Jong Woong Park
- grid.410914.90000 0004 0628 9810Orthopaedic Oncology Clinic, Center for Rare Cancers, National Cancer Center, Goyang-si, Gyeonggi-do Republic of Korea ,grid.410914.90000 0004 0628 9810Surgical Oncology branch, Division of Clinical Research, National Cancer Center, Goyang-si, Gyeonggi-do Republic of Korea
| | - Hyenmin Park
- grid.410914.90000 0004 0628 9810Surgical Oncology branch, Division of Clinical Research, National Cancer Center, Goyang-si, Gyeonggi-do Republic of Korea
| | - June Hyuk Kim
- grid.410914.90000 0004 0628 9810Orthopaedic Oncology Clinic, Center for Rare Cancers, National Cancer Center, Goyang-si, Gyeonggi-do Republic of Korea
| | | | | | - Hyun Guy Kang
- grid.410914.90000 0004 0628 9810Orthopaedic Oncology Clinic, Center for Rare Cancers, National Cancer Center, Goyang-si, Gyeonggi-do Republic of Korea
| |
Collapse
|
29
|
Zhu D, Wang L, Fu J, Guo Z, Wang Z, Fan H. Comparison of customized 3D-printed prosthesis and screw-rod-cage system reconstruction following resection of periacetabular tumors. Front Oncol 2022; 12:953266. [PMID: 36303843 PMCID: PMC9592706 DOI: 10.3389/fonc.2022.953266] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background and purpose Various operative methods are used for reconstructing pelvic girdle after resection of primary malignant periacetabular tumor has been reported. The objective of this study was to evaluate the accuracy, effectiveness, and safety of customized three dimensional-printed prosthesis (3DP) in the reconstruction of bone defects compared with conventional reconstruction using the screw-rod-cage system. Methods A retrospective case–control analysis of 40 patients who underwent pelvic tumor resection and reconstruction with a customized 3D-printed prosthesis (3DP), or screw-rod-cage system (SRCS) between January 2010 and December 2019 was performed. The minimum follow-up time for patients alive was 2 years. Blood loss, operation time, complications, surgical margin, local recurrence, distant metastases, status at time of latest follow-up, MSTS-93 score, Harris hip score, and postoperative radiographic parameters were recorded. Moreover, overall survival, tumor-free survival, and prosthesis survival rates in both groups were compared. Results Customized 3DP reconstruction was performed in 15 patients, and SRCS reconstruction was done in 25 patients. The group of patients treated with customized 3DP reconstruction had significantly shorter operation time (323.7 ± 83.7 vs. 393.6 ± 98.8 min; P = 0.028) and more precise (all P < 0.05) radiographic reconstruction parameters than patients in the SRCS group. Fewer complications (P = 0.026), better MSTS score (P = 0.030), and better Harris hip score (P = 0.016) were achieved in the 3DP group. Furthermore, the survival rate of prosthesis was also significantly better in the 3DP group (P = 0.039). However, blood loss, surgical margin, local recurrence, distant metastases, and status at time of latest follow-up had no significant difference between two groups. Conclusion Compared with the screw-rod-cage system reconstruction, the customized 3D-printed prosthesis reconstruction is equally safe and effective, but it is more accurate and time-saving and is associated with fewer complications.
Collapse
Affiliation(s)
- Dongze Zhu
- Department of Orthopedic Surgery, Xi-jing Hospital, Fourth Military Medical University, Xi’an, China
| | - Lei Wang
- Department of Orthopedic Surgery, Xi-jing Hospital, Fourth Military Medical University, Xi’an, China
| | - Jun Fu
- Department of Orthopedic Surgery, Xi-jing Hospital, Fourth Military Medical University, Xi’an, China
| | - Zheng Guo
- Department of Orthopedic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi’an, China
| | - Zhen Wang
- Department of Orthopedic Surgery, Xi-jing Hospital, Fourth Military Medical University, Xi’an, China
| | - Hongbin Fan
- Department of Orthopedic Surgery, Xi-jing Hospital, Fourth Military Medical University, Xi’an, China
- *Correspondence: Hongbin Fan,
| |
Collapse
|
30
|
Gao J, Huang R, Yin H, Song D, Meng T. Research hotspots and trends of chordoma: A bibliometric analysis. Front Oncol 2022; 12:946597. [PMID: 36185236 PMCID: PMC9523362 DOI: 10.3389/fonc.2022.946597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Chordoma is a type of mesenchymal malignancy with a high recurrence rate and poor prognosis. Due to its rarity, the tumorigenic mechanism and optimal therapeutic strategy are not well known. Methods All relevant articles of chordoma research from 1 January 2000 to 26 April 2022 were obtained from Web of Science Core Collection database. Blibliometrix was used to acquire basic publication data. Visualization and data table of collaboration network, dynamic analysis, trend topics, thematic map, and factorial analysis were acquired using Blibliometrix package. VOSviewer was used to generate a visualization map of co-citation analysis and co-occurrence. Results A total of 2,285 articles related to chordoma were identified. The most influential and productive country/region was the United States, and Capital Medical University has published the most articles. Among all high-impact authors, Adrienne M. Flanagan had the highest average citation rate. Neurosurgery was the important periodical for chordoma research with the highest total/average citation rate. We focused on four hotspots in recent chordoma research. The research on surgical treatment and radiotherapy was relatively mature. The molecular signaling pathway, targeted therapy and immunotherapy for chordoma are not yet mature, which will be the future trends of chordoma research. Conclusion This study indicates that chordoma studies are increasing. Surgery and radiotherapy are well reported and always play fundamental roles in chordoma treatment. The molecular signaling pathway, targeted therapy, and immunotherapy of chordoma are the latest research hotspots.
