Journal articles on the topic 'Custom orthopedic implants'
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Okazaki, Yoshimitsu. "Development trends of custom-made orthopedic implants." Journal of Artificial Organs 15, no. 1 (August 11, 2011): 20–25. http://dx.doi.org/10.1007/s10047-011-0584-6.
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Ertürk, Cemil, Simel Ayyıldız, and Cevdet Erdöl. "Orthopedics and 3D technology in Turkey: A preliminary report." Joint Diseases and Related Surgery 32, no. 2 (June 11, 2021): 279–89. http://dx.doi.org/10.52312/jdrs.2021.20.
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Objectives: In this study, we present the use of case specific three- dimensional (3D) printed plastic models and custom-made acetabular implants in orthopedic surgery. Materials and methods: Between March 2018 and September 2020, surgeries were simulated using plastic models manufactured by 3D printers on the two patients with pilon fractures. Also, custom-made acetabular implants were used on two patients with an acetabular bone defect for the revision of total hip arthroplasty (THA). Results: More comfortable surgeries were experienced in pilon fractures using preoperative plastic models. Similarly, during the follow-up period, the patients that applied custom-made acetabular implants showed a fixed and well-positioning in radiographic examination. These patients did not experience any surgical complications and achieved an excellent recovery. Conclusion: Preoperative surgical simulation with 3D printed models can increase the comfort of fracture surgeries. Also, custom-made 3D printed acetabular implants can perform an important task in patients treated with revision THA surgery due to severe acetabular defects.
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Sahal, Mohammed, Mu Tao Chen, Shruti Sharma, Sidharth Sukumaran Nair, and Vaishakh Gopalakrishnan Nair. "3DP materials and methods for orthopedic, dental and maxillofacial implants: a brief comparative report." Journal of 3D Printing in Medicine 3, no. 3 (August 2019): 127–34. http://dx.doi.org/10.2217/3dp-2018-0020.
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The current approach of modifying standardized prosthetics for orthopedic, dental and maxillofacial implants made from conventional manufacturing techniques have been found inconvenient to customize for specific cases as the complex geometry of the skeletal tissue varies appreciably from patient to patient [ 1 , 2 ]. These standard procedures justly demand patient-specific, complex-shaped, custom-made implants be reliably delivered in minimal time. In this specific regard, 3DP implants are extensively researched [ 3 ]. A significant number of research outcomes sufficiently emphasize the desirable superior shape conformity and the short delivery time provided by the custom-made 3DP implants compared over conventional implants. These potential benefits facilitated by the novel 3DP technology can be adequately explained by the inherent ability of various modern 3DP disciplines to manufacture complex shaped implants by efficiently converting any patient-specific x-ray or CT scans into STL files. In this academic paper, we comparatively review the methods and materials utilized for specific 3DP implants.
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Abdelaal, Osama, Saied Darwish, Hassan El-Hofy, and Yoshio Saito. "Patient-specific design process and evaluation of a hip prosthesis femoral stem." International Journal of Artificial Organs 42, no. 6 (December 11, 2018): 271–90. http://dx.doi.org/10.1177/0391398818815479.
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Introduction: There are several commercially available hip implant systems. However, for some cases, custom implant designed based on patient-specific anatomy can offer the patient the best available implant solution. Currently, there is a growing trend toward personalization of medical implants involving additive manufacturing into orthopedic medical implants’ manufacturing. Methods: This article introduces a systematic design methodology of femoral stem prosthesis based on patient’s computer tomography data. Finite element analysis is used to evaluate and compare the micromotion and stress distribution of the customized femoral component and a conventional stem. Results: The proposed customized femoral stem achieved close geometrical fit and fill between femoral canal and stem surfaces. The customized stem demonstrated lower micromotion (peak: 21 μm) than conventional stem (peak: 34 μm). Stress results indicate up to 89% increase in load transfer by conventional stem than custom stem because the higher stiffness of patient-specific femoral stem proximally increases the custom stem shielding in Gruen’s zone 7. Moreover, patient-specific femoral stem transfers the load widely in metaphyseal region. Conclusion: The customized femoral stem presented satisfactory results related to primary stability, but compromising proximo-medial load transfer due to increased stem cross-sectional area increased stem stiffness.
