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Li Z, Luo Y, Lu M, Wang Y, Gong T, He X, Hu X, Long J, Zhou Y, Min L, Tu C. Biomimetic design and clinical application of Ti-6Al-4V lattice hemipelvis prosthesis for pelvic reconstruction. J Orthop Surg Res 2024; 19:210. [PMID: 38561755 PMCID: PMC10983619 DOI: 10.1186/s13018-024-04672-5] [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: 01/04/2024] [Accepted: 03/13/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE This study aims to biomimetic design a new 3D-printed lattice hemipelvis prosthesis and evaluate its clinical efficiency for pelvic reconstruction following tumor resection, focusing on feasibility, osseointegration, and patient outcomes. METHODS From May 2020 to October 2021, twelve patients with pelvic tumors underwent tumor resection and subsequently received 3D-printed lattice hemipelvis prostheses for pelvic reconstruction. The prosthesis was strategically incorporated with lattice structures and solid to optimize mechanical performance and osseointegration. The pore size and porosity were analyzed. Patient outcomes were assessed through a combination of clinical and radiological evaluations. RESULTS Multiple pore sizes were observed in irregular porous structures, with a wide distribution range (approximately 300-900 μm). The average follow-up of 34.7 months, ranging 26 from to 43 months. One patient with Ewing sarcoma died of pulmonary metastasis 33 months after surgery while others were alive at the last follow-up. Postoperative radiographs showed that the prosthesis's position was consistent with the preoperative planning. T-SMART images showed that the host bone was in close and tight contact with the prosthesis with no gaps at the interface. The average MSTS score was 21 at the last follow-up, ranging from 18 to 24. There was no complication requiring revision surgery or removal of the 3D-printed hemipelvis prosthesis, such as infection, screw breakage, and prosthesis loosening. CONCLUSION The newly designed 3D-printed lattice hemipelvis prosthesis created multiple pore sizes with a wide distribution range and resulted in good osteointegration and favorable limb function.
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Affiliation(s)
- Zhuangzhuang Li
- Department of Orthopedics and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, People's Republic of China
| | - Yi Luo
- Department of Orthopedics and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, People's Republic of China
| | - Minxun Lu
- Department of Orthopedics and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, People's Republic of China
| | - Yitian Wang
- Department of Orthopedics and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, People's Republic of China
| | - Taojun Gong
- Department of Orthopedics and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, People's Republic of China
| | - Xuanhong He
- Department of Orthopedics and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, People's Republic of China
| | - Xin Hu
- Department of Orthopedics and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, People's Republic of China
| | - Jingjunjiao Long
- Department of Orthopedics and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, People's Republic of China
| | - Yong Zhou
- Department of Orthopedics and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, People's Republic of China
| | - Li Min
- Department of Orthopedics and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China.
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, People's Republic of China.
| | - Chongqi Tu
- Department of Orthopedics and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China.
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, People's Republic of China.
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Kolomenskaya E, Butova V, Poltavskiy A, Soldatov A, Butakova M. Application of Artificial Intelligence at All Stages of Bone Tissue Engineering. Biomedicines 2023; 12:76. [PMID: 38255183 PMCID: PMC10813365 DOI: 10.3390/biomedicines12010076] [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: 12/06/2023] [Revised: 12/23/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024] Open
Abstract
The development of artificial intelligence (AI) has revolutionized medical care in recent years and plays a vital role in a number of areas, such as diagnostics and forecasting. In this review, we discuss the most promising areas of AI application to the field of bone tissue engineering and prosthetics, which can drastically benefit from AI-assisted optimization and patient personalization of implants and scaffolds in ways ranging from visualization and real-time monitoring to the implantation cases prediction, thereby leveraging the compromise between specific architecture decisions, material choice, and synthesis procedure. With the emphasized crucial role of accuracy and robustness of developed AI algorithms, especially in bone tissue engineering, it was shown that rigorous validation and testing, demanding large datasets and extensive clinical trials, are essential, and we discuss how through developing multidisciplinary cooperation among biology, chemistry with materials science, and AI, these challenges can be addressed.
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Affiliation(s)
- Ekaterina Kolomenskaya
- The Smart Materials Research Institute, Southern Federal University, 178/24 Sladkova, 344090 Rostov-on-Don, Russia; (V.B.); (A.P.); (A.S.); (M.B.)
| | - Vera Butova
- The Smart Materials Research Institute, Southern Federal University, 178/24 Sladkova, 344090 Rostov-on-Don, Russia; (V.B.); (A.P.); (A.S.); (M.B.)
- Institute of General and Inorganic Chemistry, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria
| | - Artem Poltavskiy
- The Smart Materials Research Institute, Southern Federal University, 178/24 Sladkova, 344090 Rostov-on-Don, Russia; (V.B.); (A.P.); (A.S.); (M.B.)
| | - Alexander Soldatov
- The Smart Materials Research Institute, Southern Federal University, 178/24 Sladkova, 344090 Rostov-on-Don, Russia; (V.B.); (A.P.); (A.S.); (M.B.)
| | - Maria Butakova
- The Smart Materials Research Institute, Southern Federal University, 178/24 Sladkova, 344090 Rostov-on-Don, Russia; (V.B.); (A.P.); (A.S.); (M.B.)
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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.
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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.
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Khaohoen A, Sornsuwan T, Chaijareenont P, Poovarodom P, Rungsiyakull C, Rungsiyakull P. Biomaterials and Clinical Application of Dental Implants in Relation to Bone Density-A Narrative Review. J Clin Med 2023; 12:6924. [PMID: 37959389 PMCID: PMC10649288 DOI: 10.3390/jcm12216924] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 10/29/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023] Open
Abstract
Titanium has been the material of choice for dental implant fixtures due to its exceptional qualities, such as its excellent balance of rigidity and stiffness. Since zirconia is a soft-tissue-friendly material and caters to esthetic demands, it is an alternative to titanium for use in implants. Nevertheless, bone density plays a vital role in determining the material and design of implants. Compromised bone density leads to both early and late implant failures due to a lack of implant stability. Therefore, this narrative review aims to investigate the influence of implant material/design and surgical technique on bone density from both biomechanical and biological standpoints. Relevant articles were included for analysis. Dental implant materials can be fabricated from titanium, zirconia, and PEEK. In terms of mechanical and biological aspects, titanium is still the gold standard for dental implant materials. Additionally, the macro- and microgeometry of dental implants play a role in determining and planning the appropriate treatment because it can enhance the mechanical stress transmitted to the bone tissue. Under low-density conditions, a conical titanium implant design, longer length, large diameter, reverse buttress with self-tapping, small thread pitch, and deep thread depth are recommended. Implant material, implant design, surgical techniques, and bone density are pivotal factors affecting the success rates of dental implant placement in low-density bone. Further study is required to find the optimal implant material for a clinical setting's bone state.
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Affiliation(s)
- Angkoon Khaohoen
- Department of Prosthodontics, Faculty of Dentistry, Chiang Mai University, Chiang Mai 50200, Thailand; (A.K.); (P.C.); (P.P.)
| | - Tanapon Sornsuwan
- Department of Restorative Dentistry, Faculty of Dentistry, Naresuan University, Phitsanulok 65000, Thailand;
| | - Pisaisit Chaijareenont
- Department of Prosthodontics, Faculty of Dentistry, Chiang Mai University, Chiang Mai 50200, Thailand; (A.K.); (P.C.); (P.P.)
| | - Pongsakorn Poovarodom
- Department of Prosthodontics, Faculty of Dentistry, Chiang Mai University, Chiang Mai 50200, Thailand; (A.K.); (P.C.); (P.P.)
| | - Chaiy Rungsiyakull
- Department of Mechanical Engineering, Faculty of Engineering, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Pimduen Rungsiyakull
- Department of Prosthodontics, Faculty of Dentistry, Chiang Mai University, Chiang Mai 50200, Thailand; (A.K.); (P.C.); (P.P.)
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Liang W, Zhou C, Zhang H, Bai J, Jiang B, Jiang C, Ming W, Zhang H, Long H, Huang X, Zhao J. Recent advances in 3D printing of biodegradable metals for orthopaedic applications. J Biol Eng 2023; 17:56. [PMID: 37644461 PMCID: PMC10466721 DOI: 10.1186/s13036-023-00371-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023] Open
Abstract
The use of biodegradable polymers for treating bone-related diseases has become a focal point in the field of biomedicine. Recent advancements in material technology have expanded the range of materials suitable for orthopaedic implants. Three-dimensional (3D) printing technology has become prevalent in healthcare, and while organ printing is still in its early stages and faces ethical and technical hurdles, 3D printing is capable of creating 3D structures that are supportive and controllable. The technique has shown promise in fields such as tissue engineering and regenerative medicine, and new innovations in cell and bio-printing and printing materials have expanded its possibilities. In clinical settings, 3D printing of biodegradable metals is mainly used in orthopedics and stomatology. 3D-printed patient-specific osteotomy instruments, orthopedic implants, and dental implants have been approved by the US FDA for clinical use. Metals are often used to provide support for hard tissue and prevent complications. Currently, 70-80% of clinically used implants are made from niobium, tantalum, nitinol, titanium alloys, cobalt-chromium alloys, and stainless steels. However, there has been increasing interest in biodegradable metals such as magnesium, calcium, zinc, and iron, with numerous recent findings. The advantages of 3D printing, such as low manufacturing costs, complex geometry capabilities, and short fabrication periods, have led to widespread adoption in academia and industry. 3D printing of metals with controllable structures represents a cutting-edge technology for developing metallic implants for biomedical applications. This review explores existing biomaterials used in 3D printing-based orthopedics as well as biodegradable metals and their applications in developing metallic medical implants and devices. The challenges and future directions of this technology are also discussed.
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Grants
- (LGF22H060023 to WQL) Public Technology Applied Research Projects of Zhejiang Province
- (2022KY433 to WQL, 2023KY1303 to HGL) Medical and Health Research Project of Zhejiang Province
- (2022KY433 to WQL, 2023KY1303 to HGL) Medical and Health Research Project of Zhejiang Province
- (2021FSYYZY45 to WQL) Research Fund Projects of The Affiliated Hospital of Zhejiang Chinese Medicine University
- (2022C31034 to CZ, 2023C31019 to HJZ) Science and Technology Project of Zhoushan
- (2022C31034 to CZ, 2023C31019 to HJZ) Science and Technology Project of Zhoushan
- (2022ZB380 to JYZ, 2023016295 to WYM, 2023007231 to CYJ ) Traditional Chinese Medicine Science and Technology Projects of Zhejiang Province
- (2022ZB380 to JYZ, 2023016295 to WYM, 2023007231 to CYJ ) Traditional Chinese Medicine Science and Technology Projects of Zhejiang Province
- (2022ZB380 to JYZ, 2023016295 to WYM, 2023007231 to CYJ ) Traditional Chinese Medicine Science and Technology Projects of Zhejiang Province
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Affiliation(s)
- Wenqing Liang
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, 355 Xinqiao Road, Dinghai District, Zhoushan, 316000 Zhejiang Province China
| | - Chao Zhou
- Department of Orthopedics, Zhoushan Guanghua Hospital, Zhoushan, 316000 China
| | - Hongwei Zhang
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, 355 Xinqiao Road, Dinghai District, Zhoushan, 316000 Zhejiang Province China
| | - Juqin Bai
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, 355 Xinqiao Road, Dinghai District, Zhoushan, 316000 Zhejiang Province China
| | - Bo Jiang
- Rehabilitation Department, Zhoushan Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, Zhoushan, 316000 China
| | - Chanyi Jiang
- Department of Orthopedics, Zhoushan Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, Zhoushan, 316000 Zhejiang Province P.R. China
| | - Wenyi Ming
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, 355 Xinqiao Road, Dinghai District, Zhoushan, 316000 Zhejiang Province China
| | - Hengjian Zhang
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, 355 Xinqiao Road, Dinghai District, Zhoushan, 316000 Zhejiang Province China
| | - Hengguo Long
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, 355 Xinqiao Road, Dinghai District, Zhoushan, 316000 Zhejiang Province China
| | - Xiaogang Huang
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, 355 Xinqiao Road, Dinghai District, Zhoushan, 316000 Zhejiang Province China
| | - Jiayi Zhao
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, 355 Xinqiao Road, Dinghai District, Zhoushan, 316000 Zhejiang Province China
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Zhang Q, Zhou J, Zhi P, Liu L, Liu C, Fang A, Zhang Q. 3D printing method for bone tissue engineering scaffold. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2023; 17:None. [PMID: 36909661 PMCID: PMC9995276 DOI: 10.1016/j.medntd.2022.100205] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/27/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023] Open
Abstract
3D printing technology is an emerging technology. It constructs solid bodies by stacking materials layer by layer, and can quickly and accurately prepare bone tissue engineering scaffolds with specific shapes and structures to meet the needs of different patients. The field of life sciences has received a great deal of attention. However, different 3D printing technologies and materials have their advantages and disadvantages, and there are limitations in clinical application. In this paper, the technology, materials and clinical applications of 3D printed bone tissue engineering scaffolds are reviewed, and the future development trends and challenges in this field are prospected.