Collapse
Affiliation(s)
- Jianxuan Gao
- Department of Spine Surgery, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- Tongji University Cancer Center, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Runzhi Huang
- Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Tongji University, Shanghai, China
| | - Huabin Yin
- Department of Spine Surgery, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Dianwen Song
- Department of Spine Surgery, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- *Correspondence: Tong Meng, ; Dianwen Song,
| | - Tong Meng
- Department of Spine Surgery, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- Tongji University Cancer Center, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- *Correspondence: Tong Meng, ; Dianwen Song,
| |
Collapse
|
31
|
Valente G, Benedetti MG, Paolis MD, Sambri A, Frisoni T, Leardini A, Donati DM, Taddei F. Long-term functional recovery in patients with custom-made 3D-printed anatomical pelvic prostheses following bone tumor excision. Gait Posture 2022; 97:73-79. [PMID: 35914386 DOI: 10.1016/j.gaitpost.2022.07.248] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Anatomical custom-made prostheses make it possible to reconstruct complicated bone defects following excision of bone tumors, thanks to 3D-printed technology. To date, clinical measures have been used to report clinical-functional outcome and provide evidence for the effectiveness of this new surgical approach. However, there are no studies that quantified the achievable recovery during common activities by using instrumental clinical-functional evaluation in these patients. RESEARCH QUESTION What is the motor performance, functional outcome and quality of life in patients with custom-made 3D-printed pelvic prostheses following bone tumor? METHODS To analyze motor performance, six patients performed motion analysis during five motor activities at follow-up of 32 ± 18 months. Joint angles, ground reaction forces and joint moments of the operated and contralateral limbs were compared. On-off activity of lower-limb muscles were calculated from electromyography and compared to a healthy matched population. To analyze functional outcome and quality of life, differences in measured hip abductor strength between limbs were evaluated, as well as clinical-functional scores (Harris Hip Score, Barthel Index, Musculoskeletal Tumor Society score), and quality of life (SF-36 health survey). RESULTS We found only slight differences in joint kinematics when comparing operated and contralateral limb. The activity of gluteal muscles was normal, while hamstrings showed out-of-phase activities. Ground reaction forces and hip moments showed asymmetries between limbs, particularly in more demanding motor activities. We found a mean difference in hip abductor strength of 48 ± 82 N between limbs, good clinical-functional scores, and quality of life scores within normative. SIGNIFICANCE Our study showed optimal long-term results in functional recovery, mainly achieved through recovery of the gluteal function, although minor impairments were found, which may be considered for future improvement of this innovative surgery. The effect of a more loaded contralateral limb on internal loads and long-term performance of the implant remains unknown and deserves further investigation.
Collapse
Affiliation(s)
- Giordano Valente
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Maria Grazia Benedetti
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Massimiliano De Paolis
- Department of Orthopaedics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Andrea Sambri
- Department of Orthopaedics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Tommaso Frisoni
- Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | | | - Fulvia Taddei
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| |
Collapse
|
32
|
Johansson ML, Shah FA, Eeg-Olofsson M, Monksfield P, Thomsen P, Palmquist A. Long-term osseointegration of laser-ablated hearing implants in sheep cranial bone. Front Surg 2022; 9:885964. [PMID: 36117815 PMCID: PMC9470750 DOI: 10.3389/fsurg.2022.885964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 08/12/2022] [Indexed: 11/23/2022] Open
Abstract
Osseointegration, the ability for an implant to be anchored in bone tissue with direct bone-implant contact and allowing for continuous adaptive remodelling, is clinically used in different reconstructive fields, such as dentistry, orthopedics and otology. The latter uses a bone conducting sound processor connected to a skin-penetrating abutment that is mounted on a titanium implant placed in the temporal bone, thereby acting as a path for transmission of the vibrations generated by the sound processor. The success of the treatment relies on bone healing and osseointegration, which could be improved by surface modifications. The aim of this study was to evaluate the long-term osseointegration in a sheep skull model and compare a laser-ablated implant surface with a machined implant. Commercially available 4 mm titanium implants, either with a machined (Wide Ponto) or a laser-ablated surface (Ponto BHX, Oticon Medical, Sweden), were used in the current study. The surfaces were evaluated by scanning electron microscopy. The implantation was performed with a full soft tissue flap and the osteotomy was prepared using the MIPS drill kit (Oticon Medical, Sweden) prior to installation of the implants in the frontal bone of eight female sheep. After five months, biopsies including the implant and surrounding bone tissue obtained, processed and analysed using histology, histomorphometry, scanning electron microscopy and Raman spectroscopy. The animals healed well, without signs of adverse events. Histomorphometry showed a large amount of bone tissue around both implant types, with 75% of the threaded area occupied by bone for both implant types. A large amount of bone-implant contact was observed for both implant types, with 67%–71% of the surface covered by bone. Both implant types were surrounded by mature remodelled lamellar bone with high mineral content, corroborating the histological observations. The current results show that the laser-ablated surface induces healing similar to the well-known clinically used machined surface in ovine cranial bone. In conclusion, the present long-term experimental results indicate that a laser-ablated implant performs equally well as a clinically used implant with a machined surface. This, together with previously reported, improved early biomechanical anchorage, suggests future, safe and efficient clinical potential.