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Bechtold, Joan E. "Application of Computer Graphics in the Design of Custom Orthopedic Implants." Orthopedic Clinics of North America 17, no. 4 (October 1986): 605–12. http://dx.doi.org/10.1016/s0030-5898(20)32307-5.
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Park, Jong-Woong, Hyun-Guy Kang, June-Hyuk Kim, and Han-Soo Kim. "3D-Printed Connector for Revision Limb Salvage Surgery in Long Bones Previously Using Customized Implants." Metals 11, no. 5 (April 26, 2021): 707. http://dx.doi.org/10.3390/met11050707.
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In orthopedic oncology, revisional surgery due to mechanical failure or local recurrence is not uncommon following limb salvage surgery using an endoprosthesis. However, due to the lack of clinical experience in limb salvage surgery using 3D-printed custom-made implants, there have been no reports of revision limb salvage surgery using a 3D-printed implant. Herein, we present two cases of representative revision limb salvage surgeries that utilized another 3D-printed custom-made implant while retaining the previous 3D-printed custom-made implant. A 3D-printed connector implant was used to connect the previous 3D-printed implant to the proximal ulna of a 40-year-old man and to the femur of a 69-year-old woman. The connector bodies for the two junctions of the previous implant and the remaining host bone were designed for the most functional position or angle by twisting or tilting. Using the previous 3D-printed implant as a taper, the 3D-printed connector was used to encase the outside of the previous implant. The gap between the previous implant and the new one was subsequently filled with bone cement. For both the upper and lower extremities, the 3D-printed connector showed stable reconstruction and excellent functional outcomes (Musculoskeletal Tumor Society scores of 87% and 100%, respectively) in the short-term follow-up. To retain the previous 3D-printed implant during revision limb salvage surgery, an additional 3D-printed implant may be a feasible surgical option.
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Gao, Terry, Michael Rivlin, and John A. Abraham. "Three-dimensional Printing Technology and Role for Custom Implants in Orthopedic Oncology." Techniques in Orthopaedics 33, no. 3 (September 2018): 166–74. http://dx.doi.org/10.1097/bto.0000000000000292.
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Zdravković, Milan, Miroslav Trajanović, Miloš Stojković, Dragan Mišić, and Nikola Vitković. "A case of using the Semantic Interoperability Framework for custom orthopedic implants manufacturing." Annual Reviews in Control 36, no. 2 (December 2012): 318–26. http://dx.doi.org/10.1016/j.arcontrol.2012.09.013.
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Mosca, Massimiliano, Alberto Grassi, and Silvio Caravelli. "Osteochondral Lesions of Ankle and Knee. Will Future Treatments Really Be Represented by Custom-Made Metal Implants?" Journal of Clinical Medicine 11, no. 13 (July 1, 2022): 3817. http://dx.doi.org/10.3390/jcm11133817.
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Tappa, Karthik, Udayabhanu Jammalamadaka, Jeffery Weisman, David Ballard, Dallas Wolford, Cecilia Pascual-Garrido, Larry Wolford, Pamela Woodard, and David Mills. "3D Printing Custom Bioactive and Absorbable Surgical Screws, Pins, and Bone Plates for Localized Drug Delivery." Journal of Functional Biomaterials 10, no. 2 (April 1, 2019): 17. http://dx.doi.org/10.3390/jfb10020017.
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Additive manufacturing has great potential for personalized medicine in osseous fixation surgery, including maxillofacial and orthopedic applications. The purpose of this study was to demonstrate 3D printing methods for the fabrication of patient-specific fixation implants that allow for localized drug delivery. 3D printing was used to fabricate gentamicin (GS) and methotrexate (MTX)-loaded fixation devices, including screws, pins, and bone plates. Scaffolds with different infill ratios of polylactic acid (PLA), both without drugs and impregnated with GS and MTX, were printed into cylindrical and rectangular-shaped constructs for compressive and flexural strength mechanical testing, respectively. Bland PLA constructs showed significantly higher flexural strength when printed in a Y axis at 100% infill compared to other axes and infill ratios; however, there was no significant difference in flexural strength between other axes and infill ratios. GS and MTX-impregnated constructs had significantly lower flexural and compressive strength as compared to the bland PLA constructs. GS-impregnated implants demonstrated bacterial inhibition in plate cultures. Similarly, MTX-impregnated implants demonstrated a cytotoxic effect in osteosarcoma assays. This proof of concept work shows the potential of developing 3D printed screws and plating materials with the requisite mechanical properties and orientations. Drug-impregnated implants were technically successful and had an anti-bacterial and chemotherapeutic effect, but drug addition significantly decreased the flexural and compressive strengths of the custom implants.
