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Marin E. Forged to heal: The role of metallic cellular solids in bone tissue engineering. Mater Today Bio 2023; 23:100777. [PMID: 37727867 PMCID: PMC10506110 DOI: 10.1016/j.mtbio.2023.100777] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/21/2023] Open
Abstract
Metallic cellular solids, made of biocompatible alloys like titanium, stainless steel, or cobalt-chromium, have gained attention for their mechanical strength, reliability, and biocompatibility. These three-dimensional structures provide support and aid tissue regeneration in orthopedic implants, cardiovascular stents, and other tissue engineering cellular solids. The design and material chemistry of metallic cellular solids play crucial roles in their performance: factors such as porosity, pore size, and surface roughness influence nutrient transport, cell attachment, and mechanical stability, while their microstructure imparts strength, durability and flexibility. Various techniques, including additive manufacturing and conventional fabrication methods, are utilized for producing metallic biomedical cellular solids, each offering distinct advantages and drawbacks that must be considered for optimal design and manufacturing. The combination of mechanical properties and biocompatibility makes metallic cellular solids superior to their ceramic and polymeric counterparts in most load bearing applications, in particular under cyclic fatigue conditions, and more in general in application that require long term reliability. Although challenges remain, such as reducing the production times and the associated costs or increasing the array of available materials, metallic cellular solids showed excellent long-term reliability, with high survival rates even in long term follow-ups.
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Affiliation(s)
- Elia Marin
- Ceramic Physics Laboratory, Kyoto Institute of Technology, Sakyo-ku, Matsugasaki, 606-8585, Kyoto, Japan
- Department of Dental Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan
- Department Polytechnic of Engineering and Architecture, University of Udine, 33100, Udine, Italy
- Biomedical Research Center, Kyoto Institute of Technology, Sakyo-ku, Matsugasaki, Kyoto, 606-8585, Japan
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Gupta R, Grove K, Wei A, Lee J, Akkouch A. Ankle and Foot Arthroplasty and Prosthesis: A Review on the Current and Upcoming State of Designs and Manufacturing. MICROMACHINES 2023; 14:2081. [PMID: 38004938 PMCID: PMC10673427 DOI: 10.3390/mi14112081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023]
Abstract
The foot and ankle serve vital roles in weight bearing, balance, and flexibility but are susceptible to many diverse ailments, making treatment difficult. More commonly, Total Ankle Arthroplasty (TAA) and Total Talus Replacement (TTR) are used for patients with ankle degeneration and avascular necrosis of the talus, respectively. Ankle prosthesis and orthosis are also indicated for use with lower limb extremity amputations or locomotor disability, leading to the development of powered exoskeletons. However, patient outcomes remain suboptimal, commonly due to the misfitting of implants to the patient-specific anatomy. Additive manufacturing (AM) is being used to create customized, patient-specific implants and porous implant cages that provide structural support while allowing for increased bony ingrowth and to develop customized, lightweight exoskeletons with multifunctional actuators. AM implants and devices have shown success in preserving stability and mobility of the joint and achieving fast recovery, as well as significant improvements in gait rehabilitation, gait assistance, and strength for patients. This review of the literature highlights various devices and technologies currently used for foot and ankle prosthesis and orthosis with deep insight into improvements from historical technologies, manufacturing methods, and future developments in the biomedical space.
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Affiliation(s)
- Richa Gupta
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI 49008, USA; (R.G.); (K.G.); (A.W.); (J.L.)
| | - Kyra Grove
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI 49008, USA; (R.G.); (K.G.); (A.W.); (J.L.)
| | - Alice Wei
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI 49008, USA; (R.G.); (K.G.); (A.W.); (J.L.)
| | - Jennifer Lee
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI 49008, USA; (R.G.); (K.G.); (A.W.); (J.L.)