Collapse
Affiliation(s)
- Martin Lars Johansson
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research and Technology, Oticon Medical AB, Askim, Sweden
- Correspondence: Martin Lars Johansson
| | - Furqan A. Shah
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Måns Eeg-Olofsson
- Department of Otorhinolaryngology Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Monksfield
- ENT Department, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Peter Thomsen
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Palmquist
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
33
|
Titanium nanotopography induces osteocyte lacunar-canalicular networks to strengthen osseointegration. Acta Biomater 2022; 151:613-627. [PMID: 35995407 DOI: 10.1016/j.actbio.2022.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 11/20/2022]
Abstract
Osteocyte network architecture is closely associated with bone turnover. The cellular mechanosensing system regulates osteocyte dendrite formation by enhancing focal adhesion. Therefore, titanium surface nanotopography might affect osteocyte network architecture and improve the peri-implant bone tissue quality, leading to strengthened osseointegration of bone-anchored implants. We aimed to investigate the effects of titanium nanosurfaces on the development of osteocyte lacunar-canalicular networks and osseointegration of dental implants. Alkaline etching created titanium nanosurfaces with anisotropically patterned dense nanospikes, superhydrophilicity, and hydroxyl groups. MLO-Y4 mouse osteocyte-like cells cultured on titanium nanosurfaces developed neuron-like dendrites with increased focal adhesion assembly and gap junctions. Maturation was promoted in osteocytes cultured on titanium nanosurfaces compared to cells cultured on machined or acid-etched micro-roughened titanium surfaces. Osteocytes cultured in type I three-dimensional collagen gels for seven days on nano-roughened titanium surfaces displayed well-developed interconnectivity with highly developed dendrites and gap junctions compared to the poor interconnectivity observed on the other titanium surfaces. Even if superhydrophilicity and hydroxyl groups were maintained, the loss of anisotropy-patterned nanospikes reduced expression of gap junction in osteocytes cultured on alkaline-etched titanium nanosurfaces. Four weeks after placing the titanium nanosurface implants in the upper jawbone of wild-type rats, osteocytes with numerous dendrites were found directly attached to the implant surface, forming well-developed lacunar-canalicular networks around the nano-roughened titanium implants. The osseointegration strength of the nano-roughened titanium implants was significantly higher than that of the micro-roughened titanium implants. These data indicate that titanium nanosurfaces promote osteocyte lacunar-canalicular network development via nanotopographical cues and strengthen osseointegration. STATEMENT OF SIGNIFICANCE: The clinical stability of bone-anchoring implant devices is influenced by the bone quality. The osteocyte network potentially affects bone quality and is established by the three-dimensional (3D) connection of neuron-like dendrites of well-matured osteocytes within the bone matrix. No biomaterials are known to regulate formation of the osteocyte network. The present study provides the first demonstration that titanium nanosurfaces with nanospikes created by alkali-etching treatment enhance the 3D formation of osteocyte networks by promoting osteocyte dendrite formation and maturation by nanotopographic cues, leading to strengthened osseointegration of titanium implants. Osteocytes attached to the titanium nanosurfaces via numerous cellular projections. The success of osteocyte regulation by nanotechnology paves the way for development of epoch-making technologies to control bone quality.
Collapse
|
34
|
Tang Y, Zhang Y, Meng Z, Sun Q, Peng L, Zhang L, Lu W, Liang W, Chen G, Wei Y. Accuracy of additive manufacturing in stomatology. Front Bioeng Biotechnol 2022; 10:964651. [PMID: 36051587 PMCID: PMC9424550 DOI: 10.3389/fbioe.2022.964651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
With the rapid development of the three-dimensional (3D) printing technology in recent decades, precise and personalized manufacturing has been achieved gradually, bringing benefit to biomedical application, especially stomatology clinical practice. So far, 3D printing has been widely applied to prosthodontics, orthodontics, and maxillofacial surgery procedures, realizing accurate, efficient operation processes and promising treatment outcomes. Although the printing accuracy has improved, further exploration is still needed. Herein, we summarized the various additive manufacturing techniques and their applications in dentistry while highlighting the importance of accuracy (precision and trueness).
Collapse
Affiliation(s)
- Yao Tang
- Department of Orthodontics, Cranial Facial Growth and Development Center, Peking University School and Hospital of Stomatology, Beijing, China
- NMPA Key Laboratory for Dental Materials, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China
| | - Yunfan Zhang
- Department of Orthodontics, Cranial Facial Growth and Development Center, Peking University School and Hospital of Stomatology, Beijing, China
- NMPA Key Laboratory for Dental Materials, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China
| | - Zhaoqiang Meng
- Department of Geriatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Qiannan Sun
- Department of Orthodontics, Cranial Facial Growth and Development Center, Peking University School and Hospital of Stomatology, Beijing, China
- NMPA Key Laboratory for Dental Materials, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China
| | - Liying Peng
- Department of Orthodontics, Cranial Facial Growth and Development Center, Peking University School and Hospital of Stomatology, Beijing, China
- NMPA Key Laboratory for Dental Materials, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China
| | - Lingyun Zhang
- Department of Orthodontics, Cranial Facial Growth and Development Center, Peking University School and Hospital of Stomatology, Beijing, China
- NMPA Key Laboratory for Dental Materials, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China
| | - Wenhsuan Lu
- Department of Orthodontics, Cranial Facial Growth and Development Center, Peking University School and Hospital of Stomatology, Beijing, China
- NMPA Key Laboratory for Dental Materials, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China
| | - Wei Liang
- Department of Orthodontics, Cranial Facial Growth and Development Center, Peking University School and Hospital of Stomatology, Beijing, China
- NMPA Key Laboratory for Dental Materials, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China
- *Correspondence: Wei Liang, ; Gui Chen, ; Yan Wei,
| | - Gui Chen
- Department of Orthodontics, Cranial Facial Growth and Development Center, Peking University School and Hospital of Stomatology, Beijing, China
- NMPA Key Laboratory for Dental Materials, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China
- *Correspondence: Wei Liang, ; Gui Chen, ; Yan Wei,
| | - Yan Wei
- Department of Geriatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
- *Correspondence: Wei Liang, ; Gui Chen, ; Yan Wei,
| |
Collapse
|
35
|
Xiang H, Van Paepegem W, Kestens LAI. Study of Microstructural Morphology of Ti-6Al-4V Alloy by Crystallographic Analysis and Phase Field Simulation. MATERIALS 2022; 15:ma15155325. [PMID: 35955256 PMCID: PMC9369925 DOI: 10.3390/ma15155325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/26/2022] [Accepted: 07/30/2022] [Indexed: 01/27/2023]
Abstract
Formation of a habit plane during martensitic transformation is related to an invariant plane strain transformation, which involves dislocation glide and twins. In the current work, the Phenomenological Theory of Martensitic Transformation (PTMT) is employed to study the crystallographic features while the phase field simulation is used to study the microstructure evolution for martensitic transformation of Ti-6Al-4V alloy. Results show that mechanical constraints play a key role in the microstructure evolution. It is shown that a twinned structure with very small twinned variants is geometrically difficult to form due to the lattice parameters of Ti-6Al-4V alloy. It is concluded that the predicted habit plane from the PTMT is consistent with results of the micro-elastic theory. The formation of a triangular morphology is favored geometrically and elastically.