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Friedman, Lisa GM, and Grant E. Garrigues. "Anatomic Augmented Glenoid Implants for the Management of the B2 Glenoid." Journal of Shoulder and Elbow Arthroplasty 3 (January 2019): 247154921987035. http://dx.doi.org/10.1177/2471549219870350.
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The B2 glenoid is defined by Walch et al. as a glenoid that is biconcave with posterior erosion accompanied by posterior humeral head subluxation. This creates unique challenges for the treating orthopedic surgeon. Bone loss, excessive retroversion, and posterior subluxation make anatomic shoulder arthroplasty in this setting fraught with increased complications, including instability, glenoid component loosening, and poor clinical outcomes. Many techniques have been devised to treat the arthritic shoulder with a B2 glenoid, including hemiarthroplasty, total shoulder arthroplasty using eccentric reaming, bone grafting and custom implantation, and reverse total shoulder arthroplasty. In this review, we will focus on anatomic total shoulder arthroplasty using augmented glenoid implants to treat the B2 glenoid. Indications, clinical results, and basic science analyses of augmented anatomic glenoids are also discussed.
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Kösters, Clemens, Daniel den Toom, Sebastian Metzlaff, Kiriakos Daniilidis, Linda Barz, and Steffen Roßlenbroich. "Peri- and Interprosthetic Femoral Fractures—Current Concepts and New Developments for Internal Fixation." Journal of Clinical Medicine 11, no. 5 (March 2, 2022): 1371. http://dx.doi.org/10.3390/jcm11051371.
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Treatment of peri- and interprosthetic fractures represents a challenge in orthopedic trauma surgery. Multiple factors such as osteoporosis, polymedication and comorbidities impede therapy and the rehabilitation of this difficult fracture entity. This article summarizes current concepts and highlights new developments for the internal fixation of periprosthetic fractures. Since the elderly are unable to follow partial weight bearing, stable solutions are required. Therefore, a high primary stability is necessary. Numerous options, such as new angular stable plate systems with additional options for variable angle screw positioning, already exist and are in the process of being further improved. Lately, individually produced custom-made implants are offering interesting alternatives to treat periprosthetic fractures.
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Khandaker, Morshed, Abdellah Ait Moussa, Desmond Nuyebga Sama, Fereshteh Safavinia, Susmita Hazra, Onur Can Kalay, Fatih Karpat, Erik Clary, and Amgad Haleem. "Laser-Induced Microgrooves Improve the Mechanical Responses of Cemented Implant Systems." Micromachines 11, no. 5 (April 29, 2020): 466. http://dx.doi.org/10.3390/mi11050466.
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The impact of a laser-induced microgroove (LIM) architecture on mechanical responses of two cemented implant systems was evaluated. One system consisted of two aluminum alloy rods bonded end-to-end by polymethylmethacrylate cement. The second system consisted of a custom-made, aluminum tibial tray (TT) cemented in an artificial canine tibia. Control specimens for each system were polished smooth at the cement interface. For LIM samples in the rod system, microgrooves were engraved (100 µm depth, 200 µm width, 500 µm spacing) on the apposing surface of one of the two rods. For TT system testing, LIM engraving (100 µm spacing) was confined to the underside and keel of the tray. Morphological analysis of processed implant surfaces revealed success in laser microgrooving procedures. For cemented rods tested under static tension, load to failure was greater for LIM samples (279.0 ± 14.9 N vs. 126.5 ± 4.5 N). Neither non-grooved nor grooved TT samples failed under cyclic compression testing (100,000 cycles at 1 Hz). Compared with control specimens, LIM TT constructs exhibited higher load to failure under static compression and higher strain at the bone interface under cyclic compression. Laser-induced microgrooving has the potential to improve the performance of cemented orthopedic implants.