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Affiliation(s)
- Qiliang Zhang
- Department of Orthopaedic Surgery, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, China
| | - Jian Zhou
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Engineering Medicine, Beihang University, Beijing, 100191, China
- Department of Orthopaedic Surgery, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, China
| | - Peixuan Zhi
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Engineering Medicine, Beihang University, Beijing, 100191, China
- Department of Orthopaedic Surgery, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, China
- The First Affiliated Hospital and Its National Resident Standardized Training Base, Dalian Medical University, Dalian, 116000, China
| | - Leixin Liu
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Engineering Medicine, Beihang University, Beijing, 100191, China
- Department of Orthopaedic Surgery, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, China
- The First Affiliated Hospital and Its National Resident Standardized Training Base, Dalian Medical University, Dalian, 116000, China
| | - Chaozong Liu
- Division of Surgery and Interventional Science, Royal National Orthopaedic Hospital, University College London, London, United Kingdom
| | - Ao Fang
- Division of Surgery and Interventional Science, Royal National Orthopaedic Hospital, University College London, London, United Kingdom
- Department of Rehabilitation Medicine, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310003, China
- Corresponding author. Division of Surgery and Interventional Science, Royal National Orthopaedic Hospital, University College London, London, United Kingdom.
| | - Qidong Zhang
- Division of Surgery and Interventional Science, Royal National Orthopaedic Hospital, University College London, London, United Kingdom
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Engineering Medicine, Beihang University, Beijing, 100191, China
- Corresponding author. Division of Surgery and Interventional Science, Royal National Orthopaedic Hospital, University College London, London, United Kingdom.
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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.
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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.
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Zhang Y, Lu M, Hu X, Li Z, Wang J, Gong T, Zhou Y, Luo L, Min L, Tu C. Three-dimensional-printed porous prosthesis for the joint-sparing reconstruction of the proximal humeral tumorous defect. Front Bioeng Biotechnol 2023; 10:1098973. [PMID: 36714618 PMCID: PMC9877454 DOI: 10.3389/fbioe.2022.1098973] [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: 11/15/2022] [Accepted: 12/30/2022] [Indexed: 01/15/2023] Open
Abstract
Background: Tumorous bone defect reconstructions of the proximal humerus with joint sparing is a challenge. Numerous reconstruction methods have been proposed but the proximal residual humerus is commonly sacrificed because of its extremely short length. To preserve the proximal humerus and improve clinical outcomes, we designed a three-dimensional (3D) printed uncemented prosthesis with a porous structure to treat tumorous bone defects of the proximal humerus. Methods: Our analysis included seven patients treated between March 2018 and July 2019. A 3D model was established, and related data were obtained, including the diameter of the humeral head, the resection length, and the residual length. A prosthesis was designed and fabricated based on these data. Functional and oncologic outcomes were recorded, and complications and osseointegration were evaluated. Results: The mean age of the patients was 20.3 years, and the median follow-up period was 26 months. The lengths of the residual proximal humerus were 17.9 mm on average. All the patients had preserved humeral heads and most of the rotator cuff was intact. The average postoperative range of motion (ROM) of the affected shoulder was 83.8°; flexion was 82.5°, extension was 43.8°, and adduction was 16.3°. The average Musculoskeletal Tumor Society score (MSTS) was 94.3%. Good osseointegration was observed on the interface between the bone and prosthesis. Conclusion: A 3D printed porous prosthesis with cone-like structures successfully achieved joint-sparing reconstruction of proximal humeral tumorous defects with satisfying functional outcomes. The preservation of the rotator cuff and humeral head plays an essential role in the function of the shoulder joint.
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Affiliation(s)
- Yuqi Zhang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Minxun Lu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Xin Hu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Zhuangzhuang Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Jie Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Taojun Gong
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Yong Zhou
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Li Luo
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Li Min
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Chongqi Tu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
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9
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Chen Z, Lü G, Wang X, He H, Yuan H, Pan C, Kuang L. Is 3D-printed prosthesis stable and economic enough for anterior spinal column reconstruction after spinal tumor resection? A retrospective comparative study between 3D-printed off-the-shelf prosthesis and titanium mesh cage. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:261-270. [PMID: 36477893 DOI: 10.1007/s00586-022-07480-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/31/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022]
Abstract
OBJECT To investigate the stability and cost-effectiveness of the three-dimensional-printed (3DP) off-the-shelf (OTS) prosthesis in the reconstruction of the anterior column of the thoracic/lumbar spine after tumor resection. METHODS Thirty-five patients (26 with primary malignant tumors and nine with metastatic malignant tumors) who underwent tumor resection and anterior column reconstruction between January 2014 and January 2019 were included in a single institute. Patients were divided into the 3DP OTS prosthesis (3DP) group (n = 14) and the titanium mesh cage (TMC) group (n = 21) by the type of implant. The operation time, intraoperative blood loss, hospital stay, history of radiotherapy, surgical level and total cost were collected and compared between the two groups. Mechanical complications and radiological parameters including mean vertebral height, subsidence, fixation failure(nonunion, migration, screw loosening, rod breakage) rate were recorded at preoperation, 1 week, 3 months, 6 months, 12 months after surgery then at 1 year interval or stop until the end of survival. The follow-up patients were also sent with short form-36 to assess their health-related quality of life (HRQoL) and questions about the current condition of their disease. RESULTS The mean overall follow-up was 24.6 months. Of the 35 patients involved, six patients died and six were lost to follow-up. The differences between the two groups in operative time, intraoperative blood loss, and hospital stay were not statistically significant (p > 0.05). The differences in fixation failure and the subsidence rate between the two groups were not statistical significant (p > 0.05). The difference of subsidence rate between the cases with and without osteoporosis, cases with and without radiotherapy was statistically significant within each group (p < 0.05). However, the difference of subsidence rate between the surgical level above or below T10 was not statistically significant (p > 0.05). The response rate of the questionnaire among the survived patients was 100% (23/23 patients). The results of the Short Form- (SF-)36 between the two groups were similar (p > 0.05). The total cost was higher in the 3DP group (p < 0.05) with its higher graft cost (p < 0.05), but the differences in internal fixation cost and other cost were not statistically significant between groups (p > 0.05). CONCLUSION Compared to TMC, the 3DP OTS prosthesis achieved similar clinical and radiological results in spinal anterior spinal column reconstruction of thoracic/lumbar spinal tumor resection. However, the 3DP OTS prosthesis was more expansive than TMC.
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Affiliation(s)
- Zejun Chen
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Guohua Lü
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Xiaoxiao Wang
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Haoyu He
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Hui Yuan
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Changyu Pan
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Lei Kuang
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China.
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10
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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.
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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
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11
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Sun Z, Yin M, Sun Y, Cheng M, Fang M, Huang W, Ma J, Yan W. Customized Multilevel 3D Printing Implant for Reconstructing Spine Tumor: A Retrospective Case Series Study in a Single Center. Orthop Surg 2022; 14:2016-2022. [PMID: 35894154 PMCID: PMC9483039 DOI: 10.1111/os.13357] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/28/2022] Open
Abstract
Objective To investigate the clinical efficacy and safety of 3D printed artificial vertebral body for patients who underwent multilevel total en bloc spondylectomy (TES) and analyze whether it could reduce the incidence of implant subsidence. Methods This is a retrospective study. From January 2017 to May 2018, eight consecutive cases with spine tumor undergoing multilevel TES were analyzed. All patients underwent X‐ray and CT examinations to evaluate the stability of internal fixation during the postoperative follow‐up. Demographic, surgical details, clinical data, and perioperative complications was collected. Visual analog scale, Frankel score, and spinal instability neoplastic score (SINS) classification were also recorded. Results There were six cases of primary spinal tumor and two cases of metastatic spinal tumor. All patients achieved remarkable pain relief and improvement in neurological function. Five patients underwent operation through the posterior approach, one patient underwent operation through the anterior approach and the remaining two patients through a combined anterior and posterior approach. At the last follow‐up period, X‐rays showed that the 3D printed artificial vertebral body of all cases matched well, and the fixation was reliable. Hardware failure such as loosening, sinking, breaking, and displacement wasn't observed during the follow‐up period. Conclusion 3D printed customized artificial vertebral body can provide satisfying good clinical and radiological outcomes for patients who have undergone multilevel TES.
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Affiliation(s)
- Zhengwang Sun
- Department of Musculoskeletal Surgery, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Mengchen Yin
- Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yueli Sun
- Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Mo Cheng
- Department of Musculoskeletal Surgery, Shanghai Cancer Center, Fudan University, Shanghai, China
| | | | - Wending Huang
- Department of Musculoskeletal Surgery, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Junming Ma
- Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wangjun Yan
- Department of Musculoskeletal Surgery, Shanghai Cancer Center, Fudan University, Shanghai, China
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12
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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.
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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.
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13
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Output performance of the novel active transcutaneous bone conduction implant Sentio at different stimulation sites. Hear Res 2021; 421:108369. [PMID: 34728110 DOI: 10.1016/j.heares.2021.108369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/26/2021] [Accepted: 10/01/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The output performance of a novel semi-implantable transcutaneous bone conduction device was compared to an established percutaneous bone-anchored hearing system device using cadaver heads. The influence of actuator position, tissue growth below the actuator and mounting it on the surface or in a flattened bone bed on the performance of the implanted actuator was investigated. MATERIALS AND METHODS The percutaneous and the new transcutaneous device were sequentially implanted at two sites in five human cadaver heads: 55 mm superior-posterior to the ear canal opening (position A) and, closer to the cochlea, about 20 mm inferior-posterior to the ear canal opening behind the pinna on the mastoid (position B). The ipsi- and contralateral cochlear promontory (CP) velocity magnitude responses to percutaneous and transcutaneous stimulation were measured using laser Doppler vibrometry. In addition, the CP vibration of the transcutaneous device placed directly on the skull bone surface was compared with the placement in a flattened bone bed at a depth of about 3 mm. Finally, the influence of placing a thin silicone interposition layer under the implanted transducer was also explored. RESULTS The percutaneous device provided about an 11 dB higher average CP vibration level than the transcutaneous device at frequencies between 0.5 and 10 kHz. The ipsilateral CP vibration responses with stimulations at position B were on average 13 dB higher compared to stimulation at position A. The placement of the transcutaneous transducer at position B provided similar or higher average vibration magnitudes than the percutaneous transducer at position A. The 3 mm deep flattened bone bed had no significant effects on the output performance. Placing a thin silicone layer under the transcutaneous transducer had no significant influence on the output of the transcutaneous device. CONCLUSIONS Our results using the CP vibration responses show that at frequencies above 500 Hz the new transcutaneous device at position B provides similar output levels as the percutaneous device at position A. The results also indicated that neither a bone bed for the placement of the transcutaneous transducer nor a simulated tissue growth between the actuator and the bone affect the output performance of the device.
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14
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Jin Y, Zhao B, Lu X, Zhao Y, Zhao X, Wang X, Zhou R, Qi D, Wang W. Mid- and Long-Term Follow-Up Efficacy Analysis of 3D-Printed Interbody Fusion Cages for Anterior Cervical Discectomy and Fusion. Orthop Surg 2021; 13:1969-1978. [PMID: 34523808 PMCID: PMC8528997 DOI: 10.1111/os.13005] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/01/2021] [Accepted: 03/09/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate the safety and stability of 3D-printed interbody fusion cages (3D-printed cages) in anterior cervical discectomy and fusion (ACDF) by investigating the mid- and long-term follow-up outcomes. METHODS In this prospective study, the clinical data of 30 patients with CSM admitted to the Second Hospital of Shanxi Medical University from May 2012 to May 2014 were analyzed. The cohort comprised 18 males and 12 females with an average age of 60.22 ± 3.2 years. All patients were examined by X-ray, CT and MRI before the operation. A total of 30 cases of CSM were treated by ACDF with 3D printed cage implantation. Mid- and long-term follow-ups were performed after the surgery. Clinical efficacy was evaluated by comparing the JOA score, SF-36 score, change in neurological function, cervical curvature index (CCI), vertebral intervertebral height (VIH) and fusion rate before the operation, 6 months after the operation, and at the last follow-up. RESULTS Two of the 30 patients were lost to follow-up. The remaining patients were followed up for 48-76 (65.23 ± 3.54) months. The patients recovered satisfactorily with a significant clinical effect. The JOA score increased meanfully and the improvement rate was 89.4% at the final follow-up. The SF-36 score increased significantly from pre- to postoperatively. The height of the intervertebral space at the last follow-up was not statistically significantly different from that at 6 months after surgery (P > 0.05), showing that the height of the intervertebral space did not change much and the severity of cage subsidence (CS) decreased. The CCI improved from pre- to postoperatively. The CCI did not change much from the 6-month follow-up to the last follow-up. and the cage rate (CR) was 100% at the 6-month and last follow-ups. No severe complications, such as spinal cord injury, esophageal fistula, cerebrospinal fluid leakage, cervical hematoma or wound infection, occurred in any of the patients. CONCLUSION The clinical and radiological results show that the application of 3D-printed cages in ACDF can significantly relieve symptoms. Moreover, 3D-printed cages can restore the curvature of the cervical spine, effectively maintain the intervertebral height for a long time, and prevent complications related to postoperative subsidence.