Collapse
Affiliation(s)
- Hao Xiang
- Department of Electromechanical, Systems and Metal Engineering, Faculty of Engineering and Architecture, Ghent University, Tech-Lane Ghent Science Park-Campus A, Technologiepark Zwijnaarde 46, B-9052 Ghent, Belgium
- Correspondence: (H.X.); (L.A.I.K.)
| | - Wim Van Paepegem
- Department of Materials, Textiles and Chemical Engineering (MaTCh), Faculty of Engineering and Architecture, Ghent University, Tech-Lane Ghent Science Park-Campus A, Technologiepark Zwijnaarde 46, B-9052 Ghent, Belgium;
| | - Leo A. I. Kestens
- Department of Electromechanical, Systems and Metal Engineering, Faculty of Engineering and Architecture, Ghent University, Tech-Lane Ghent Science Park-Campus A, Technologiepark Zwijnaarde 46, B-9052 Ghent, Belgium
- Correspondence: (H.X.); (L.A.I.K.)
| |
Collapse
|
36
|
Reconditioning by Welding of Prosthesis Obtained through Additive Manufacturing. METALS 2022. [DOI: 10.3390/met12071177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Biocompatible titanium alloys are increasingly being used to make custom medical implants using additive manufacturing processes. This paper considered the welding reconditioning of a titanium-alloy customized additive manufactured hip implant with several manufacturing defects. The personalized implants are made starting from a Computer-Aided Design (CAD) model as a direct result from the medical imaging investigations of the areas of interest. Then the customized implant is fabricated using an additive manufacturing process (in this case Powder Bed Fusion—Direct Metal Laser Sintering—DMLS). The analysis of the chemical composition values as well as the values of the mechanical properties of the samples obtained via DMLS additive manufacturing process, revealed that such a manufacturing process can be successfully used to make customized surgical implants. The mechanical properties values of the DMLS samples are approximately equal to those specified by the manufacturer of the titanium powder used for sintering. On average, the tensile strength was found to be 24.75% higher, while yield strength 22.7% higher than the values provided in the standard for surgical implants applications. In case the additive manufacturing process produces products with defects one might want to try and recover the implant due to costs and time constraints. The Tungsten Inert Gas (TIG) welding reconditioning process with ERTi-5 Ti64 rod for welding titanium alloys with a content of 6% aluminum and 4% vanadium filler material was used to restore the geometric characteristics as well as the functional properties of a custom hip medical prosthesis. After welding depositing successive layers of materials, the surfaces of the prosthesis were machined to restore the functional properties according to the characteristics of the original 3D model. A 3D scan was used to compare the geometrical characteristics between the original part and reconditioned one. Deviations were less than 1 mm and were acceptable from the medical point of view.
Collapse
|
37
|
Liang H, Guo W, Yang Y, Li D, Yang R, Tang X, Yan T. Efficacy and safety of a 3D-printed arthrodesis prosthesis for reconstruction after resection of the proximal humerus: preliminary outcomes with a minimum 2-year follow-up. BMC Musculoskelet Disord 2022; 23:635. [PMID: 35787280 PMCID: PMC9251937 DOI: 10.1186/s12891-022-05581-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 06/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this study was to investigate the feasibility of using a three-dimensional (3D)-printed arthrodesis prosthesis for reconstruction of the proximal humeral defect after tumor resection. Methods A novel proximal humeral prosthesis was designed to restore bone continuity and shoulder arthrodesis and was fabricated via 3D printing technology. Ten patients with primary malignancies in the proximal humerus underwent intra-articular resection and replacement with this prosthesis from 2017 to 2019. Baseline and operative data, oncological and prosthetic survival, and functional status were summarized. Results This cohort consisted of 9 males and 1 female with a mean age of 32.1 ± 16.1 years. Diagnoses included 5 cases of osteosarcoma, 3 cases of chondrosarcoma and 1 each case of undifferentiated pleomorphic sarcoma and malignant myoepithelioma. The mean operative duration, intraoperative hemorrhage and postoperative length of hospitalization were 151.5 ± 61.0 min, 410.0 ± 353.4 ml and 5.3 ± 1.9 d, respectively. The mean follow-up duration was 29.3 ± 6.4 months, with a minimum of 24 months for the surviving patients. Two patients experienced local recurrence, and four patients developed distant metastases. Detachment of the taper occurred in two patients. One was managed conservatively, and the other received amputation due to concurrent tumor recurrence. The mean MSTS-93 and ASES scores and ranges of forwards flexion and abduction were 24.9 ± 3.1, 79.4 ± 8.3, 71.3 ± 19.4°, and 61.3 ± 16.4°, respectively. The functional outcomes were independent of the preservation of the axillary nerve. Histological study of the glenoid component showed evidence of bone ingrowth at the bone-prosthesis porous interface. Conclusion Application of the 3D-printed arthrodesis prosthesis might be a safe and efficacious method for functional reconstruction in patients who underwent resection of the proximal humerus, especially for those without preservation of the axillary nerve. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05581-6.
Collapse
Affiliation(s)
- Haijie Liang
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Xizhimen Nan 11#, Xicheng District, Beijing, 100044, China
| | - Wei Guo
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Xizhimen Nan 11#, Xicheng District, Beijing, 100044, China.
| | - Yi Yang
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Xizhimen Nan 11#, Xicheng District, Beijing, 100044, China
| | - Dasen Li
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Xizhimen Nan 11#, Xicheng District, Beijing, 100044, China
| | - Rongli Yang
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Xizhimen Nan 11#, Xicheng District, Beijing, 100044, China
| | - Xiaodong Tang
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Xizhimen Nan 11#, Xicheng District, Beijing, 100044, China
| | - Taiqiang Yan
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Xizhimen Nan 11#, Xicheng District, Beijing, 100044, China
| |
Collapse
|
38
|
Zhou R, Xue H, Wang J, Wang X, Wang Y, Zhang A, Zhang J, Han Q, Zhao X. Improving the Stability of a Hemipelvic Prosthesis Based on Bone Mineral Density Screw Channel and Prosthesis Optimization Design. Front Bioeng Biotechnol 2022; 10:892385. [PMID: 35706507 PMCID: PMC9189365 DOI: 10.3389/fbioe.2022.892385] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
In pelvic reconstruction surgery, the hemipelvic prosthesis can cause significant changes in stress distribution due to its high stiffness, and its solid structure is not suitable for osseointegration. The purpose of this study was to identify a novel bone mineral density screw channel and design the structure of the prosthesis so as to improve the distribution of stress, promote bone growth, and enhance the biomechanical properties of the prosthesis. The mechanical characteristics of bone mineral density screw and traditional screw were compared by finite element analysis method, and redesigned by topology optimization. The direction of the newly proposed screw channel was the posterolateral entrance of the auricular surface, ending at the contralateral sacral cape. Compared to the original group, the maximum stress of the optimized prosthesis was decreased by 24.39%, the maximum stress of the sacrum in the optimized group was decreased by 27.23%, and the average strain energy density of the sacrum in the optimized group was increased by 8.43%. On the surface of screw and connecting plate, the area with micromotion more than 28 μm is reduced by 12.17%. On the screw surface, the area with micromotion more than 28 μm is reduced by 22.9%. The newly determined screw channel and optimized prosthesis design can effectively improve the biomechanical properties of a prosthesis and the microenvironment of osseointegration. This method can provide a reference for the fixation of prostheses in clinical pelvic reconstruction.