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Okazaki, Yoshimitsu, Emiko Gotoh, and Jun Mori. "Strength–Durability Correlation of Osteosynthesis Devices Made by 3D Layer Manufacturing." Materials 12, no. 3 (January 31, 2019): 436. http://dx.doi.org/10.3390/ma12030436.
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To develop orthopedic implants that are optimized for each patient’s needs or skeletal structure (custom-made implants), evaluations of the bending strength, bending stiffness, and durability of various types of conventional osteosynthesis devices have become important. Four-point bending tests and compression bending tests of osteosynthesis devices (bone plates, intramedullary nail rods, spinal rods, compression hip screws (CHSs), short femoral nails, and metaphyseal plates) were carried out to measure their bending stiffness, bending strength, and durability. The bending stiffness of bone plates, intramedullary nails, spinal rods, CHSs, short femoral nails, and metaphyseal plates increased with increasing bending strength. The durability limit of various types of osteosynthesis devices linearly increased with increasing bending strength. The relationship (durability limit at 106 cycles) = 0.67 × (bending strength) (N·m) (R2 = 0.85) was obtained by regression. The relationship for the highly biocompatible Ti-15Zr-4Nb-4Ta alloy was also linear. The mechanical strength and ductility of specimens that were cut from various osteosynthesis devices were excellent and their microstructures consisted of fine structures, which were considered to be related to the excellent durability. These results are expected to be useful for the development of implants suitable for the skeletal structure of patients using three-dimensional (3D) layer manufacturing technologies.
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Chudinova, Ekaterina, Maria Surmeneva, Andrey Koptioug, Irina V. Savintseva, Irina Selezneva, Per Skoglund, M. Syrtanov, and Roman Surmenev. "In Vitro Assessment of Hydroxyapatite Coating on the Surface of Additive Manufactured Ti6Al4V Scaffolds." Materials Science Forum 879 (November 2016): 2444–49. http://dx.doi.org/10.4028/www.scientific.net/msf.879.2444.
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Custom orthopedic and dental implants may be fabricated by additive manufacturing (AM), for example using electron beam melting technology. This study is focused on the modification of the surface of Ti6Al4V alloy coin-like scaffolds fabricated via AM technology (EBM®) by radio frequency (RF) magnetron sputter deposition of hydroxyapatite (HA) coating. The scaffolds with HA coating were characterized by Scanning Electron microscopy, X-ray diffraction. HA coating showed a nanocrystalline structure with the crystallites of an average size of 32±9 nm. The ability of the surface to support adhesion and the proliferation of human mesenchymal stem cells was studied using biological short-term tests in vitro. In according to in vitro assessment, thin HA coating stimulated the attachment and proliferation of cells. Human mesenchymal stem cells cultured on the HA-coated scaffold also formed mineralized nodules.
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Resnik, Matic, Metka Benčina, Eva Levičnik, Niharika Rawat, Aleš Iglič, and Ita Junkar. "Strategies for Improving Antimicrobial Properties of Stainless Steel." Materials 13, no. 13 (June 30, 2020): 2944. http://dx.doi.org/10.3390/ma13132944.
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In this review, strategies for improving the antimicrobial properties of stainless steel (SS) are presented. The main focus given is to present current strategies for surface modification of SS, which alter surface characteristics in terms of surface chemistry, topography and wettability/surface charge, without influencing the bulk attributes of the material. As SS exhibits excellent mechanical properties and satisfactory biocompatibility, it is one of the most frequently used materials in medical applications. It is widely used as a material for fabricating orthopedic prosthesis, cardiovascular stents/valves and recently also for three dimensional (3D) printing of custom made implants. Despite its good mechanical properties, SS lacks desired biofunctionality, which makes it prone to bacterial adhesion and biofilm formation. Due to increased resistance of bacteria to antibiotics, it is imperative to achieve antibacterial properties of implants. Thus, many different approaches were proposed and are discussed herein. Emphasis is given on novel approaches based on treatment with highly reactive plasma, which may alter SS topography, chemistry and wettability under appropriate treatment conditions. This review aims to present and critically discuss different approaches and propose novel possibilities for surface modification of SS by using highly reactive gaseous plasma in order to obtain a desired biological response.
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Zhang, Xinjie, Shuai Liu, Yude Liu, Hanjie Guo, and Wentian Shi. "Titanium Alloy Fabricated by Additive Manufacturing for Medical Applications: Obtaining, Characterization and Application—Review." Metals 13, no. 3 (February 23, 2023): 462. http://dx.doi.org/10.3390/met13030462.