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Affiliation(s)
- Yuan‐zhang Jin
- Department of OrthopaedicsThe Second Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Bin Zhao
- Department of OrthopaedicsThe Second Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Xiang‐dong Lu
- Department of OrthopaedicsThe Second Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Yi‐bo Zhao
- Department of OrthopaedicsThe Second Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Xiao‐feng Zhao
- Department of OrthopaedicsThe Second Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Xiao‐nan Wang
- Department of OrthopaedicsThe Second Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Run‐tian Zhou
- Department of OrthopaedicsThe Second Hospital of Shanxi Medical UniversityTaiyuanChina
| | - De‐tai Qi
- Department of OrthopaedicsThe Second Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Wen‐xuan Wang
- Department of OrthopaedicsThe Second Hospital of Shanxi Medical UniversityTaiyuanChina
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15
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Wang J, An J, Lu M, Zhang Y, Lin J, Luo Y, Zhou Y, Min L, Tu C. Is three-dimensional-printed custom-made ultra-short stem with a porous structure an acceptable reconstructive alternative in peri-knee metaphysis for the tumorous bone defect? World J Surg Oncol 2021; 19:235. [PMID: 34365976 PMCID: PMC8349501 DOI: 10.1186/s12957-021-02355-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/01/2021] [Indexed: 02/08/2023] Open
Abstract
Background Long-lasting reconstruction after extensive resection involving peri-knee metaphysis is a challenging problem in orthopedic oncology. Various reconstruction methods have been proposed, but they are characterized by a high complication rate. The purposes of this study were to (1) assess osseointegration at the bone implant interface and correlated incidence of aseptic loosening; (2) identify complications including infection, endoprosthesis fracture, periprosthetic fracture, leg length discrepancy, and wound healing problem in this case series; and (3) evaluate the short-term function of the patient who received this personalized reconstruction system. Methods Between September 2016 and June 2018, our center treated 15 patients with malignancies arising in the femur or tibia shaft using endoprosthesis with a 3D-printed custom-made stem. Osseointegration and aseptic loosening were assessed with digital tomosynthesis. Complications were recorded by reviewing the patients’ records. The function was evaluated with the 1993 version of the Musculoskeletal Tumor Society (MSTS-93) score at a median of 42 (range, 34 to 54) months after reconstruction. Results One patient who experienced early aseptic loosening was managed with immobilization and bisphosphonates infusion. All implants were well osseointegrated at the final follow-up examination. There are two periprosthetic fractures intraoperatively. The wire was applied to assist fixation, and the fracture healed at the latest follow-up. Two patients experienced significant leg length discrepancies. The median MSTS-93 score was 26 (range, 23 to 30). Conclusions A 3D-printed custom-made ultra-short stem with a porous structure provides acceptable early outcomes in patients who received peri-knee metaphyseal reconstruction. With detailed preoperative design and precise intraoperative techniques, the reasonable initial stability benefits osseointegration to osteoconductive porous titanium, and therefore ensures short- and possibly long-term durability. Personalized adaptive endoprosthesis, careful intraoperative operation, and strict follow-up management enable effective prevention and treatment of complications. The functional results in our series were acceptable thanks to reliable fixation in the bone-endoprosthesis interface and an individualized rehabilitation program. These positive results indicate this device series can be a feasible alternative for critical bone defect reconstruction. Nevertheless, longer follow-up is required to determine whether this technique is superior to other forms of fixation.
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Affiliation(s)
- Jie Wang
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China.,Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jingjing An
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China.,Department of Operating Room, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, People's Republic of China
| | - Minxun Lu
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China.,Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yuqi Zhang
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China.,Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jingqi Lin
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yi Luo
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China.,Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yong Zhou
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China.,Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Li Min
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China.,Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Chongqi Tu
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China. .,Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
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Wang J, Min L, Lu M, Zhang Y, Lin J, Luo Y, Zhou Y, Tu C. Three-dimensional-printed custom-made hemipelvic endoprosthesis for the revision of the aseptic loosening and fracture of modular hemipelvic endoprosthesis: a pilot study. BMC Surg 2021; 21:262. [PMID: 34039325 PMCID: PMC8157625 DOI: 10.1186/s12893-021-01257-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 05/18/2021] [Indexed: 02/08/2023] Open
Abstract
Background The aims of this pilot study were (1) to assess the efficacy of 3D-printed custom-made hemipelvic endoprosthesis in restoring the natural location of acetabulum for normal bodyweight transmission; (2) to evaluate the short-term function of the revision with this endoprosthesis and (3) to identify short-term complications associated with the use of this endoprosthesis. Methods Between February 2017 and December 2017, seven patients received revision with 3D-printed custom-made hemipelvic endoprosthesis. The body weight moment arm (BWMA) and cup height discrepancy (CHD) after primary and revisional surgery were analyzed to assess acetabulum location with plain radiography. After a median follow-up duration of 29 months (range 24–34), the function was evaluated with the Musculoskeletal Tumor Society (MSTS-93) score and Harris hip score (HHS). Complications were recorded by chart review. Results The acetabulum locations were deemed reasonable, as evaluated by median BWMA (primary vs. revision, 10 cm vs. 10 cm) and median CHD (primary vs. revision, 10 mm vs. 8 mm). The median MSTS-93 score and HHS score were 21 (range 18–23) and 78 (range 75–82) after the revision. No short or mid-term complication was observed in the follow-up of this series. Conclusions Revision with 3D-printed custom-made hemipelvic endoprostheses benefited in reconstructing stable pelvic ring and natural bodyweight transmission for patients encountering the aseptic loosening and fracture of modular hemipelvic endoprosthesis. The revision surgery and appropriate rehabilitation program improved patients’ function to a median MSTS score of 22 and pain-free ambulation. The incidence of the complications was low via this individualized workflow.
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Affiliation(s)
- Jie Wang
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, People's Republic of China.,Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Li Min
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, People's Republic of China.,Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Minxun Lu
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, People's Republic of China.,Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yuqi Zhang
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, People's Republic of China.,Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jingqi Lin
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, People's Republic of China
| | - Yi Luo
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, People's Republic of China.,Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yong Zhou
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, People's Republic of China.,Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Chongqi Tu
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, People's Republic of China. .,Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
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Zhang Y, Min L, Lu M, Wang J, Wang Y, Luo Y, Zhou Y, Duan H, Tu C. Three-dimensional-printed customized prosthesis for pubic defect: clinical outcomes in 5 cases at a mean follow-up of 24 months. BMC Musculoskelet Disord 2021; 22:405. [PMID: 33941162 PMCID: PMC8091684 DOI: 10.1186/s12891-021-04294-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/14/2021] [Indexed: 02/08/2023] Open
Abstract
Background Pubic defects resulting from type III hemipelvectomy are commonly not reconstructed due to the need to preserve the weight-bearing axis. However, the opening of the anterior pelvic ring will inevitably lead to increased pelvic instability. To improve long-term pelvic stability, three-dimensional (3D)-printed customized prostheses were designed to reconstruct pubic defects. This study presents and evaluates the short-term clinical outcomes and complications from the use of this construct. Methods Five patients who underwent type III hemipelvectomy and 3D-printed customized prosthesis reconstruction at our institution between 2017 and 2019 were retrospectively analysed. Operation time and blood loss during the operation were recorded. Local and functional recovery was assessed. Prosthetic position and osseointegration were evaluated. Oncology results and complications were recorded. Results The prostheses consisted of three with stems and two without. The mean follow-up time was 23.6 months. At the last follow-up, all five patients were alive with no evidence of disease. No deep infections or local recurrence had occurred. The mean blood loss and mean intraoperative time were 1680 ml and 294 min, respectively. The mean functional MSTS score at the final follow-up was 29.8. Fretting wear around the prosthetic stem was found in 3 patients, while bone wear on the normal-side pubis was found in 2 patients. Osseointegration was observed in all patients. Conclusions 3D-printed customized prostheses for reconstructing pubic bone defects after type III hemipelvectomy showed acceptable early outcomes. The good outcomes were inseparable from the precision prosthesis design, strict surgical procedures, and sensible postoperative management.
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Affiliation(s)
- Yuqi Zhang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxuexiang, 610041, Chengdu, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Sichuan, 610041, Chengdu, People's Republic of China
| | - Li Min
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxuexiang, 610041, Chengdu, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Sichuan, 610041, Chengdu, People's Republic of China
| | - Minxun Lu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxuexiang, 610041, Chengdu, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Sichuan, 610041, Chengdu, People's Republic of China
| | - Jie Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxuexiang, 610041, Chengdu, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Sichuan, 610041, Chengdu, People's Republic of China
| | - Yitian Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxuexiang, 610041, Chengdu, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Sichuan, 610041, Chengdu, People's Republic of China
| | - Yi Luo
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxuexiang, 610041, Chengdu, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Sichuan, 610041, Chengdu, People's Republic of China
| | - Yong Zhou
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxuexiang, 610041, Chengdu, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Sichuan, 610041, Chengdu, People's Republic of China
| | - Hong Duan
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxuexiang, 610041, Chengdu, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Sichuan, 610041, Chengdu, People's Republic of China
| | - Chongqi Tu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxuexiang, 610041, Chengdu, Sichuan, People's Republic of China. .,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Sichuan, 610041, Chengdu, People's Republic of China.
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Current interpretations on the in vivo response of bone to additively manufactured metallic porous scaffolds: A review. BIOMATERIALS AND BIOSYSTEMS 2021; 2:100013. [PMID: 36824658 PMCID: PMC9934422 DOI: 10.1016/j.bbiosy.2021.100013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/20/2021] [Accepted: 02/13/2021] [Indexed: 01/08/2023] Open
Abstract
Recent advances in the field of metallic additive manufacturing have expanded production capabilities for bone implants to include porous lattice structures. While traditional models of de novo bone formation can be applied to fully dense implant materials, their applicability to the interior of porous materials has not been well-characterized. Unlike other reviews that focus on materials and mechanical properties of lattice structures, this review compiles biological performance from in vivo studies in pre-clinical models only. First, we introduce the most common lattice geometry designs employed in vivo and discuss some of their fabrication advantages and limitations. Then lattice geometry is correlated to quantitative (histomorphometric) and qualitative (histological) assessments of osseointegration. We group studies according to two common implant variables: pore size and percent porosity, and explore the extent of osseointegration using common measures, including bone-implant contact (BIC), bone area (BA), bone volume/total volume (BV/TV) and biomechanical stability, for various animal models and implantation times. Based on this, trends related to in vivo bone formation on the interior of lattice structures are presented. Common challenges with lattice structures are highlighted, including nonuniformity of bone growth through the entirety of the lattice structure due to occlusion effects and avascularity. This review paper identifies a lack of systematic in vivo studies on porous AM implants to target optimum geometric design, including pore shape, size, and percent porosity in controlled animal models and critical-sized defects. Further work focusing on surface modification strategies and systematic geometric studies to homogenize in vivo bone growth through the scaffold interior are recommended to increase implant stability in the early stages of osseointegration.
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Veronesi F, Torricelli P, Martini L, Tschon M, Giavaresi G, Bellini D, Casagranda V, Alemani F, Fini M. An alternative ex vivo method to evaluate the osseointegration of Ti-6Al-4V alloy also combined with collagen. Biomed Mater 2021; 16:025007. [PMID: 33445161 DOI: 10.1088/1748-605x/abdbda] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Due to the increasing number of orthopedic implantation surgery and advancements in biomaterial manufacturing, chemistry and topography, there is an increasing need of reliable and rapid methods for the preclinical investigation of osseointegration and bone ingrowth. Implant surface composition and topography increase osteogenicity, osteoinductivity, osteoconductivity and osseointegration of a prosthesis. Among the biomaterials used to manufacture an orthopedic prosthesis, titanium alloy (Ti-6Al-4V) is the most used. Type I collagen (COLL I) induces cell function, adhesion, differentiation and bone extracellular matrix component secretion and it is reported to improve osseointegration if immobilized on the alloy surface. The aim of the present study was to evaluate the feasibility of an alternative ex vivo model, developed by culturing rabbit cortical bone segments with Ti-6Al-4V alloy cylinders (Ti-POR), fabricated through the process of electron beam melting (EBM), to evaluate osseointegration. In addition, a comparison was made with Ti-POR coated with COLL I (Ti-POR-COLL) to evaluate osseointegration in terms of bone-to-implant contact (BIC) and new bone formation (nBAr/TAr) at 30, 60 and 90 d of culture. After 30 and 60 d of culture, BIC and nBAr/TAr resulted significantly higher in Ti-POR-COLL implants than in Ti-POR. No differences have been found at 90 d of culture. With the developed model it was possible to distinguish the biomaterial properties and behavior. This study defined and confirmed for the first time the validity of the alternative ex vivo method to evaluate osseointegration and that COLL I improves osseointegration and bone growth of Ti-6Al-4V fabricated through EBM.