Collapse
|
39
|
Sayardoust S, Norstedt W, Shah FA. The long-term impact of alveolar ridge preservation with xenograft bone mineral on peri-implant health after 5 years in function: A retrospective cohort study of 108 patients assessed clinically and radiologically. Clin Exp Dent Res 2022; 8:640-649. [PMID: 35510846 PMCID: PMC9209797 DOI: 10.1002/cre2.583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 04/11/2022] [Accepted: 04/20/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives When teeth are lost, dental implants contribute to improved oral function and quality of life. Limitations in dental implant placement arising from poor bone anatomy may be circumvented via alveolar ridge preservation (ARP). The aim is to evaluate the long‐term impact of ARP on peri‐implant health and the relationship with common risk indicators such as smoking and history of periodontitis. Materials and Methods One hundred and eight patients were enrolled in this retrospective cohort study with 308 implants. Of these, ∼41% were placed in bone sites that had previously received ARP with deproteinized bovine bone mineral xenograft. Association between baseline variables: ARP, age, gender, number of implants per patient, anatomical site, smoking, and previous history of grade III/IV periodontitis, and outcome variables: mucositis, peri‐implantitis, implant loss, full‐mouth plaque score (FMPS), full‐mouth bleeding score, and marginal bone loss (MBL) was evaluated using both univariate and multivariate models. Results After 5 years, the overall survival rate was 93.7%. The occurrence of peri‐implantitis was 21.3% and the extent of MBL was ~2.2 mm. Both peri‐implantitis occurrence and MBL were comparable between ARP+ and ARP−. Smoking is associated with higher FMPS and MBL. Conclusions The findings indicate that peri‐implant health can be maintained around dental implants for up to 5 years in ARP+ sites using Bio‐Oss®. Smoking is a major risk indicator for peri‐implantitis, whereas the association between history of periodontitis and the risk of peri‐implantitis, based on this specific, well‐maintained cohort and the specific implants used, remains inconclusive.
Collapse
Affiliation(s)
- Shariel Sayardoust
- Centre for Oral Health, School of Health and WelfareJönköping UniversityJönköpingSweden
- Department of PeriodontologyInstitute for Postgraduate Dental EducationJönköpingSweden
- Department of Biomaterials, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Wilhelm Norstedt
- Department of PeriodontologyInstitute for Postgraduate Dental EducationJönköpingSweden
| | - Furqan A. Shah
- Department of Biomaterials, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| |
Collapse
|
40
|
De Paolis M, Sambri A, Zucchini R, Frisoni T, Spazzoli B, Taddei F, Donati DM. Custom-made 3D-Printed Prosthesis in Periacetabular Resections Through a Novel Ileo-adductor Approach. Orthopedics 2022; 45:e110-e114. [PMID: 34978936 DOI: 10.3928/01477447-20211227-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Resection of sarcomas around the acetabulum presents major challenges. The resulting bone effect can be reconstructed with personalized custom-made prostheses. Patient-specific instruments (PSIs) have been demonstrated to be of added value for bone-cutting accuracy, and they may improve pelvic surgery. The authors describe a novel ileo-adductor approach for pelvic tumor surgery and report the preliminary results of 5 reconstructions using custom 3D-printed prostheses associated with PSI surgical guides. This combined technique allows an optimal restoration of the anatomy with reduced surgical time and reduced postoperative complications such as infections and wound healing problems. [Orthopedics. 2022;45(2):e110-e114.].
Collapse
|
41
|
Gu Y, Sun Y, Shujaat S, Braem A, Politis C, Jacobs R. 3D-printed porous Ti6Al4V scaffolds for long bone repair in animal models: a systematic review. J Orthop Surg Res 2022; 17:68. [PMID: 35109907 PMCID: PMC8812248 DOI: 10.1186/s13018-022-02960-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/21/2022] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Titanium and its alloys have been widely employed for bone tissue repair and implant manufacturing. The rapid development of three-dimensional (3D) printing technology has allowed fabrication of porous titanium scaffolds with controllable microstructures, which is considered to be an effective method for promoting rapid bone formation and decreasing bone absorption. The purpose of this systematic review was to evaluate the osteogenic potential of 3D-printed porous Ti6Al4V (Ti64) scaffold for repairing long bone defects in animal models and to investigate the influential factors that might affect its osteogenic capacity. METHODS Electronic literature search was conducted in the following databases: PubMed, Web of Science, and Embase up to September 2021. The SYRCLE's tool and the modified CAMARADES list were used to assess the risk of bias and methodological quality, respectively. Due to heterogeneity of the selected studies in relation to protocol and outcomes evaluated, a meta-analysis could not be performed. RESULTS The initial search revealed 5858 studies. Only 46 animal studies were found to be eligible based on the inclusion criteria. Rabbit was the most commonly utilized animal model. A pore size of around 500-600 µm and porosity of 60-70% were found to be the most ideal parameters for designing the Ti64 scaffold, where both dodecahedron and diamond pores optimally promoted osteogenesis. Histological analysis of the scaffold in a rabbit model revealed that the maximum bone area fraction reached 59.3 ± 8.1% at weeks 8-10. Based on micro-CT assessment, the maximum bone volume fraction was found to be 34.0 ± 6.0% at weeks 12. CONCLUSIONS Ti64 scaffold might act as a promising medium for providing sufficient mechanical support and a stable environment for new bone formation in long bone defects. Trail registration The study protocol was registered in the PROSPERO database under the number CRD42020194100.