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Metal additive manufacturing (metal-AM) technology has made significant progress in the field of biomedicine in recent years. Originally, it was only used as an innovative resource for prototypes. With the development of technology, custom orthopedic implants could be produced for different patients. Titanium alloy is non-toxic and harmless in the human body. It has excellent biocompatibility and can promote the growth and regeneration of bones in its interior. Therefore, it is widely used in the medical industry. However, in the process of additive manufacturing and printing titanium alloys, there are often cases where the powder is not completely melted or the powder adheres to the product structure after printing, which introduces new biological risks. This paper summarizes the causes of powder adhesion from the perspective of the process involved in additive manufacturing, expounds the influence of different processes on the powder adhesion of titanium alloy forming parts, introduces the mainstream methods of powder sticking removal and summarizes the application of the additive manufacturing of titanium alloy in the medical field, which provides a theoretical basis for further development of the application of titanium alloy additive manufacturing technology in the medical industry.
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Gkavardina, Anthippi, and Panagiotis Tsagozis. "The Use of Megaprostheses for Reconstruction of Large Skeletal Defects in the Extremities: A Critical Review." Open Orthopaedics Journal 8, no. 1 (October 17, 2014): 384–89. http://dx.doi.org/10.2174/1874325001408010384.
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In the case of primary malignant tumors, extensive metastatic disease, major trauma or end-stage revision arthroplasty, the orthopaedic surgeon often has to deal with the need to reconstruct large skeletal defects, or replace bone of low quality. In the past years this was frequently impossible, and the only solution was amputation of the extremity. Later, the introduction of custom-made endoprostheses capable of reconstructing large skeletal defects, also known as megaprostheses, allowed for sparing of the extremity. This was especially valuable in the case of oncologic orthopaedic surgery, as advances in the medical treatment of sarcoma patients improved prognosis and limb-preserving surgery proved to have comparable patient survival rates to amputation. However, custom-made designs were implicated in frequent mechanical failures. Furthermore, they were extremely difficult to revise. The introduction of modular endoprostheses in the 1980s marked a new era in orthopaedic oncologic surgery. Modular megaprostheses consist of a number of different components in readily available sets, which can be assembled in various combinations to best address the specific bone defect. Moreover, they proved to have considerably lower rate of mechanical failures, which were also much easier to address during revision surgery by replacing only the parts that failed. The functional outcome after reconstruction with megasprostheses is often very satisfactory and the patient can enjoy a good quality of life. Nowadays, the major challenge is to eliminate the rate of non-mechanical complications associated with surgery of that magnitude, namely the risk for wound dehiscence and necrosis, deep infection, as well as local recurrence of the tumor. In our present mini-review, we attempt to make a critical approach of the available literature, focusing on the multiple aspects of reconstructive surgery using megaprostheses. We present the evolution of megasprosthetic implants, the indications for their use, and describe the outcome of surgery, so that the non-specialized orthopedic surgeon also becomes familiar with that kind of surgery which is usually performed in tertiary centers. A special interest lays in the recent developments that promise for even better results and fewer complications.
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Wittbjer, Jan, Karl-Victor Sarnäs, and Bodil Rune. "Displacement of the Mandible in a Child with Congenital Unilateral Temporomandibular Joint Ankylosis Treated with Two-Stage Condylar Replacement: A Long-Term Study with the Aid of Roentgen Stereometric Analysis." Cleft Palate-Craniofacial Journal 38, no. 6 (November 2001): 636–44. http://dx.doi.org/10.1597/1545-1569_2001_038_0636_dotmia_2.0.co_2.