| | - Adil Akkouch
- Department of Orthopaedic Surgery and Medical Engineering Program, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI 49008, USA
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Meng M, Wang J, Huang H, Liu X, Zhang J, Li Z. 3D printing metal implants in orthopedic surgery: Methods, applications and future prospects. J Orthop Translat 2023; 42:94-112. [PMID: 37675040 PMCID: PMC10480061 DOI: 10.1016/j.jot.2023.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/28/2023] [Accepted: 08/02/2023] [Indexed: 09/08/2023] Open
Abstract
Background Currently, metal implants are widely used in orthopedic surgeries, including fracture fixation, spinal fusion, joint replacement, and bone tumor defect repair. However, conventional implants are difficult to be customized according to the recipient's skeletal anatomy and defect characteristics, leading to difficulties in meeting the individual needs of patients. Additive manufacturing (AM) or three-dimensional (3D) printing technology, an advanced digital fabrication technique capable of producing components with complex and precise structures, offers opportunities for personalization. Methods We systematically reviewed the literature on 3D printing orthopedic metal implants over the past 10 years. Relevant animal, cellular, and clinical studies were searched in PubMed and Web of Science. In this paper, we introduce the 3D printing method and the characteristics of biometals and summarize the properties of 3D printing metal implants and their clinical applications in orthopedic surgery. On this basis, we discuss potential possibilities for further generalization and improvement. Results 3D printing technology has facilitated the use of metal implants in different orthopedic procedures. By combining medical images from techniques such as CT and MRI, 3D printing technology allows the precise fabrication of complex metal implants based on the anatomy of the injured tissue. Such patient-specific implants not only reduce excessive mechanical strength and eliminate stress-shielding effects, but also improve biocompatibility and functionality, increase cell and nutrient permeability, and promote angiogenesis and bone growth. In addition, 3D printing technology has the advantages of low cost, fast manufacturing cycles, and high reproducibility, which can shorten patients' surgery and hospitalization time. Many clinical trials have been conducted using customized implants. However, the use of modeling software, the operation of printing equipment, the high demand for metal implant materials, and the lack of guidance from relevant laws and regulations have limited its further application. Conclusions There are advantages of 3D printing metal implants in orthopedic applications such as personalization, promotion of osseointegration, short production cycle, and high material utilization. With the continuous learning of modeling software by surgeons, the improvement of 3D printing technology, the development of metal materials that better meet clinical needs, and the improvement of laws and regulations, 3D printing metal implants can be applied to more orthopedic surgeries. The translational potential of this paper Precision, intelligence, and personalization are the future direction of orthopedics. It is reasonable to believe that 3D printing technology will be more deeply integrated with artificial intelligence, 4D printing, and big data to play a greater role in orthopedic metal implants and eventually become an important part of the digital economy. We aim to summarize the latest developments in 3D printing metal implants for engineers and surgeons to design implants that more closely mimic the morphology and function of native bone.
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Affiliation(s)
- Meng Meng
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, PR China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, PR China
| | - Jinzuo Wang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, PR China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, PR China
| | - Huagui Huang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, PR China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, PR China
| | - Xin Liu
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, PR China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, PR China
| | - Jing Zhang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, PR China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, PR China
| | - Zhonghai Li
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, PR China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, PR China
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Kovács ÁÉ, Csernátony Z, Csámer L, Méhes G, Szabó D, Veres M, Braun M, Harangi B, Serbán N, Zhang L, Falk G, Soósné Horváth H, Manó S. Comparative Analysis of Bone Ingrowth in 3D-Printed Titanium Lattice Structures with Different Patterns. MATERIALS (BASEL, SWITZERLAND) 2023; 16:ma16103861. [PMID: 37241487 DOI: 10.3390/ma16103861] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/14/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023]
Abstract
In this study, metal 3D printing technology was used to create lattice-shaped test specimens of orthopedic implants to determine the effect of different lattice shapes on bone ingrowth. Six different lattice shapes were used: gyroid, cube, cylinder, tetrahedron, double pyramid, and Voronoi. The lattice-structured implants were produced from Ti6Al4V alloy using direct metal laser sintering 3D printing technology with an EOS M290 printer. The implants were implanted into the femoral condyles of sheep, and the animals were euthanized 8 and 12 weeks after surgery. To determine the degree of bone ingrowth for different lattice-shaped implants, mechanical, histological, and image processing tests on ground samples and optical microscopic images were performed. In the mechanical test, the force required to compress the different lattice-shaped implants and the force required for a solid implant were compared, and significant differences were found in several instances. Statistically evaluating the results of our image processing algorithm, it was found that the digitally segmented areas clearly consisted of ingrown bone tissue; this finding is also supported by the results of classical histological processing. Our main goal was realized, so the bone ingrowth efficiencies of the six lattice shapes were ranked. It was found that the gyroid, double pyramid, and cube-shaped lattice implants had the highest degree of bone tissue growth per unit time. This ranking of the three lattice shapes remained the same at both 8 and 12 weeks after euthanasia. In accordance with the study, as a side project, a new image processing algorithm was developed that proved suitable for determining the degree of bone ingrowth in lattice implants from optical microscopic images. Along with the cube lattice shape, whose high bone ingrowth values have been previously reported in many studies, it was found that the gyroid and double pyramid lattice shapes produced similarly good results.