Collapse
Affiliation(s)
- Yifei Gu
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Yi Sun
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Sohaib Shujaat
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Annabel Braem
- Department of Materials Engineering, Biomaterials and Tissue Engineering Research Group, KU Leuven, 3000, Leuven, Belgium
| | - Constantinus Politis
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium. .,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium. .,Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
| |
Collapse
|
42
|
Wang H, Yuan C, Lin K, Zhu R, Zhang S. Modifying a 3D-Printed Ti6Al4V Implant with Polydopamine Coating to Improve BMSCs Growth, Osteogenic Differentiation, and In Situ Osseointegration In Vivo. Front Bioeng Biotechnol 2021; 9:761911. [PMID: 34926418 PMCID: PMC8678591 DOI: 10.3389/fbioe.2021.761911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022] Open
Abstract
Nowadays, 3D printing technology has been applied in dentistry to fabricate customized implants. However, the biological performance is unsatisfactory. Polydopamine (PDA) has been used to immobilize bioactive agents on implant surfaces to endow them with multiple properties, such as anti-infection and pro-osteogenesis, benefiting rapid osseointegration. Herein, we fabricated a PDA coating on a 3D-printed implant surface (3D-PDA) via the in situ polymerization method. Then the 3D-PDA implants' pro-osteogenesis capacity and the osseointegration performance were evaluated in comparison with the 3D group. The in vitro results revealed that the PDA coating modification increased the hydrophilicity of the implants, promoting the improvement of the adhesion, propagation, and osteogenic differentiation of bone marrow-derived mesenchymal stem cells (BMSCs) in vitro. Additionally, the 3D-PDA implant improved osteointegration performance in vivo. The present study suggested that PDA coating might be a feasible strategy to optimize 3D-printed implant surfaces, making a preliminary research basis for the subsequent work to immobilize bioactive factors on the 3D-printed implant surface.
Collapse
Affiliation(s)
- Hui Wang
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - Changyong Yuan
- School of Stomatology, Xuzhou Medical University, Xuzhou, China
| | - Kaili Lin
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - Rui Zhu
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Orthopaedic Department of Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shilei Zhang
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| |
Collapse
|
43
|
Use of a 3D-Printed Patient-Specific Surgical Jig and Ready-Made Total Sacral Endoprosthesis for Total Sacrectomy and Reconstruction. BIOMED RESEARCH INTERNATIONAL 2021. [PMID: 33812731 PMCID: PMC8687827 DOI: 10.1155/2021/3250002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective In the present study, the authors aimed to optimize the workflow of utilizing a 3D printing technique during surgical treatment for malignant sacral tumors, mainly on preparation of patient-specific surgical jigs and ready-made 3D-printed total sacral endoprosthesis. Methods Three patients with a malignant sacral tumor received total sacrectomy with preoperative design of a patient-specific 3D-printed cutting jig and endoprosthetic reconstruction. Size of ready-made 3D-printed endoprosthesis was determined based on preoperative images, planned surgical margin, and size of the endoprosthesis. A patient-specific cutting jig was designed with a bilateral cutting slot matching the bilateral planes of the implant precisely. The tumor was removed en bloc through a single posterior approach only, being followed by reconstruction with ready-made total sacral endoprosthesis. Results The mean time for preoperative design and manufacture of the surgical jig was 6.3 days. Surgical jigs were successfully used during surgery and facilitated the osteotomy. The mean operation time was 177 minutes (range 150-190 minutes). The mean blood loss was 3733 ml (range 3600-4000 ml). R0 resections were achieved in all the three cases proven by pathology. Evaluation of osteotomy accuracy was conducted by comparing preoperative plans and postoperative CT scans. The mean osteotomy deviation was 2.1 mm (range 0-4 mm), and mean angle deviation of osteotomy was 3.2° (range 0-10°). At a mean follow-up of 18.7 months, no local recurrence was observed. One patient had lung metastasis 15 months after surgery. Two patients were alive with no evidence of the disease. Conclusions The patient-specific surgical jig and ready-made 3D-printed total sacral endoprosthesis can shorten the surgical preparation time preoperatively, facilitating accurate osteotomy and efficient reconstruction intraoperatively. The workflow seems to be feasible and practical.
Collapse
|
44
|
Kumar L, Haleem A, Javaid M. Impact of three dimensional printing in orthopedics. GLOBAL HEALTH JOURNAL 2021. [DOI: 10.1016/j.glohj.2021.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
45
|
Ionic liquid treatment for efficient sample preparation of hydrated bone for scanning electron microscopy. Micron 2021; 153:103192. [PMID: 34896685 DOI: 10.1016/j.micron.2021.103192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 11/20/2022]
Abstract
This study presents a new protocol for preparing bone samples for scanning electron microscopy (SEM) using a room temperature ionic liquid (RTIL) treatment method. RTIL-based solutions can be adopted as an alternative to lengthy and laborious traditional means of preparation for SEM due to their unique low-vapour pressure and conductive properties. Applied to biological samples, RTILs can be used quickly and efficiently to observe hydrated, unfixed structures in typical SEM systems. This first-time feasibility study of the optimization of this protocol for bone was explored through various SEM modalities using two distinct ionic liquids, 1-ethyl-3-methylimidazolium tetrafluoroborate ([EMI][BF4]) and 1-butyl-3-methyl imidazolium tetrafluoroborate ([BMI][BF4]), at varying concentrations of 5, 10, and 25 % v/v in aqueous solution through an addition-based method. Based on qualitative observations in the SEM, a 60-second solution addition treatment of 10 % v/v [BMI][BF4] performed the best in imaging hydrated, unfixed bone samples, resulting in minimal charge buildup and no solution pooling on the surface. The treatment was applied effectively to a variety of bone samples, notably flat and polished, as well as highly topographical bone fracture surfaces of both healthy and osteoporotic human bone samples. In comparison to conventionally dehydrated bone, the RTIL treatment better preserved the natural bone structure, resulting in minimal microcracking in observed structures.