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Objective: To monitor mandibular displacement in three dimensions with a high degree of accuracy before, during, and after treatment. Design: Prospective roentgen stereometric analysis from age 3 years 7 months to age 13 years 8 months. Setting: Center for Craniofacial Anomalies and Department of Maxillofacial Surgery, Malmö University Hospital, Malmö, Sweden. Patient: Girl with unilateral congenital temporomandibular joint (TMJ) ankylosis and marked facial asymmetry. Interventions: Epipharyngeal inspection at age 2 years 6 months and insertion of implants under general anesthesia. Resection of the affected right condyle at age 5 years 4 months, replacement of the ramus-condyle complex with a custom made titanium prosthesis at age 5 years 5 months, and replacement of the artificial condyle by a costochondral graft at age 9 years 7 months. Roentgen examinations were performed at intervals from age 3 years 7 months to age 13 years 8 months. Body length was measured annually. Main Outcome Measures: Stereo roentgenograms were digitized by the Department of Orthopedic Surgery, Malmö University Hospital. Results: Unexpected lowering of the mandible occurred before treatment. Each procedure had a distinct effect on the direction of mandibular displacement. There was little or no pathological involvement of the functional matrix. Growth of the costochondral graft exceeded growth of the unaffected TMJ. Anterior displacement as well as rotation and tilting of the mandible to the unaffected side accelerated after the age of body peak height velocity. Conclusions: Accurate monitoring of mandibular displacement may contribute to a rationale for clinicians’ decision on treatment protocol and reveal compensatory differential growth.
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Aversa, Raffaella, Relly Victoria Petrescu, Valeria Perrotta, Liviu Marian Ungureanu, Antonio Apicella, and Florian Ion Tiberiu Petrescu. "Somethings About Biological Prostheses." Independent Journal of Management & Production 13, no. 2 (April 1, 2022): 507–47. http://dx.doi.org/10.14807/ijmp.v13i2.1585.
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Finite element models of the female biofidel were developed using a specific combination of segmentation with computed tomography and solid modeling tools capable of representing bone physiology and structural behavior. This biofidel finite element (FEM) model is used to evaluate the change in the physiological distribution of stress in the femoral prosthesis and to evaluate the new design criteria for biopsy. Biomimetics, biomechanics, and tissue engineering are three multidisciplinary fields that have been considered in this research to achieve the goal of improving the reliability of prosthetic implants. The authors took these studies to gather the untapped potential of such advanced materials and design technologies by developing finite models of Biofidel elements capable of correctly mimicking the biomechanical behavior of the femur. The new remodeling of the tetrahedral elements was performed in 3Matic looking for the congruence of the node at the bone-implant interfaces, where the material was defined for the new configuration of the finite elements. The evaluation of the mechanical properties was made taking into account the mechanical characteristics of the cortical and trabecular bone. For biomechanical integration of the implant, a custom material with an improved combination of strength and rigidity that matches the bone should be used. This greater biomechanical compatibility will avoid weakening the implant and increase lifespan, avoiding additional surgery for revision and allowing good biological integration (bone growth). Innovative biomimetic materials for tissue engineering based on hydrophilic polymers were developed by our research group and presented attractive physical, biological, and mechanical properties for biomedical applications. For use with metal prostheses, the authors have developed a hybrid biocompatible material, extremely biocompatible, based on hydrophilic chemicals and hydroxy-ethyl-methacrylate type. The structural metal composition of the new prostheses will be made of titanium alloys using additive technology based on melting thin layers of titanium powder (about 50 microns) on each other until the desired component is obtained (sandwich method). Then, the biomaterial and osteoconductive nanostructured material developed in our previous studies can cover the titanium structural prosthetic skeleton. These hybrid biological prostheses, which are made using synthetic materials capable of inducing the growth of biological networks and structural steel scaffolding, may favor the emergence of new classes of orthopedic hybrids in the medical field. The new hybrid bio-prosthesis could drastically reduce protection against stress while providing an advantageous improvement in the life of the prosthesis compared to traditional solutions. Recovering optimal joint functionality will improve the patient's quality of life, which perceives a significant reduction in the risk of the new surgery. The requirement to predict potential structural changes that could be induced by improper use of biologically compatible prostheses in bone structure and morphology has forced our studies to evaluate fictitious models that could be considered for efficient bone distribution and orthotropic behavior.
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Voloshin, V. P., A. G. Galkin, S. A. Oshkukov, A. S. Sankaranarayanan, E. V. Stepanov, and A. A. Afanasev. "Additive technologies in the management of patients with extensive lower limb bone defects." Genij Ortopedii 27, no. 2 (April 2021): 227–31. http://dx.doi.org/10.18019/1028-4427-2021-27-2-227-231.