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Affiliation(s)
- Francesca Veronesi
- Complex Structure of Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136 Bologna, Italy
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Spece H, Basgul C, Andrews CE, MacDonald DW, Taheri ML, Kurtz SM. A systematic review of preclinical in vivo testing of 3D printed porous Ti6Al4V for orthopedic applications, part I: Animal models and bone ingrowth outcome measures. J Biomed Mater Res B Appl Biomater 2021; 109:1436-1454. [PMID: 33484102 DOI: 10.1002/jbm.b.34803] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 11/20/2020] [Accepted: 01/09/2021] [Indexed: 01/20/2023]
Abstract
For Ti6Al4V orthopedic and spinal implants, osseointegration is often achieved using complex porous geometries created via additive manufacturing (AM). While AM porous titanium (pTi) has shown clinical success, concerns regarding metallic implants have spurred interest in alternative AM biomaterials for osseointegration. Insights regarding the evaluation of these new materials may be supported by better understanding the role of preclinical testing for AM pTi. We therefore asked: (a) What animal models have been most commonly used to evaluate AM porous Ti6Al4V for orthopedic bone ingrowth; (b) What were the primary reported quantitative outcome measures for these models; and (c) What were the bone ingrowth outcomes associated with the most frequently used models? We performed a systematic literature search and identified 58 articles meeting our inclusion criteria. We found that AM pTi was evaluated most often using rabbit and sheep femoral condyle defect (FCD) models. Additional ingrowth models including transcortical and segmental defects, spinal fusions, and calvarial defects were also used with various animals based on the study goals. Quantitative outcome measures determined via histomorphometry including ''bone ingrowth'' (range: 3.92-53.4% for rabbit/sheep FCD) and bone-implant contact (range: 9.9-59.7% for rabbit/sheep FCD) were the most common. Studies also used 3D imaging to report outcomes such as bone volume fraction (BV/TV, range: 4.4-61.1% for rabbit/sheep FCD), and push-out testing for outcomes such as maximum removal force (range: 46.6-3092 N for rabbit/sheep FCD). Though there were many commonalities among the study methods, we also found significant heterogeneity in the outcome terms and definitions. The considerable diversity in testing and reporting may no longer be necessary considering the reported success of AM pTi across all model types and the ample literature supporting the rabbit and sheep as suitable small and large animal models, respectively. Ultimately, more standardized animal models and reporting of bone ingrowth for porous AM materials will be useful for future studies.
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Affiliation(s)
- Hannah Spece
- Implant Research Core, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
| | - Cemile Basgul
- Implant Research Core, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Daniel W MacDonald
- Implant Research Core, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Steven M Kurtz
- Implant Research Core, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA.,Exponent, Inc., Philadelphia, Pennsylvania, USA
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21
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Reproducibility of Replicated Trabecular Bone Structures from Ti6Al4V Extralow Interstitials Powder by Selective Laser Melting. ARABIAN JOURNAL FOR SCIENCE AND ENGINEERING 2021. [DOI: 10.1007/s13369-020-05145-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Ahmed A, Al-Rasheed A, Badwelan M, Alghamdi HS. Peri-Implant bone response around porous-surface dental implants: A preclinical meta-analysis. Saudi Dent J 2020; 33:239-247. [PMID: 34194186 PMCID: PMC8236543 DOI: 10.1016/j.sdentj.2020.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 12/09/2022] Open
Abstract
Introduction This meta-analysis of relevant animal studies was conducted to assess whether the use of porous-surface implants improves osseointegration compared to the use of non-porous-surface implants. Material and methods An electronic search of PubMed (MEDLINE) resulted in the selection of ten animal studies (out of 865 publications) for characterization and quality assessment. Risk of bias assessment indicated poor reporting for the majority of studies. The results for bone-implant contact (BIC%) and peri-implant bone formation (BF%) were extracted from the eligible studies and used for the meta-analysis. Data for porous-surface implants were compared to those for non-porous-surface implants, which were considered as the controls. Results The random-effects meta-analysis showed that the use of porous-surface implants did not significantly increase overall BIC% (mean difference or MD: 3.63%; 95% confidence interval or 95% CI: −1.66 to 8.91; p = 0.18), whereas it significantly increased overall BF% (MD: 5.43%; CI: 2.20 to 8.67; p = 0.001), as compared to the controls. Conclusion Porous-surface implants promote osseointegration with increase in BF%. However, their use shows no significant effect on BIC%. Further preclinical and clinical investigations are required to find conclusive evidence on the effect of porous-surface implants.
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Affiliation(s)
- Abeer Ahmed
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz Al-Rasheed
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Badwelan
- Department of Oral and Maxillofacial Surgery, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.,Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Aden University, Aden, Yemen
| | - Hamdan S Alghamdi
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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The Role of Epigenetic Functionalization of Implants and Biomaterials in Osseointegration and Bone Regeneration-A Review. Molecules 2020; 25:molecules25245879. [PMID: 33322654 PMCID: PMC7763898 DOI: 10.3390/molecules25245879] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/03/2020] [Accepted: 12/09/2020] [Indexed: 02/07/2023] Open
Abstract
The contribution of epigenetic mechanisms as a potential treatment model has been observed in cancer and autoimmune/inflammatory diseases. This review aims to put forward the epigenetic mechanisms as a promising strategy in implant surface functionalization and modification of biomaterials, to promote better osseointegration and bone regeneration, and could be applicable for alveolar bone regeneration and osseointegration in the future. Materials and Methods: Electronic and manual searches of the literature in PubMed, MEDLINE, and EMBASE were conducted, using a specific search strategy limited to publications in the last 5 years to identify preclinical studies in order to address the following focused questions: (i) Which, if any, are the epigenetic mechanisms used to functionalize implant surfaces to achieve better osseointegration? (ii) Which, if any, are the epigenetic mechanisms used to functionalize biomaterials to achieve better tissue regeneration? Findings from several studies have emphasized the role of miRNAs in functionalizing implants surfaces and biomaterials to promote osseointegration and bone regeneration, respectively. However, there are scarce data on the role of DNA methylation and histone modifications for these specific applications, despite being commonly applied in cancer research. Studies over the past few years have demonstrated that biomaterials are immunomodulatory rather than inert materials. In this context, epigenetics can act as next generation of advanced treatment tools for future regenerative techniques. Yet, there is a need to evaluate the efficacy/cost effectiveness of these techniques in comparison to current standards of care.
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Wallace N, Schaffer NE, Aleem IS, Patel R. 3D-printed Patient-specific Spine Implants: A Systematic Review. Clin Spine Surg 2020; 33:400-407. [PMID: 32554986 DOI: 10.1097/bsd.0000000000001026] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To review the current clinical use of 3-dimensional printed (3DP) patient-specific implants in the spine. SUMMARY OF BACKGROUND DATA Additive manufacturing is a transformative manufacturing method now being applied to spinal implants. Recent innovations in technology have allowed the production of medical-grade implants with unprecedented structure and customization, and the complex anatomy of the spine is ideally suited for patient-specific devices. Improvement in implant design through the process of 3DP may lead to improved osseointegration, lower subsidence rates, and faster operative times. METHODS A comprehensive search of the literature was conducted using Ovid MEDLINE, EMBASE, Scopus, and other sources that resulted in 1842 unique articles. All manuscripts describing the use of 3DP spinal implants in humans were included. Two independent reviewers (N.W. and N.E.S.) assessed eligibility for inclusion. The following outcomes were collected: pain score, Japanese Orthopedic Association (JOA) score, subsidence, fusion, Cobb angle, vertebral height, and complications. No conflicts of interest existed. No funding was received for this work. RESULTS A total of 17 studies met inclusion criteria with a total of 35 patients. Only case series and case reports were identified. Follow-up times ranged from 3 to 36 months. Implant types included vertebral body replacement cages, interbody cages, sacral reconstruction prostheses, iliolumbar rods, and a posterior cervical plate. All studies reported improvement in both clinical and radiographic outcomes. 11 of 35 cases showed subsidence >3 mm, but only 1 case required a revision procedure. No migration, loosening, or pseudarthrosis occurred in any patient on the basis of computed tomography or flexion-extension radiographs. CONCLUSIONS Results of the systematic review indicate that 3DP technology is a viable means to fabricate patient-matched spinal implants. The effects on clinical and radiographic outcome measures are still in question, but these devices may produce favorable subsidence and pseudoarthrosis rates. Currently, the technology is ideally suited for complex tumor pathology and atypical bone defects. Future randomized controlled trials and cost analyses are still needed. LEVEL OF EVIDENCE IV-systematic review.
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Affiliation(s)
- Nicholas Wallace
- Department of Orthopedic Surgery, Division of Spine Surgery, University of Michigan, Ann Arbor, MI
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Fu J, Xiang Y, Ni M, Qu X, Zhou Y, Hao L, Zhang G, Chen J. In Vivo Reconstruction of the Acetabular Bone Defect by the Individualized Three-Dimensional Printed Porous Augment in a Swine Model. BIOMED RESEARCH INTERNATIONAL 2020; 2020:4542302. [PMID: 33335923 PMCID: PMC7723487 DOI: 10.1155/2020/4542302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/14/2020] [Accepted: 11/17/2020] [Indexed: 11/17/2022]
Abstract
METHODS As an acetabular bone defect model created in Bama miniswine, an augment individually fabricated by 3D print technique with Ti6Al4V powders was implanted to repair the defect. Nine swine were divided into three groups, including the immediate biomechanics group, 12-week biomechanics group, and 12-week histological group. The inner structural parameters of the 3D printed porous augment were measured by scanning electron microscopy (SEM), including porosity, pore size, and trabecular diameter. The matching degree between the postoperative augment and the designed augment was assessed by CT scanning and 3D reconstruction. In addition, biomechanical properties, such as stiffness, compressive strength, and the elastic modulus of the 3D printed porous augment, were measured by means of a mechanical testing machine. Moreover, bone ingrowth and implant osseointegration were histomorphometrically assessed. RESULTS In terms of the inner structural parameters of the 3D printed porous augment, the porosity was 55.48 ± 0.61%, pore size 319.23 ± 25.05 μm, and trabecular diameter 240.10 ± 23.50 μm. Biomechanically, the stiffness was 21464.60 ± 1091.69 N/mm, compressive strength 231.10 ± 11.77 MPa, and elastic modulus 5.35 ± 0.23 GPa, respectively. Furthermore, the matching extent between the postoperative augment and the designed one was up to 91.40 ± 2.83%. Besides, the maximal shear strength of the 3D printed augment was 929.46 ± 295.99 N immediately after implantation, whereas the strength was 1521.93 ± 98.38 N 12 weeks after surgery (p = 0.0302). The bone mineral apposition rate (μm per day) 12 weeks post operation was 3.77 ± 0.93 μm/d. The percentage bone volume of new bone was 22.30 ± 4.51% 12 weeks after surgery. CONCLUSION The 3D printed porous Ti6Al4V augment designed in this study was well biocompatible with bone tissue, possessed proper biomechanical features, and was anatomically well matched with the defect bone. Therefore, the 3D printed porous Ti6Al4V augment possesses great potential as an alternative for individualized treatment of severe acetabular bone defects.
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Affiliation(s)
- Jun Fu
- Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| | - Yi Xiang
- Department of Orthopaedics, The Logistics Support Forces of Chinese PLA 985 Hospital, Taiyuan, Shanxi 030001, China
| | - Ming Ni
- Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| | - Xiaojuan Qu
- Otolaryngological Department, The Logistics Support Forces of Chinese PLA 985 Hospital, Taiyuan, Shanxi 030001, China
| | - Yonggang Zhou
- Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| | - Libo Hao
- Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| | - Guoqiang Zhang
- Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| | - Jiying Chen
- Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
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He S, Yang X, Yang J, Ye C, Liu W, Wei H, Xiao J. Customized "Whole-Cervical-Vertebral-Body" Reconstruction After Modified Subtotal Spondylectomy of C2-C7 Spinal Tumor Via Piezoelectric Surgery. Oper Neurosurg (Hagerstown) 2020; 17:580-587. [PMID: 31089696 DOI: 10.1093/ons/opz077] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 12/25/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Radical resection is the first-line option in managing cervical primary chondrosarcoma. Favorable anterior reconstruction is challenging after multilevel total spondylectomy in the cervical spine. OBJECTIVE To illustrate the application of piezoelectric surgery and three-dimensional (3D) printing techniques in spine surgery. METHODS A 27-yr-old patient was referred to our center with complaints of nocturnal neck pain and right upper extremity weakness. A 2-stage radical tumor resection was conducted using piezoelectric surgery with pathologically tumor-free margins. A 3D-printed titanium microporous prosthesis (3D-PTMP) was designed to reconstruct the anterior column of the cervical spine between C1 and T1 for stability. RESULTS The whole intraoperative blood loss was 2300 mL over the 2 procedures. The patient had an uneventful recovery, regaining ambulatory status 3 wk after the 2 operations without ventilator support or other severe complications. By the final 14-mo follow-up, the patient had achieved marked pain relief and favorable neurological improvement; a postoperative computed tomography scan indicated a good position of the 3D-printed construct between the endplates with no sign of tumor recurrence or implant subsidence. CONCLUSION The applications of piezosurgery in total spondylectomy and in 3D-PTMP in reconstruction can be a favorable alternative for managing multilevel cervical spinal tumors. Further studies are warranted to validate this surgical strategy.