Collapse
|
46
|
Computer Assisted Surgery and 3D Printing in Orthopaedic Oncology: A Lesson Learned by Cranio-Maxillo-Facial Surgery. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11188584] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Primary bone sarcomas are rare tumors and surgical resection in combination with chemo and radiation therapy is the mainstay of treatment. Some specific anatomical sites still represent a reconstructive challenge due to their complex three-dimensional anatomy. In recent years, patient specific instruments along with 3D printing technology has come to represent innovative techniques in orthopaedic oncology. We retrospectively reviewed 23 patients affected by primary bone sarcoma treated with patient-specific instruments and 3D printing custom made prostheses. At follow up after approximately two years, the infection rate was 26%, mechanical complication rate 13%, and local recurrence rate 13% (with a five-years implant survival rate of 74%). Based on our experience, patient-specific instruments and 3D custom-made prostheses represents a reliable and safe technique for improving the accuracy of resection of primary bone tumour, with a particular use in pelvic surgery ameliorating functional results.
Collapse
|
47
|
Silver-Releasing Micro-/Nanoporous Coating on Additively Manufactured Macroporous Ti-Ta-Nb-Zr Scaffolds with High Osseointegration and Antibacterial Properties. COATINGS 2021. [DOI: 10.3390/coatings11060716] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The two major problems of titanium alloy surface of bone/dental implants were the lack of native tissue integration and associated infection. To solve these problems, the development of self-defending implants with intrinsic osteogenic properties has been highlighted, in which titanium alloy surfaces of bone/dental implants are endowed with antibacterial property by silver (Ag) incorporated in biomaterials. In this study, we biofunctionalized the surface of selective laser melting (SLM) manufactured volume-porous Ti-Ta-Nb-Zr scaffolds by using plasma electrolytic oxidation (PEO) as a way to eliminate the peri-operative bacterial load and promote osseointegration. In the experiment, the PEO process operated with three different concentration (1, 1, and 2 g/L) of a AgNO3 solution. As a result, a titanium oxide coating embedded with calcium and phosphorous and Ag was formed by one-step PEO treatment, and a presence of HAp was detected by X-ray diffraction (XRD) and XPS. In addition, Ag ions were found to be released from the scaffolds for at least 28 days, resulting in an effective prevention of bacterial adhesion and a decrease of the number of planktonic bacteria, with no sign of cytotoxicity shown simultaneously. Highly porosity micropores were formed on the surface of scaffolds after oxidation, and the mechanical properties did not show any signs of change. Besides, a strong calcium deposition and osteoconductive effect were found on the surface of PEO-treated Ag scaffolds. To sum up, this study reveals the potential of PEO coatings to biofunctionalize SLM Ti-Ta-Nb-Zr scaffolds with antibacterial agents. The biomaterials developed here, therefore, exploit the biofunctionalized behavior of Ag to offer strong antibacterial behavior and osteogenic promotion without cytotoxicity of Ag against mammalian cells.
Collapse
|
48
|
Gupta SK, Shahidsha N, Bahl S, Kedaria D, Singamneni S, Yarlagadda PKDV, Suwas S, Chatterjee K. Enhanced biomechanical performance of additively manufactured Ti-6Al-4V bone plates. J Mech Behav Biomed Mater 2021; 119:104552. [PMID: 33934037 DOI: 10.1016/j.jmbbm.2021.104552] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/31/2021] [Accepted: 04/17/2021] [Indexed: 01/25/2023]
Abstract
As the global trauma fixation devices market expands rapidly, it is imperative to improve the production of fixation devices through enhanced design accuracy and fit for best performance and maximum patient comfort. Selective laser melting (SLM) is one of the mature additive manufacturing methods, which provides a viable route for the rapid production of such devices. In this work, the ability of SLM to produce near-net-shape parts, as desired for medical implants, was utilized for the fabrication of bone plates from Ti-6Al-4V alloy powder. Martensitic microstructure obtained after the printing of alloy resulted in poor ductility, limiting its application in the field of orthopedics. A specially designed repeated cyclic heating and cooling close to but below the β-transus was used to transform from acicular to a bimodal microstructure without the need for plastic deformation prior to heat treatment for improving the ductility. Bone plates subjected to this heat treatment were mechanically tested by means of tensile and 3-point bend tests and demonstrated large improvement in ductility, and the values were comparable to those similar plates prepared from wrought alloy. Other important properties required for implants were assessed, such as corrosion resistance in simulated body fluid and cytocompatibility in vitro using MC3T3-E1 cells. These results for the bone plate after heat treatment were excellent and similar to those of the additively manufactured and wrought plates. Taken together, the performance of the additively manufactured bone plates after subjecting to heat treatment was similar to those of bone plate manufactured using wrought alloy. These results have important implications for the fabrication of patient-specific metallic orthopedic devices using SLM without compromising their biomechanical performance by subjecting them to a tailored heat treatment.
Collapse
Affiliation(s)
- Saurabh Kumar Gupta
- Department of Materials Engineering, Indian Institute of Science, Bangalore, India
| | - Nagur Shahidsha
- Department of Materials Engineering, Indian Institute of Science, Bangalore, India
| | - Sumit Bahl
- Department of Materials Engineering, Indian Institute of Science, Bangalore, India
| | - Dhaval Kedaria
- Department of Materials Engineering, Indian Institute of Science, Bangalore, India
| | - Sarat Singamneni
- Department of Mechanical Engineering, Auckland University of Technology, Auckland, New Zealand
| | - Prasad K D V Yarlagadda
- School of Chemistry, Physics and Mechanical Engineering, Science and Engineering Faculty, Queensland University of Technology, Brisbane, Australia
| | - Satyam Suwas
- Department of Materials Engineering, Indian Institute of Science, Bangalore, India
| | - Kaushik Chatterjee
- Department of Materials Engineering, Indian Institute of Science, Bangalore, India.