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Affiliation(s)
- Ágnes Éva Kovács
- Laboratory of Biomechanics, Department of Orthopaedic Surgery, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary
| | - Zoltán Csernátony
- Laboratory of Biomechanics, Department of Orthopaedic Surgery, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary
| | - Loránd Csámer
- Laboratory of Biomechanics, Department of Orthopaedic Surgery, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary
| | - Gábor Méhes
- Department of Pathology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary
| | - Dániel Szabó
- Laboratory of Biomechanics, Department of Orthopaedic Surgery, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary
| | - Mihály Veres
- Isotoptech Private Limited Company, H-4026 Debrecen, Hungary
| | - Mihály Braun
- Isotoptech Private Limited Company, H-4026 Debrecen, Hungary
| | - Balázs Harangi
- Department of Data Science and Visualization, Faculty of Informatics, University of Debrecen, H-4028 Debrecen, Hungary
| | - Norbert Serbán
- Department of Data Science and Visualization, Faculty of Informatics, University of Debrecen, H-4028 Debrecen, Hungary
| | - Lei Zhang
- Laboratory of Biomechanics, Department of Orthopaedic Surgery, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary
| | - György Falk
- Varinex Private Limited Company, H-1141 Budapest, Hungary
| | - Hajnalka Soósné Horváth
- Laboratory of Biomechanics, Department of Orthopaedic Surgery, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary
| | - Sándor Manó
- Laboratory of Biomechanics, Department of Orthopaedic Surgery, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary
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Abu-Awwad A, Tudoran C, Patrascu JM, Faur C, Tudoran M, Mekeres GM, Abu-Awwad SA, Csep AN. Unexpected Repercussions of the COVID-19 Pandemic on Total Hip Arthroplasty with Cemented Hip Prosthesis versus Cementless Implants. MATERIALS (BASEL, SWITZERLAND) 2023; 16:1640. [PMID: 36837270 PMCID: PMC9966432 DOI: 10.3390/ma16041640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/09/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: Total hip arthroplasty (THA) is one of the most common procedures used for adult hip reconstruction, employing mainly two types of prostheses: cemented (CHP) and cementless (CLHP). This study aims to analyze the impact of the COVID-19 pandemic on THA with CHP and CLHP, in terms of the benefit/cost ratio. (2) Methods: This article represents a retrospective analysis of the differences concerning the benefit/cost ratio between THA with the two types of prostheses in 2950 patients admitted for THA in the two orthopedic clinics of our hospital between 1 January 2015-1 March 2020 in comparison with 1005 THA subjects seen between 1 April 2020-31 December 2022. (3) Results: In the first period, THA with CHP was performed in 45.83% of cases, while CLHP was used in 54.16% of patients. During the COVID-19 period, CHP was inserted in 52% of THA patients, while the other 48% had CLHP inserted, with a hospitalization duration reduced by over 50% for both types of implants (p ˂ 0.001). (4) Conclusions: CHP offered good outcomes, with quicker mobilization, and shorter hospitalization duration, compared to CLHP, but optimization of the patients' management can be achieved mainly by reducing the length of hospitalization through an appropriate preoperative patient evaluation through a multidisciplinary approach, an aspect that was proven during the COVID-19 pandemic.
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Affiliation(s)
- Ahmed Abu-Awwad
- Department XV—Discipline of Orthopedics—Traumatology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- “Pius Brinzeu” Emergency Clinical County Hospital, Bld Liviu Rebreanu, No. 156, 300723 Timisoara, Romania
| | - Cristina Tudoran
- “Pius Brinzeu” Emergency Clinical County Hospital, Bld Liviu Rebreanu, No. 156, 300723 Timisoara, Romania
- Department VII, Internal Medicine II, Discipline of Cardiology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- Academy of Romanian Scientists, Ilfov Str. Nr. 3, 030167 Bucuresti, Romania
| | - Jenel Marian Patrascu
- Department XV—Discipline of Orthopedics—Traumatology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- “Pius Brinzeu” Emergency Clinical County Hospital, Bld Liviu Rebreanu, No. 156, 300723 Timisoara, Romania
| | - Cosmin Faur
- Department XV—Discipline of Orthopedics—Traumatology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- “Pius Brinzeu” Emergency Clinical County Hospital, Bld Liviu Rebreanu, No. 156, 300723 Timisoara, Romania
| | - Mariana Tudoran
- “Pius Brinzeu” Emergency Clinical County Hospital, Bld Liviu Rebreanu, No. 156, 300723 Timisoara, Romania
| | - Gabriel Mihai Mekeres
- Faculty of Medicine and Pharmacy, University of Oradea, Universitatii Street No.1, 410087 Oradea, Romania
| | - Simona-Alina Abu-Awwad
- “Pius Brinzeu” Emergency Clinical County Hospital, Bld Liviu Rebreanu, No. 156, 300723 Timisoara, Romania
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Andrei Nicolae Csep
- Faculty of Medicine and Pharmacy, University of Oradea, Universitatii Street No.1, 410087 Oradea, Romania
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