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Affiliation(s)
- Shaohui He
- Spinal Tumor Center, Department of Orthopaedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xinghai Yang
- Spinal Tumor Center, Department of Orthopaedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jian Yang
- Spinal Tumor Center, Department of Orthopaedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Chen Ye
- Spinal Tumor Center, Department of Orthopaedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Weibo Liu
- Spinal Tumor Center, Department of Orthopaedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China.,Department of Spine Surgery, Central Hospital of Qingdao, Shandong Province, China
| | - Haifeng Wei
- Spinal Tumor Center, Department of Orthopaedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jianru Xiao
- Spinal Tumor Center, Department of Orthopaedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Chatain GP, Finn M. Compassionate use of a custom 3D-printed sacral implant for revision of failing sacrectomy: case report. J Neurosurg Spine 2020; 33:513-518. [PMID: 32442976 DOI: 10.3171/2020.3.spine191497] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 03/20/2020] [Indexed: 11/06/2022]
Abstract
Reconstruction of the spinopelvic continuity after sacral resection for primary sacral tumors remains challenging. Complex anatomical and biomechanical factors of this transition zone may be addressed with the advancement of 3D-printed implants. Here, the authors report on a 67-year-old patient with a sacral chordoma who initially underwent total en bloc sacrectomy followed by standard spinopelvic reconstruction. Pseudarthrosis and instrumentation failure of the lumbosacral junction construct subsequently developed. A custom 3D-printed sacral prosthesis was created using high-resolution CT images. Emergency Food and Drug Administration approval was obtained, and the custom device was implanted as a salvage reconstruction surgery. Made of porous titanium mesh, the custom artificial sacrum was placed in the defect based on the anticipated osteotomic planes and was fixed with a screw-rod system along with a fibular bone strut graft. At the 18-month follow-up, the patient was disease free and walking short distances with assistance. CT revealed excellent bony incorporation into the graft.The use of a custom 3D-printed prosthesis in spinal reconstruction has been rarely reported, and its application in sacral reconstruction and long-term outcome are novel. While the implant was believed to be critical in endowing the region with enough biomechanical stability to promote healing, the procedure was difficult and several key learning points were discovered along the way.
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Zhang Y, Min L, Lu M, Wang J, Wang Y, Luo Y, Zhou Y, Duan H, Tu C. Three-dimensional-printed customized prosthesis for pubic defect: prosthesis design and surgical techniques. J Orthop Surg Res 2020; 15:261. [PMID: 32660528 PMCID: PMC7359288 DOI: 10.1186/s13018-020-01766-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 06/28/2020] [Indexed: 02/08/2023] Open
Abstract
Background This study is to describe the detailed design and surgical techniques of three-dimensional (3D)-printed customized prosthesis for pubic bone defect. Patients and methods Five patients under type III resections were included in this study. Based on radiography data, 3D pelvic model was established and virtual surgery was simulated. Detailed anatomy data were measured including the size and arc of normal pubis, the size of residual bone in acetabular side. Different fixation ways were considered according to shape of defect. After features modification and porous structure design, prostheses were fabricated. The osteotomy guides and plastic models were used during surgery. Result Of 5 cases, the prostheses consist of the type with stem (3, 60%) and the type without stem (2, 40%). Mean follow-up period was 13.6 months (range, 8-24 months). For partial pubis removed cases, the mean length and width of narrowest part of normal superior pubis were 13.19 mm (range, 12.51-14.12 mm) and 7.80 mm (range, 7.18-8.26 mm) respectively. Mean arc of normal pubis was 2.71 rad (range, 2.66-2.73 rad). For the entire pubis resection cases, the mean diameter of narrowest parts and length of normal superior pubis were 11.52 mm (range, 11.13-11.91 mm) and 64.78 mm (range, 63.46-66.09 mm), while the diameter of narrowest part and length of normal inferior pubis were 7.37 mm (range, 7.20-7.54 mm) and 86.43 mm (range, 84.28-88.57 mm). Mean length and arc of intramedullary stem was 20 mm (range, 18-21 mm) and 2.7 rad. Mean screw holes number was 6.3 (range, 6-7) while ultimate screws number in surgeries was 4.3 (range, 4-5). Porous structure with 600-μm-pore size and 70% porosity was applied in parts of contact with residual bone. Conclusion 3D-printed customized prostheses could be a feasible option to reconstruct bone defect after type III resection. The design of 3D-printed customized prostheses is a multi-step process which is based on strict anatomic measurement.
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Affiliation(s)
- Yuqi Zhang
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Li Min
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Minxun Lu
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jie Wang
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yitian Wang
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yi Luo
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yong Zhou
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Hong Duan
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Chongqi Tu
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China. .,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.
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Wang Q, Zhou P, Liu S, Attarilar S, Ma RLW, Zhong Y, Wang L. Multi-Scale Surface Treatments of Titanium Implants for Rapid Osseointegration: A Review. NANOMATERIALS (BASEL, SWITZERLAND) 2020; 10:E1244. [PMID: 32604854 PMCID: PMC7353126 DOI: 10.3390/nano10061244] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/30/2020] [Accepted: 06/22/2020] [Indexed: 02/06/2023]
Abstract
The propose of this review was to summarize the advances in multi-scale surface technology of titanium implants to accelerate the osseointegration process. The several multi-scaled methods used for improving wettability, roughness, and bioactivity of implant surfaces are reviewed. In addition, macro-scale methods (e.g., 3D printing (3DP) and laser surface texturing (LST)), micro-scale (e.g., grit-blasting, acid-etching, and Sand-blasted, Large-grit, and Acid-etching (SLA)) and nano-scale methods (e.g., plasma-spraying and anodization) are also discussed, and these surfaces are known to have favorable properties in clinical applications. Functionalized coatings with organic and non-organic loadings suggest good prospects for the future of modern biotechnology. Nevertheless, because of high cost and low clinical validation, these partial coatings have not been commercially available so far. A large number of in vitro and in vivo investigations are necessary in order to obtain in-depth exploration about the efficiency of functional implant surfaces. The prospective titanium implants should possess the optimum chemistry, bionic characteristics, and standardized modern topographies to achieve rapid osseointegration.
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Affiliation(s)
- Qingge Wang
- School of Metallurgical Engineering, Xi’an University of Architecture and Technology, No.13 Yanta Road, Xi’an 710055, China;
| | - Peng Zhou
- School of Aeronautical Materials Engineering, Xi’an Aeronautical Polytechnic Institute, Xi’an 710089, China;
| | - Shifeng Liu
- School of Metallurgical Engineering, Xi’an University of Architecture and Technology, No.13 Yanta Road, Xi’an 710055, China;
| | - Shokouh Attarilar
- State Key Laboratory of Metal Matrix Composites, School of Material Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China;
| | - Robin Lok-Wang Ma
- Department of Mechanical and Aerospace Engineering, The Hong Kong University of Science and Technology, Hong Kong 999077, China; (R.L.-W.M.); (Y.Z.)
| | - Yinsheng Zhong
- Department of Mechanical and Aerospace Engineering, The Hong Kong University of Science and Technology, Hong Kong 999077, China; (R.L.-W.M.); (Y.Z.)
| | - Liqiang Wang
- State Key Laboratory of Metal Matrix Composites, School of Material Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China;
- National Engineering Research Center for Nanotechnology (NERCN), 28 East JiangChuan Road, Shanghai 200241, China
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Response of Saos-2 osteoblast-like cells to kilohertz-resonance excitation in porous metallic scaffolds. J Mech Behav Biomed Mater 2020; 106:103726. [DOI: 10.1016/j.jmbbm.2020.103726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 02/10/2020] [Accepted: 03/10/2020] [Indexed: 12/13/2022]
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3D-printed Titanium Prosthetic Reconstruction of the C2 Vertebra: Techniques and Outcomes of Three Consecutive Cases. Spine (Phila Pa 1976) 2020; 45:667-672. [PMID: 31809469 DOI: 10.1097/brs.0000000000003360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Three patients were treated at our center with patient-specific three-dimensional (3D)-printed titanium prostheses for the reconstruction of structurally compromised C2 vertebrae. OBJECTIVE To describe our surgical and device design approach to these clinical scenarios and evaluate their outcomes. SUMMARY OF BACKGROUND DATA There are a limited but increasing number of case reports and series describing the use of 3D-printed prostheses for high cervical surgery. METHODS We have collated and reviewed three cases using patient-specific 3D-printed prostheses. RESULTS We report two cases arising from neoplastic destruction; one resulting from metastatic medullary thyroid carcinoma, and the other from multiple myeloma. We additionally describe a case of C2 compromise as a complication of rheumatoid arthritis. All patients included in this report achieved successful surgical outcomes and symptom relief without significant complication. Clinical and radiological follow-up has demonstrated good outcomes in all cases up to 14-months postprocedure. CONCLUSIONS These cases describe successful use of custom 3D-printed prostheses for reconstruction of the anterior vertebral column through C2, and add to the emerging body of literature detailing the use of custom prostheses for complex spinal surgery. LEVEL OF EVIDENCE 4.
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Xie K, Guo Y, Zhao S, Wang L, Wu J, Tan J, Yang Y, Wu W, Jiang W, Hao Y. Partially Melted Ti6Al4V Particles Increase Bacterial Adhesion and Inhibit Osteogenic Activity on 3D-printed Implants: An In Vitro Study. Clin Orthop Relat Res 2019; 477:2772-2782. [PMID: 31764350 PMCID: PMC6907305 DOI: 10.1097/corr.0000000000000954] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 08/14/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND A porous Ti6Al4V implant that is manufactured using selective laser melting (SLM) has broad potential applications in the field of orthopaedic implants. The pore structure of the SLM porous Ti6Al4V implant allows for cell migration and osteogenic differentiation, which is favorable for bone ingrowth and osseointegration. However, it is unclear whether the pore structure and partially melted Ti6Al4V particles on a SLM porous Ti6Al4V implant will increase bacterial adhesion and, perhaps, the risk of implant-related infection. QUESTIONS/PURPOSES (1) Is there more bacterial adhesion and colonization on SLM porous Ti6Al4V implants than on polished orthopaedic implants? (2) Do partially melted Ti6Al4V particles on SLM porous Ti6Al4V implants reduce human bone mesenchymal stem cells (hBMSCs) adhesion, viability, and activity? METHODS To determine bacterial adhesion and biofilm formation, we incubated five different Ti6Al4V discs (polished, grit-blasted, plasma-sprayed, particle SLM porous, and nonparticle SLM porous discs) with methicillin-resistant Staphylococcus aureus (MRSA) and Escherichia coli. Bacterial coverage on the surface of the five different Ti6Al4V discs were evaluated based on scanning electron microscopy (SEM) images quantitatively. In addition, a spread-plate method was used to quantitatively evaluate the bacterial adhesion on those implants. The biofilm formation was stained with crystal violet and semi-quantitatively determined with a microplate reader. The morphology and adhesion of hBMSCs on the five Ti6Al4V discs were observed with SEM. The cell viability was quantitatively evaluated with a Cell Counting Kit-8 assay. In addition, the osteogenic activity was determined in vitro with a quantitatively alkaline phosphatase activity assay and alizarin-red staining. For semiquantitative analysis, the alizarin-red stained mineralized nodules were dissolved and determined with a microplate reader. RESULTS The polished discs had the lowest MRSA adhesion (8.3% ± 2.6%) compared with grit-blasted (19.1% ± 3.9%; p = 0.006), plasma-sprayed (38.5% ± 5.3%; p < 0.001), particle (23.1% ± 2.8%; p < 0.001), and nonparticle discs (15.7% ± 2.5%; p = 0.003). Additionally, when comparing the two SLM discs, we found that particle discs had higher bacterial coverage than nonparticle discs (23.1% ± 2.8% versus 15.7% ± 2.5%; p = 0.020). An E. coli analysis showed similar results, with the higher adhesion to particle SLM discs than to nonparticle discs (20.7% ± 4.2% versus 14.4% ± 3.6%; p = 0.011). In addition, on particle SLM porous discs, bacterial colonies were localized around the partially melted Ti6Al4V particles, based on SEM images. After a 7-day incubation period, the cell viability in the particle group (optical density value 0.72 ± 0.05) was lower than that in the nonparticle groups (optical density value: 0.87 ± 0.08; p = 0.003). Alkaline phosphatase activity, as a marker of osteogenic differentiation, was lower in the particle group than in the nonparticle group (1.32 ± 0.12 U/mL versus 1.58 ± 0.09 U/mL; p = 0.012). CONCLUSION Higher bacterial adhesion was observed on SLM porous discs than on polished discs. The partially melted Ti6Al4V particles on SLM porous discs not only enhanced bacterial adhesion but also inhibited the osteogenic activity of hBMSCs. Postprocessing treatment is necessary to remove partially melted Ti6Al4V particles on an SLM implant before further use. Additional studies are needed to determine whether an SLM porous Ti6Al4V implant increases the risk of implant-related infection in vivo. CLINICAL RELEVANCE As implants with porous Ti6Al4V made using SLM are being designed, our preliminary findings suggest that postprocessing treatment is needed to remove partially melted Ti6Al4V particles before further use. In addition, the depth of the porous structure of the SLM implant should not exceed the maximum depth of bone ingrowth because the host immune defense cannot prevent bacterial adhesion without integration.