| |
Collapse
|
49
|
Magnesium whitlockite - omnipresent in pathological mineralisation of soft tissues but not a significant inorganic constituent of bone. Acta Biomater 2021; 125:72-82. [PMID: 33610767 DOI: 10.1016/j.actbio.2021.02.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/26/2021] [Accepted: 02/12/2021] [Indexed: 01/03/2023]
Abstract
Whitlockite is a calcium phosphate that was first identified in minerals collected from the Palermo Quarry, New Hampshire. The terms magnesium whitlockite [Mg-whitlockite; Ca18Mg2(HPO4)2(PO4)12] and beta-tricalcium phosphate [β-TCP; β-Ca3(PO4)2] are often used interchangeably since Mg-whitlockite is not easily distinguished from β-Ca3(PO4)2 by powder X-ray diffraction although their crystalline structures differ significantly. Being both osteoconductive and bioresorbable, Mg-whitlockite is pursued as a synthetic bone graft substitute. In recent years, advances in development of synthetic Mg-whitlockite have been accompanied by claims that Mg-whitlockite is the second most abundant inorganic constituent of bone, occupying as much as 20-35 wt% of the inorganic fraction. To find evidence in support of this notion, this review presents an exhaustive summary of Mg-whitlockite identification in biological tissues. Mg-whitlockite is mainly found in association with pathological mineralisation of various soft tissues and dental calculus, and occasionally with enamel and dentine. With the exception of high-temperature treated tumoural calcified deposits around interphalangeal and metacarpal joints and rhomboidal Mg-whitlockite crystals in post-apoptotic osteocyte lacunae in human alveolar bone, this unusual mineral has never been detected in the extracellular matrix of mammalian bone. Characterisation techniques capable of unequivocally distinguishing between different calcium phosphate phases, such as high-resolution imaging, crystallography, and/or spectroscopy have exclusively identified bone mineral as poorly crystalline, ion-substituted, carbonated apatite. The idea that Mg-whitlockite is a significant constituent of bone mineral remains unsubstantiated. Contrary to claims that such biomaterials represent a bioinspired/biomimetic approach to bone repair, Mg-whitlockite remains, exclusively, a pathological biomineral. STATEMENT OF SIGNIFICANCE: Magnesium whitlockite (Mg-whitlockite) is a unique calcium phosphate that typically features in pathological calcification of soft tissues; however, an alarming trend emerging in the synthetic bioceramics community claims that Mg-whitlockite occupies 20-35 wt% of bone mineral and therefore synthetic Mg-whitlockite represents a biomimetic approach towards bone regeneration. By providing an overview of Mg-whitlockite detection in biological tissues and scrutinising a diverse cross-section of literature relevant to bone composition analysis, this review concludes that Mg-whitlockite is exclusively a pathological biomineral, and having never been reported in bone extracellular matrix, Mg-whitlockite does not constitute a biomimetic strategy for bone repair.
Collapse
|
50
|
Tang X, Yang Y, Zang J, Du Z, Yan T, Yang R, Guo W. Preliminary Results of a 3D-Printed Modular Vertebral Prosthesis for Anterior Column Reconstruction after Multilevel Thoracolumbar Total En Bloc Spondylectomy. Orthop Surg 2021; 13:949-957. [PMID: 33817999 PMCID: PMC8126945 DOI: 10.1111/os.12975] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 01/19/2021] [Accepted: 02/01/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate preliminary results of a 3D-printed modular prosthesis for spinal reconstruction after multilevel thoracolumbar total en bloc spondylectomy (TES). METHODS Patients with thoracolumbar spinal tumors treated surgically between January 2016 and April 2019 were included in this retrospective study. A total of 17 male and 10 female patients with a mean age of 42 (range, 15-72) years comprised the sample. The pathological diagnoses included six chondrosarcomas (one of them was mesenchymal chondrosarcoma), six giant cell tumors, three malignant peripheral nerve sheath tumors, two osteosarcomas, two undifferentiated high-grade pleomorphic sarcomas (UPS), two solitary fibrous tumors, one Ewing's sarcoma, one liposarcoma, and four metastatic tumors. Tumors involved 2 levels in 14 patients, 3 levels in seven patients, 4 levels in four patients, 5 levels in one patient, and 6 levels in one patient. A 3D-printed modular prosthesis was used for anterior column reconstruction after TES. All analyses were performed using SPSS version 18.0 (SPSS, Inc., Chicago, IL). Descriptive statistics were used to analyze the demographic data and clinical outcomes. Data forms included mean, standard deviation and range. RESULTS Under general anesthesia, all patients received TES with an average operative time of 639 (range, 210-1650) min, and the mean blood loss during operation was 4.1 (range, 0.8-13.3) L. Twenty-two patients have been transferred to ICU for a mean time of 3.2 (range, 0-6) d. All patients had follow-up procedures except for one, who died of perioperative complications. Mean time of follow-up was 22 (range, 12-41) months. Local recurrence (19.2%) occurred in two patients with intralesional margin and three patients with marginal margin, respectively. At the end of follow-up, three patients died of disease, eight patients were alive with disease, and 15 patients had no evidence of disease. Average lengths of resected vertebrae and modular prostheses were 71.4 ± 26.5 mm (range, 40-142 mm) and 68.4 ± 23.9 mm (range, 40-132 mm), respectively. In 26 patients with minimum follow-up of more than 1 year, no evidence of internal fixation failure or dislocation of vertebral prosthesis was found. Asymptomatic prosthetic subsidence into adjacent vertebral bodies occurred in 10 patients with a mean length of 1.8 ± 1.0 mm (range, 1-4 mm). The subsidence was seen at proximal end in two patients, distal end in four patients, and both ends in four patients. Eighteen major complications and 14 minor complications were found in 15 patients. All patients fully recovered at 3 or 6 months after operation. At the latest follow-up, in 23 alive patients, 19 can walk independently and two can achieve outdoor activities by walking aid. CONCLUSION For spinal reconstruction after multilevel thoracolumbar TES, 3D-printed modular vertebral prosthesis is suitable for different length of anterior column reconstruction with less mechanical complications, and can provide a stable environment to maintain or rehabilitate patients' neurological function in short-term follow-up.
Collapse
Affiliation(s)
- Xiaodong Tang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China
| | - Yi Yang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China
| | - Jie Zang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China
| | - Zhiye Du
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China
| | - Taiqiang Yan
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China
| | - Rongli Yang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China
| |
Collapse
|