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Affiliation(s)
- Kai Xie
- K. Xie, Y. Guo, S. Zhao, L. Wang, J. Wu, J. Tan, Y. Yang, W. Wu, Y. Hao, Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China W. Jiang, Y. Hao, Clinical and Translational Research Center for 3D Printing Technology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Li J, Jansen JA, Walboomers XF, van den Beucken JJ. Mechanical aspects of dental implants and osseointegration: A narrative review. J Mech Behav Biomed Mater 2019; 103:103574. [PMID: 32090904 DOI: 10.1016/j.jmbbm.2019.103574] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 09/23/2019] [Accepted: 11/29/2019] [Indexed: 12/28/2022]
Abstract
With the need of rapid healing and long-term stability of dental implants, the existing Ti-based implant materials do not meet completely the current expectation of patients. Low elastic modulus Ti-alloys have shown superior biocompatibility and can achieve comparable or even faster bone formation in vivo at the interface of bone and the implant. Porous structured Ti alloys have shown to allow rapid bone ingrowth through their open structure and to achieve anchorage with bone tissue by increasing the bone-implant interface area. In addition to the mechanical properties of implant materials, the design of the implant body can be used to optimize load transfer and affect the ultimate results of osseointegration. The aim of this narrative review is to define the mechanical properties of dental implants, summarize the relationship between implant stability and osseointegration, discuss the effect of metallic implant mechanical properties (e.g. stiffness and porosity) on the bone response based on existing in vitro and in vivo information, and analyze load transfer through mechanical properties of the implant body. This narrative review concluded that although several studies have presented the advantages of low elastic modulus or high porosity alloys and their effect on osseointegration, further in vivo studies, especially long-term observational studies are needed to justify these novel materials as a replacement for current Ti-based implant materials.
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Affiliation(s)
- Jinmeng Li
- Department of Biomaterials, Radboudumc, P.O. Box 9101, 6500, Nijmegen, HB, the Netherlands
| | - John A Jansen
- Department of Biomaterials, Radboudumc, P.O. Box 9101, 6500, Nijmegen, HB, the Netherlands
| | - X Frank Walboomers
- Department of Biomaterials, Radboudumc, P.O. Box 9101, 6500, Nijmegen, HB, the Netherlands
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Wang J, Min L, Lu M, Zhang Y, Wang Y, Luo Y, Zhou Y, Duan H, Tu C. Three-dimensional-printed custom-made hemipelvic endoprosthesis for primary malignancies involving acetabulum: the design solution and surgical techniques. J Orthop Surg Res 2019; 14:389. [PMID: 31775805 PMCID: PMC6882053 DOI: 10.1186/s13018-019-1455-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 11/05/2019] [Indexed: 02/05/2023] Open
Abstract
Background This study is to describe the detailed design and surgical techniques of three-dimensional (3D)-printed custom-made endoprosthesis for hemipelvic tumorous bone defect. Methods According to the pelvic tumor resection classification by Enneking and Dunham, the hemipelvis is divided into three zones including the ilium (P1), acetabulum (P2), and pubis and ischium (P3). Thirteen patients were included in this study. Of these, P1 and P2 were involved in three cases, while P1, P2, and P3 were involved in 10. Based on radiography data, 3D pelvic model was rebuilt, and virtual surgery was simulated. Different fixation methods were applied according to residual bone volume. Parameters of the first sacral (S1) vestibule, second sacral (S2) vestibule, the narrowest zone of superior pubic medullary cavity (NPSPMC), and the resected surface of superior pubic medullary cavity (RSSPMC) were selectively measured in various fixation methods. Model overlapping, feature simplifying, and size controlling were three basic steps during design procedure. Volume proportion of porous structure was determined according to estimated weight of resected specimen. Acetabular location, anteversion, and inclination were modulated. Screw diameter, direction, and combination were considered. The osteotomy guides and plastic models were used during surgery. Results Of 13 cases, after P1 resection, endoprostheses were fixed to sacra (8; 61.5%), ilia (3; 23.1%), and both (2; 15.4%). After P3 resection, endoprostheses were fixed to residual acetabulum (3; 23.1%), and residual pubis by stem (8; 61.5%) or “cap-like” structure (2; 15.4%). Mean area of the S1 vestibule, S2 vestibule, RSSPMC, and PSPMC were 327.9 (222.2 to 400), 131.7 (102.6 to 163.6), 200.5 (103.8 to 333.2), and 79.8 mm2 (40.4 to 126.2), respectively. Porous structure with 600 μm pore size and 70% porosity accounted for 68.8% (53.0 to 86.0) of the whole endoprosthesis on average. Mean acetabular anteversion and inclination were designed as 23.2° (20 to 25) and 42.4° (40 to 45). Median numbers of screws designed in the S1 vestibule was 5 (IQR, 4 to 6), in the S2 vestibule was 1 (IQR, 1 to 2), in the ilium was 5 (IQR, 2 to 6), and in the pubis was 1 (IQR, 1 to 1), while screws designed in the ischium was all 2. Median number of screws inserted in the S1 vestibule was 4 (IQR, 3 to 4), in the S2 vestibule was 1 (IQR, 1 to 1), in the ilium was 3 (IQR, 1 to 5), in the pubis was 1 (IQR, 0 to 1), and in the ischium was 1 (IQR, 1 to 1). Conclusions This study firstly presents detailed design and related surgical techniques of 3D-printed custom-made hemipelvic endoprosthesis reconstruction. Osseointegration is critical for long-term outcome and requires three design elements including interface connection, porous structure, and initial stability achieved by precise matching and proper fixation methods.
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Affiliation(s)
- Jie Wang
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Li Min
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Minxun Lu
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yuqi Zhang
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yitian Wang
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yi Luo
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yong Zhou
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Hong Duan
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Chongqi Tu
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China. .,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.
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Dos Santos LCP, Malheiros FC, Guarato AZ. Surface parameters of as-built additive manufactured metal for intraosseous dental implants. J Prosthet Dent 2019; 124:217-222. [PMID: 31759564 DOI: 10.1016/j.prosdent.2019.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 09/11/2019] [Accepted: 09/11/2019] [Indexed: 12/17/2022]
Abstract
STATEMENT OF PROBLEM To improve osseointegration, current machined implants are submitted to different surface treatments such as airborne-particle abrasion and acid etching. Although additive manufacturing has allowed the fabrication of implants with custom design, porosity, and roughness, whether good osseointegration can be achieved without subsequent surface treatments is still unclear. PURPOSE The purpose of this in vitro study was to investigate the feasibility of using additive manufacturing technology for dental implants without the use of subsequent surface treatments. MATERIAL AND METHODS The roughness, wettability, and surface energy of a flat test stainless-steel specimen produced from a 3D printer were evaluated. The roughness measurements were obtained by using a mechanical contact profilometer. The wettability was characterized by the sessile drop method by using deionized water and ethylene glycol. The surface energy values were calculated by using the Owens, Wendt, Rabel, and Kaeble (OWRK) computational method. RESULTS The experimental data obtained were Ra=4.55 μm, Rq=5.64 μm, RSm=0.235 mm, Rsk=-0.071, Rku=3.740, Rdq=13 degrees; water contact angle=66 degrees; ethylene glycol contact angle=57 degrees; surface energy=38 mN/m. The measured values were compared with data reported in the literature for commercially available implants. The parameter Ra, which is the most used parameter to describe the surface of dental implants, was 50%, 270%, and 329% higher than that reported in the literature for commercial dental implants. The surface energy was 10% and 19% lower than the representative values in the literature for commercial dental implants. CONCLUSIONS The results indicate that specimens fabricated by additive manufacturing had higher roughness and lower surface energy than reported results in the literature. Therefore, additive manufacturing was found to produce suitable surface parameters for dental implants, and subsequent surface treatments could be removed from the manufacturing process.
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An In Vivo Evaluation of Biocompatibility and Implant Accuracy of the Electron Beam Melting and Commercial Reconstruction Plates. METALS 2019. [DOI: 10.3390/met9101065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The use of additive manufacturing in medical applications has become more prevalent over the last decade. Studies have proved that reconstruction plates with a mesh structure enhance the biocompatibility and bone-ingrowth formation. However, limited studies have been reported in the customization and in vivo clinical assessment of mesh implants. The purpose of this study was to investigate the surgical treatment and implant fitting accuracy using three different reconstruction plates. Fifteen goats were divided into one control and three experimental groups (Groups 1, 2, and 3) with five in each group. An experimental segmental defect was created on these animals and was adopted with customized electron beam melting reconstruction titanium plates with mesh in Group 1 and without mesh in Group 2 and commercial reconstruction plate in Group 3. All the animals were subjected to radiographic analysis before and after surgery. The subjected animals were sacrificed after 3 months and the electron beam melting reconstruction plates were compared with the commercial plate based on clinical and histology analysis and implant fitting accuracy. Both the electron beam melting reconstruction plates (with mesh and without mesh) and commercial plates survived the three months post-operation, revealing good wound-healing with new bone formation and without any foreign-body reaction. The electron beam melting reconstructed plate with mesh (Group 1) was found to have a better implant fitting when compared to the other two groups. The average discrepancy between Groups 2 and 3 was not significant. Certainly, the commercial plate (Group 3) was found to have the least accuracy as compared to other electron beam melting reconstruction plates (Group 1 and Group 2). Custom design electron beam melting fabricated reconstruction plates possessed better functionality, aesthetic outcome, and long-term biocompatibility when compared to commercial plates. Animal results indicated that the electron beam melting plates with mesh (Group 1) were superior in comparison to the other two groups due to its ability to provide better bone-in-growth and osseointegration on its porous microstructure.
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Extra low interstitial titanium based fully porous morphological bone scaffolds manufactured using selective laser melting. J Mech Behav Biomed Mater 2019; 95:1-12. [DOI: 10.1016/j.jmbbm.2019.03.025] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/12/2019] [Accepted: 03/22/2019] [Indexed: 12/20/2022]
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Abstract
Three-dimensional (3D) printed titanium orthopaedic implants have recently revolutionized the treatment of massive bone defects in the pelvis, and we are on the verge of a change from conventional to 3D printed manufacture for the mass production of millions of off-the-shelf (non-personalized) implants. The process of 3D printing has many adjustable variables, which taken together with the possible variation in designs that can be printed, has created even more possible variables in the final product that must be understood if we are to predict the performance and safety of 3D printed implants. We critically reviewed the clinical use of 3D printing in orthopaedics, focusing on cementless acetabular components used in total hip arthroplasty. We defined the clinical and engineering rationale of 3D printed acetabular cups, summarized the key variables involved in the manufacturing process that influence the properties of the final parts, together with the main limitations of this technology, and created a classification according to end-use application to help explain the controversial and topical issues. Whilst early clinical outcomes related to 3D printed cups have been promising, in-depth robust investigations are needed, partly because regulatory approval systems have not fully adapted to the change in technology. Analysis of both pristine and retrieved cups, together with long-term clinical outcomes, will help the transition to 3D printing to be managed safely.
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Ni J, Ling H, Zhang S, Wang Z, Peng Z, Benyshek C, Zan R, Miri A, Li Z, Zhang X, Lee J, Lee KJ, Kim HJ, Tebon P, Hoffman T, Dokmeci M, Ashammakhi N, Li X, Khademhosseini A. Three-dimensional printing of metals for biomedical applications. Mater Today Bio 2019; 3:100024. [PMID: 32159151 PMCID: PMC7061633 DOI: 10.1016/j.mtbio.2019.100024] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 08/08/2019] [Accepted: 08/12/2019] [Indexed: 12/21/2022] Open
Abstract
Three-dimensional (3D) printing technology has received great attention in the past decades in both academia and industry because of its advantages such as customized fabrication, low manufacturing cost, unprecedented capability for complex geometry, and short fabrication period. 3D printing of metals with controllable structures represents a state-of-the-art technology that enables the development of metallic implants for biomedical applications. This review discusses currently existing 3D printing techniques and their applications in developing metallic medical implants and devices. Perspective about the current challenges and future directions for development of this technology is also presented.
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Affiliation(s)
- J. Ni
- Department of Bioengineering, University of California-Los Angeles, Los Angeles, CA 90095, USA
- Center for Minimally Invasive Therapeutics (C-MIT), University of California-Los Angeles, Los Angeles, CA 90095, USA
- California NanoSystems Institute, University of California-Los Angeles, Los Angeles, CA 90095, USA
- State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, PR China
| | - H. Ling
- Center for Minimally Invasive Therapeutics (C-MIT), University of California-Los Angeles, Los Angeles, CA 90095, USA
- California NanoSystems Institute, University of California-Los Angeles, Los Angeles, CA 90095, USA
- Department of Mechanical and Aerospace Engineering, University of California-Los Angeles, Los Angeles, CA 90095, USA
| | - S. Zhang
- Department of Bioengineering, University of California-Los Angeles, Los Angeles, CA 90095, USA
- Center for Minimally Invasive Therapeutics (C-MIT), University of California-Los Angeles, Los Angeles, CA 90095, USA
- California NanoSystems Institute, University of California-Los Angeles, Los Angeles, CA 90095, USA
| | - Z. Wang
- Department of Bioengineering, University of California-Los Angeles, Los Angeles, CA 90095, USA
- Center for Minimally Invasive Therapeutics (C-MIT), University of California-Los Angeles, Los Angeles, CA 90095, USA
- California NanoSystems Institute, University of California-Los Angeles, Los Angeles, CA 90095, USA
| | - Z. Peng
- Department of Orthopaedic Surgery, Ningbo Medical Treatment Center Lihuili Hospital, PR China
| | - C. Benyshek
- Department of Bioengineering, University of California-Los Angeles, Los Angeles, CA 90095, USA
- Center for Minimally Invasive Therapeutics (C-MIT), University of California-Los Angeles, Los Angeles, CA 90095, USA
- California NanoSystems Institute, University of California-Los Angeles, Los Angeles, CA 90095, USA
| | - R. Zan
- State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, PR China
| | - A.K. Miri
- Department of Bioengineering, University of California-Los Angeles, Los Angeles, CA 90095, USA
- Center for Minimally Invasive Therapeutics (C-MIT), University of California-Los Angeles, Los Angeles, CA 90095, USA
- California NanoSystems Institute, University of California-Los Angeles, Los Angeles, CA 90095, USA
| | - Z. Li
- Department of Bioengineering, University of California-Los Angeles, Los Angeles, CA 90095, USA
- Center for Minimally Invasive Therapeutics (C-MIT), University of California-Los Angeles, Los Angeles, CA 90095, USA
- California NanoSystems Institute, University of California-Los Angeles, Los Angeles, CA 90095, USA
- School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, 710049, China
| | - X. Zhang
- State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, PR China
| | - J. Lee
- Department of Bioengineering, University of California-Los Angeles, Los Angeles, CA 90095, USA
- Center for Minimally Invasive Therapeutics (C-MIT), University of California-Los Angeles, Los Angeles, CA 90095, USA
- California NanoSystems Institute, University of California-Los Angeles, Los Angeles, CA 90095, USA
| | - K.-J. Lee
- Department of Bioengineering, University of California-Los Angeles, Los Angeles, CA 90095, USA
- Center for Minimally Invasive Therapeutics (C-MIT), University of California-Los Angeles, Los Angeles, CA 90095, USA
- California NanoSystems Institute, University of California-Los Angeles, Los Angeles, CA 90095, USA
| | - H.-J. Kim
- Department of Bioengineering, University of California-Los Angeles, Los Angeles, CA 90095, USA
- Center for Minimally Invasive Therapeutics (C-MIT), University of California-Los Angeles, Los Angeles, CA 90095, USA
- California NanoSystems Institute, University of California-Los Angeles, Los Angeles, CA 90095, USA
| | - P. Tebon
- Department of Bioengineering, University of California-Los Angeles, Los Angeles, CA 90095, USA
- Center for Minimally Invasive Therapeutics (C-MIT), University of California-Los Angeles, Los Angeles, CA 90095, USA
- California NanoSystems Institute, University of California-Los Angeles, Los Angeles, CA 90095, USA
| | - T. Hoffman
- Department of Bioengineering, University of California-Los Angeles, Los Angeles, CA 90095, USA
- Center for Minimally Invasive Therapeutics (C-MIT), University of California-Los Angeles, Los Angeles, CA 90095, USA
- California NanoSystems Institute, University of California-Los Angeles, Los Angeles, CA 90095, USA
| | - M.R. Dokmeci
- Department of Bioengineering, University of California-Los Angeles, Los Angeles, CA 90095, USA
- Center for Minimally Invasive Therapeutics (C-MIT), University of California-Los Angeles, Los Angeles, CA 90095, USA
- California NanoSystems Institute, University of California-Los Angeles, Los Angeles, CA 90095, USA
- Department of Radiology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA 90095, USA
| | - N. Ashammakhi
- Department of Bioengineering, University of California-Los Angeles, Los Angeles, CA 90095, USA
- Center for Minimally Invasive Therapeutics (C-MIT), University of California-Los Angeles, Los Angeles, CA 90095, USA
- California NanoSystems Institute, University of California-Los Angeles, Los Angeles, CA 90095, USA
- Department of Radiology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA 90095, USA
| | - X. Li
- Department of Mechanical and Aerospace Engineering, University of California-Los Angeles, Los Angeles, CA 90095, USA
- Department of Materials Science and Engineering, University of California-Los Angeles, Los Angeles, CA 90095, USA
| | - A. Khademhosseini
- Department of Bioengineering, University of California-Los Angeles, Los Angeles, CA 90095, USA
- Center for Minimally Invasive Therapeutics (C-MIT), University of California-Los Angeles, Los Angeles, CA 90095, USA
- California NanoSystems Institute, University of California-Los Angeles, Los Angeles, CA 90095, USA
- Department of Radiology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA 90095, USA
- Department of Chemical and Biomolecular Engineering, University of California-Los Angeles, Los Angeles, CA 90095, USA
- Department of Bioindustrial Technologies, College of Animal Bioscience and Technology, Konkuk University, Seoul, Republic of Korea
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Shah FA, Ruscsák K, Palmquist A. 50 years of scanning electron microscopy of bone-a comprehensive overview of the important discoveries made and insights gained into bone material properties in health, disease, and taphonomy. Bone Res 2019; 7:15. [PMID: 31123620 PMCID: PMC6531483 DOI: 10.1038/s41413-019-0053-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/09/2019] [Accepted: 04/11/2019] [Indexed: 02/06/2023] Open
Abstract
Bone is an architecturally complex system that constantly undergoes structural and functional optimisation through renewal and repair. The scanning electron microscope (SEM) is among the most frequently used instruments for examining bone. It offers the key advantage of very high spatial resolution coupled with a large depth of field and wide field of view. Interactions between incident electrons and atoms on the sample surface generate backscattered electrons, secondary electrons, and various other signals including X-rays that relay compositional and topographical information. Through selective removal or preservation of specific tissue components (organic, inorganic, cellular, vascular), their individual contribution(s) to the overall functional competence can be elucidated. With few restrictions on sample geometry and a variety of applicable sample-processing routes, a given sample may be conveniently adapted for multiple analytical methods. While a conventional SEM operates at high vacuum conditions that demand clean, dry, and electrically conductive samples, non-conductive materials (e.g., bone) can be imaged without significant modification from the natural state using an environmental scanning electron microscope. This review highlights important insights gained into bone microstructure and pathophysiology, bone response to implanted biomaterials, elemental analysis, SEM in paleoarchaeology, 3D imaging using focused ion beam techniques, correlative microscopy and in situ experiments. The capacity to image seamlessly across multiple length scales within the meso-micro-nano-continuum, the SEM lends itself to many unique and diverse applications, which attest to the versatility and user-friendly nature of this instrument for studying bone. Significant technological developments are anticipated for analysing bone using the SEM.
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Affiliation(s)
- Furqan A. Shah
- Department of Biomaterials, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Krisztina Ruscsák
- Department of Biomaterials, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Palmquist
- Department of Biomaterials, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Design of Additively Manufactured Structures for Biomedical Applications: A Review of the Additive Manufacturing Processes Applied to the Biomedical Sector. JOURNAL OF HEALTHCARE ENGINEERING 2019; 2019:9748212. [PMID: 30992744 PMCID: PMC6434267 DOI: 10.1155/2019/9748212] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/26/2019] [Indexed: 11/24/2022]
Abstract
Additive manufacturing (AM) is a disruptive technology as it pushes the frontier of manufacturing towards a new design perspective, such as the ability to shape geometries that cannot be formed with any other traditional technique. AM has today shown successful applications in several fields such as the biomedical sector in which it provides a relatively fast and effective way to solve even complex medical cases. From this point of view, the purpose of this paper is to illustrate AM technologies currently used in the medical field and their benefits along with contemporary. The review highlights differences in processes, materials, and design of additive manufacturing techniques used in biomedical applications. Successful case studies are presented to emphasise the potentiality of AM processes. The presented review supports improvements in materials and design for future researches in biomedical surgeries using instruments and implants made by AM.
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Vertebral Reconstruction with Customized 3-Dimensional-Printed Spine Implant Replacing Large Vertebral Defect with 3-Year Follow-up. World Neurosurg 2019; 126:90-95. [PMID: 30797911 DOI: 10.1016/j.wneu.2019.02.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 02/12/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Destruction of the spine is a huge complication of infectious spondylitis and surgical intervention is required. However, vertebral defect is a major problem after surgical intervention and numerous methods have been researched to solve this problem. There are known methods that use variously designed, patient-customized 3-dimensional (3D)-printed implants in various medical fields. The use of 3D-printed implants has also been attempted in treating defects in the spine. We present a case of failure of expandable titanium cage fusion after infection, treated using a 3D-printed implant. CASE DESCRIPTION The patient had undergone reconstruction surgery with expandable titanium cage due to infectious spondylitis and needed reoperation owing to recurrence of infections and failure of bone fusion. The problem we faced in this operation was a large vertebral defect, for which we used a 3D-printed implant. After 3 years of follow-up, the implant and bone fusion were intact and infection or mechanical complications were not seen. CONCLUSIONS A 3D-printed implant could be an acceptable and alternative treatment option for replacing a large vertebral defect.
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Shah FA, Thomsen P, Palmquist A. Osseointegration and current interpretations of the bone-implant interface. Acta Biomater 2019; 84:1-15. [PMID: 30445157 DOI: 10.1016/j.actbio.2018.11.018] [Citation(s) in RCA: 156] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/28/2018] [Accepted: 11/12/2018] [Indexed: 02/07/2023]
Abstract
Complex physical and chemical interactions take place in the interface between the implant surface and bone. Various descriptions of the ultrastructural arrangement to various implant design features, ranging from solid and macroporous geometries to surface modifications on the micron-, submicron-, and nano- levels, have been put forward. Here, the current knowledge regarding structural organisation of the bone-implant interface is reviewed with a focus on solid devices, mainly metal (or alloy) intended for permanent anchorage in bone. Certain biomaterials that undergo surface and bulk degradation are also considered. The bone-implant interface is a heterogeneous zone consisting of mineralised, partially mineralised, and unmineralised areas. Within the meso-micro-nano-continuum, mineralised collagen fibrils form the structural basis of the bone-implant interface, in addition to accumulation of non-collagenous macromolecules such as osteopontin, bone sialoprotein, and osteocalcin. In the published literature, as many as eight distinct arrangements of the bone-implant interface ultrastructure have been described. The interpretation is influenced by the in vivo model and species-specific characteristics, healing time point(s), physico-chemical properties of the implant surface, implant geometry, sample preparation route(s) and associated artefacts, analytical technique(s) and their limitations, and non-compromised vs compromised local tissue conditions. The understanding of the ultrastructure of the interface under experimental conditions is rapidly evolving due to the introduction of novel techniques for sample preparation and analysis. Nevertheless, the current understanding of the interface zone in humans in relation to clinical implant performance is still hampered by the shortcomings of clinical methods for resolving the finer details of the bone-implant interface. STATEMENT OF SIGNIFICANCE: Being a hierarchical material by design, the overall strength of bone is governed by composition and structure. Understanding the structure of the bone-implant interface is essential in the development of novel bone repair materials and strategies, and their long-term success. Here, the current knowledge regarding the eventual structural organisation of the bone-implant interface is reviewed, with a focus on solid devices intended for permanent anchorage in bone, and certain biomaterials that undergo surface and bulk degradation. The bone-implant interface is a heterogeneous zone consisting of mineralised, partially mineralised, and unmineralised areas. Within the meso-micro-nano-continuum, mineralised collagen fibrils form the structural basis of the bone-implant interface, in addition to accumulation of non-collagenous macromolecules such as osteopontin, bone sialoprotein, and osteocalcin.
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[Safety and efficacy of an electron beam melting technique-manufactured titanium mesh cage for lumbar interbody fusion]. DER ORTHOPADE 2018; 48:150-156. [PMID: 30569206 DOI: 10.1007/s00132-018-03681-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Electron beam melting (EBM) technique enables cage design changes such as the integration of guide rails on the cage surface or a 3D matrix for osseointegration. A change in manufacturing technique or design can lead to a decreased fusion rate or impaired applicability. OBJECTIVE The aim of the present study was to evaluate cage handling, lordosis reconstruction capability, and fusion rate 1 year after surgery. MATERIALS AND METHODS In this study, 50 patients who had undergone minimally invasive transforaminal lumbar interbody fusion (TLIF) or open posterior lumbar interbody fusion (PLIF) using an EBM-manufactured cage were retrospectively included. Fusion evaluation was based on routinely performed CTs and flexion-extension radiographs 12 months postoperatively. Lumbar and segmental lordosis were compared between pre-, post, and 1‑year follow-up. Postoperative cage position was used for evaluation of cage handling. RESULTS The radiological fusion rate was 97% at the 1‑year follow-up. Two cages were placed into the endplates during surgery without an effect on fusion. In 31% of the cages, placement at the anterior third of the disk space was possible. Lumbar lordosis was improved by a mean of 5° and segmental lordosis by a mean of 4°. At final follow-up, 1° was lost in both parameters. No implant-associated complications were registered. CONCLUSION The implant is safe and leads to a very high fusion rate. A learning curve results from the fact that the cage follows a defined radius dictated by the guide rails. Addressing this, exact placement at the anterior endplate can be achieved.
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Peel S, Eggbeer D, Burton H, Hanson H, Evans PL. Additively manufactured versus conventionally pressed cranioplasty implants: An accuracy comparison. Proc Inst Mech Eng H 2018; 232:949-961. [DOI: 10.1177/0954411918794718] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This article compared the accuracy of producing patient-specific cranioplasty implants using four different approaches. Benchmark geometry was designed to represent a cranium and a defect added simulating a craniectomy. An ‘ideal’ contour reconstruction was calculated and compared against reconstructions resulting from the four approaches –‘conventional’, ‘semi-digital’, ‘digital – non-automated’ and ‘digital – semi-automated’. The ‘conventional’ approach relied on hand carving a reconstruction, turning this into a press tool, and pressing titanium sheet. This approach is common in the UK National Health Service. The ‘semi-digital’ approach removed the hand-carving element. Both of the ‘digital’ approaches utilised additive manufacturing to produce the end-use implant. The geometries were designed using a non-specialised computer-aided design software and a semi-automated cranioplasty implant-specific computer-aided design software. It was found that all plates were clinically acceptable and that the digitally designed and additive manufacturing plates were as accurate as the conventional implants. There were no significant differences between the additive manufacturing plates designed using non-specialised computer-aided design software and those designed using the semi-automated tool. The semi-automated software and additive manufacturing production process were capable of producing cranioplasty implants of similar accuracy to multi-purpose software and additive manufacturing, and both were more accurate than handmade implants. The difference was not of clinical significance, demonstrating that the accuracy of additive manufacturing cranioplasty implants meets current best practice.
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Affiliation(s)
- Sean Peel
- PDR – International Centre for Design & Research, Cardiff Metropolitan University, Cardiff, UK
| | - Dominic Eggbeer
- PDR – International Centre for Design & Research, Cardiff Metropolitan University, Cardiff, UK
| | - Hanna Burton
- PDR – International Centre for Design & Research, Cardiff Metropolitan University, Cardiff, UK
| | - Hayley Hanson
- PDR – International Centre for Design & Research, Cardiff Metropolitan University, Cardiff, UK
| | - Peter L Evans
- Morriston Hospital, Abertawe Bro Morgannwg University Health Board, Swansea, UK
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Biomimetic 3D-printed custom-made prosthesis for anterior column reconstruction in the thoracolumbar spine: a tailored option following en bloc resection for spinal tumors : Preliminary results on a case-series of 13 patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:3073-3083. [PMID: 30039254 DOI: 10.1007/s00586-018-5708-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 07/18/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Various techniques for anterior column reconstruction have been described after en bloc resection of spinal tumors. Limited evidence exists regarding one being superior to another. The purpose of this study is to evaluate 3D-printed vertebral bodies for spinal reconstruction after en bloc resection in the thoracolumbar spine. METHODS Prospective observational study on custom-made 3D-printed titanium reconstruction of vertebral bodies after en bloc resection for spinal tumor was conducted between November 2015 and June 2017. 3D-printed vertebral bodies were monitored for mechanical complications such as (1) migration, (2) subsidence into the adjacent vertebral bodies, and/or (3) breakage. Complications and related details were recorded. RESULTS Thirteen patients (7 females and 6 males) were enrolled, and reconstruction of the anterior column was performed using custom-made 3D-printed titanium prosthesis after en bloc resection for spinal tumor (8 primary bone tumors and 5 solitary metastases). Subsidence into the adjacent vertebral bodies occurred in all patients at both proximal and distal bone-implant interfaces; however, it was clinically irrelevant (asymptomatic, and no consequences on posterior instrumentation), in 11 out of 12 patients (92%). In 1 patient (#4), severity of the subsidence led to revision of the construct. At an average 10-month follow-up (range 2-16), 1 implant was removed due to local recurrence of the disease and 1 was revisioned due to progressive distal junctional kyphosis. CONCLUSION Preliminary results from this series suggest that 3D printing can be effectively used to produce custom-made prosthesis for anterior column reconstruction. These slides can be retrieved under Electronic Supplementary Material.
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Shah FA, Jergéus E, Chiba A, Palmquist A. Osseointegration of 3D printed microalloyed CoCr implants-Addition of 0.04% Zr to CoCr does not alter bone material properties. J Biomed Mater Res A 2018; 106:1655-1663. [DOI: 10.1002/jbm.a.36366] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 01/31/2018] [Accepted: 02/06/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Furqan A. Shah
- Department of Biomaterials; Sahlgrenska Academy at University of Gothenburg; Göteborg Sweden
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy; Göteborg Sweden
| | - Edvin Jergéus
- Department of Biomaterials; Sahlgrenska Academy at University of Gothenburg; Göteborg Sweden
| | - Akihiko Chiba
- Institute for Materials Research, Tohoku University; Sendai Japan
| | - Anders Palmquist
- Department of Biomaterials; Sahlgrenska Academy at University of Gothenburg; Göteborg Sweden
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy; Göteborg Sweden
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Li C, Jiang C, Peng M, Li T, Yang Z, Liu Z, Li N, Wang C, Dai K, Wang J. Proinflammatory and osteolysis-inducing effects of 3D printing Ti6Al4V particles in vitro and in vivo. RSC Adv 2018; 8:2229-2239. [PMID: 35542625 PMCID: PMC9077282 DOI: 10.1039/c7ra12677h] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 12/11/2017] [Indexed: 12/15/2022] Open
Abstract
Ti6Al4V printing particles have been recently used for fabricating orthopedic implants. Removing these particles completely from fabricated implants is challenging. Furthermore, recycled particles are commonly used in fabrication without additional analysis. Ti6Al4V wear particles derived from orthopedic implants are known to induce inflammatory responses and osteolysis. However, the biosafety of printing particles remains unknown. Here, we investigated the proinflammatory and osteolysis-inducing effects of commonly used original and recycled Ti6Al4V printing particles in vitro and in vivo. Our results indicated that although less serious effects were induced compared to wear particles, inflammatory responses and osteoclast-mediated bone resorption were induced by the original printing particles in a particle size-dependent manner. Recycled particles were found to more strongly stimulate bone resorption and inflammatory responses than the original particles; the in vivo effect was enhanced with an increase in particle concentration. Furthermore, the results of our in vitro experiments verified that the printing particles activate macrophages to secrete inflammatory cytokines and promote osteoclastogenesis, which is closely related to particle size and concentration. Taken together, our findings provide a valuable reference for the use of raw printing materials and examination of recycling procedures for implant fabrication.
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Affiliation(s)
- Cuidi Li
- School of Biomedical Engineering, Shanghai Jiao Tong University Shanghai 200030 China
- Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital Affiliated Shanghai Jiao Tong University School of Medicine Shanghai 200011 China +86-21-63139920
| | - Chuan Jiang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University Guangzhou China
| | - Mingzheng Peng
- Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital Affiliated Shanghai Jiao Tong University School of Medicine Shanghai 200011 China +86-21-63139920
| | - Tao Li
- Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital Affiliated Shanghai Jiao Tong University School of Medicine Shanghai 200011 China +86-21-63139920
| | - Zezheng Yang
- Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital Affiliated Shanghai Jiao Tong University School of Medicine Shanghai 200011 China +86-21-63139920
| | - Zhiyuan Liu
- Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital Affiliated Shanghai Jiao Tong University School of Medicine Shanghai 200011 China +86-21-63139920
| | - Ning Li
- School of Biomedical Engineering, Shanghai Jiao Tong University Shanghai 200030 China
| | - Chengtao Wang
- School of Biomedical Engineering, Shanghai Jiao Tong University Shanghai 200030 China
| | - Kerong Dai
- School of Biomedical Engineering, Shanghai Jiao Tong University Shanghai 200030 China
- Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital Affiliated Shanghai Jiao Tong University School of Medicine Shanghai 200011 China +86-21-63139920
| | - Jinwu Wang
- School of Biomedical Engineering, Shanghai Jiao Tong University Shanghai 200030 China
- Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital Affiliated Shanghai Jiao Tong University School of Medicine Shanghai 200011 China +86-21-63139920
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Siu TL, Rogers JM, Lin K, Thompson R, Owbridge M. Custom-Made Titanium 3-Dimensional Printed Interbody Cages for Treatment of Osteoporotic Fracture-Related Spinal Deformity. World Neurosurg 2017; 111:1-5. [PMID: 29223522 DOI: 10.1016/j.wneu.2017.11.160] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 11/24/2017] [Accepted: 11/27/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Advances in minimally invasive interbody fusion have greatly enhanced surgeons' capability to correct adult spinal deformity with reduced morbidity. However, the feasibility of such approaches is limited in patients with previous osteoporotic fractures as the resultant vertebral deformity renders the end plate geometry incongruous with conventional interbody implants. Current 3-dimensional (3D) printing technology offers a novel solution by fabricating custom-made implants tailored to individual anatomy. We present the results of a patient with osteoporotic lumbar fractures treated by such technology. CASE DESCRIPTION A 74-year-old woman, with previous osteoporotic fractures at L2 and L3 resulting in concave deformity of the end plates, presented with intractable radiculopathy secondary to lateral recess and foraminal stenosis (L2-3 and L3-4). A minimally invasive lateral lumbar interbody fusion at L2-3 and L3-4 was considered favorable, but due to the associated vertebral collapse, off-the-shelf implants were not compatible with patient anatomy. In silico simulation based on preoperative computed tomography (CT) imaging was thus conducted to design customized cages to cater for the depressed recipient end plates and vertebral loss. The design was converted to implantable titanium cages through 3D additive manufacturing. At surgery, a tight fit between the implants and the targeted disk space was achieved. Postoperative CT scan confirmed excellent implant-end plate matching and restoration of lost disk space. The patient began to ambulate from postoperative day 1 and at 6-month follow-up resolution of radicular symptoms and CT evidence of interbody fusion were recorded. CONCLUSIONS 3D-printed custom-made interbody cages can help overcome the difficulties in deformity correction secondary to osteoporotic fractures.
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Affiliation(s)
- Timothy L Siu
- Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, New South Wales, Australia.
| | - Jeffrey M Rogers
- Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, New South Wales, Australia
| | - Kainu Lin
- Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, New South Wales, Australia
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Tedesco J, Lee BEJ, Lin AYW, Binkley DM, Delaney KH, Kwiecien JM, Grandfield K. Osseointegration of a 3D Printed Stemmed Titanium Dental Implant: A Pilot Study. Int J Dent 2017; 2017:5920714. [PMID: 29527226 PMCID: PMC5733992 DOI: 10.1155/2017/5920714] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 08/30/2017] [Accepted: 10/03/2017] [Indexed: 11/18/2022] Open
Abstract
In this pilot study, a 3D printed Grade V titanium dental implant with a novel dual-stemmed design was investigated for its biocompatibility in vivo. Both dual-stemmed (n = 12) and conventional stainless steel conical (n = 4) implants were inserted into the tibial metaphysis of New Zealand white rabbits for 3 and 12 weeks and then retrieved with the surrounding bone, fixed, dehydrated, and embedded into epoxy resin. The implants were analyzed using correlative histology, microcomputed tomography, scanning electron microscopy (SEM), and transmission electron microscopy (TEM). The histological presence of multinucleated osteoclasts and cuboidal osteoblasts revealed active bone remodeling in the stemmed implant starting at 3 weeks and by 12 weeks in the conventional implant. Bone-implant contact values indicated that the stemmed implants supported bone growth along the implant from the coronal crest at both 3- and 12-week time periods and showed bone growth into microporosities of the 3D printed surface after 12 weeks. In some cases, new bone formation was noted in between the stems of the device. Conventional implants showed mechanical interlocking but did have indications of stress cracking and bone debris. This study demonstrates the comparable biocompatibility of these 3D printed stemmed implants in rabbits up to 12 weeks.
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Affiliation(s)
- James Tedesco
- Department of Materials Science and Engineering, McMaster University, Hamilton, ON, Canada
| | - Bryan E. J. Lee
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
| | - Alex Y. W. Lin
- Department of Materials Science and Engineering, McMaster University, Hamilton, ON, Canada
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA
| | - Dakota M. Binkley
- School of Integrated Science, McMaster University, Hamilton, ON, Canada
| | - Kathleen H. Delaney
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Jacek M. Kwiecien
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
- Department of Clinical Pathomorphology, Medical University of Lublin, Lublin, Poland
| | - Kathryn Grandfield
- Department of Materials Science and Engineering, McMaster University, Hamilton, ON, Canada
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
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