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Augments and reinforcing constructs made of titanium with a porous coating have been used for bone defect management in addition to osteoplastic materials. Additive technologies in traumatology and orthopedics for extensive defects in bones and joints have been applied when it is impossible to use standard designs. The purpose of the study was to evaluate short-term results and perspectives of using additive technologies for bone defects after failed joint arthroplasties and osteosynthesis. Materials and methods In 2018 to November 2019, seven patients with lower extremity bone defects underwent treatment at the Department of Traumatology and Orthopedics of the Moscow Regional Research and Clinical Institute with custom-made implants fabricated with additive technologies. The operations were carefully planned using CT scans, 3D modeling, and implant printing. Particular attention was paid to clean the implant from residual metal powder. Patients were distributed depending on the type of defect and the operation performed (arthroplasty, revision arthroplasty). Results The short-term results of using customized implants were analyzed in this study. The average Harris hip score before surgery was 37.8 points, and after the surgery it was 80.2 points. Pain after surgery in all patients was also evaluated by Harris scale and was 37.1 points; the functionality of patients after surgery was 38.4 points. The custom-made designs have a number of distinguishing advantages against the standard ones. A customized anatomical design provides easier fixation; ergonomic design allows implant retention without removing metal fixators if exist; there is less soft tissue injury during surgery (allinside principle); and convenient bone grafting around the implant. Conclusions The use of additive technologies for bone defects improves the functional results and life quality of the patient. At the moment, practical application of 3D designs has a number of limitations in financial and legal support in practical health care. Further implementation of additive technologies in traumatology and orthopedics will be supported by the grant from the President of the Russian Federation.
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Mohan, B., J. R. Nixon, and E. Doran. "Uncemented Custom-Made Femoral Components." HIP International 12, no. 4 (October 2002): 365–70. http://dx.doi.org/10.1177/112070000201200403.
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We present our experience of total hip replacement (THR) in younger patients using a custom-made smooth titanium alloy femoral prosthesis. Measurements made from pre-operative marker radiographs allowed creation of templates and subsequent computer analysis to mill the stem prior to surgery. Fifty-one such cementless implants were carried out in 43 patients between January 1993 and June 1996 with follow-up to an average of 47 months. Sixteen hips have required revision to date; 13 of these operations were for aseptic loosening. Two more were awaiting revision, giving an overall failure rate of 35.3 %. The average duration from primary operation to revision was 47 months. Thus, even though the concept of an uncemented custom-made femoral component is attractive, the failure rate was found to be unacceptably high. This device may achieve “fit and fill”, but adequate bone on- or in-growth was not achieved. On the basis of these data we have discontinued the use of this implant since 1996.
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Wessling, Martin, Carsten Gebert, Tilmann Hakenes, Marcel Dudda, Jendrik Hardes, Sven Frieler, Lee M. Jeys, and Yannik Hanusrichter. "Reconstruction of Paprosky III defects with custom-made implants: do we get them in the correct position?" Bone & Joint Journal 104-B, no. 10 (October 1, 2022): 1110–17. http://dx.doi.org/10.1302/0301-620x.104b10.bjj-2022-0508.r1.
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Aims The aim of this study was to examine the implant accuracy of custom-made partial pelvis replacements (PPRs) in revision total hip arthroplasty (rTHA). Custom-made implants offer an option to achieve a reconstruction in cases with severe acetabular bone loss. By analyzing implant deviation in CT and radiograph imaging and correlating early clinical complications, we aimed to optimize the usage of custom-made implants. Methods A consecutive series of 45 (2014 to 2019) PPRs for Paprosky III defects at rTHA were analyzed comparing the preoperative planning CT scans used to manufacture the implants with postoperative CT scans and radiographs. The anteversion (AV), inclination (IC), deviation from the preoperatively planned implant position, and deviation of the centre of rotation (COR) were explored. Early postoperative complications were recorded, and factors for malpositioning were sought. The mean follow-up was 30 months (SD 19; 6 to 74), with four patients lost to follow-up. Results Mean CT defined discrepancy (Δ) between planned and achieved AV and IC was 4.5° (SD 3°; 0° to 12°) and 4° (SD 3.5°; 1° to 12°), respectively. Malpositioning (Δ > 10°) occurred in five hips (10.6%). Native COR reconstruction was planned in 42 cases (93%), and the mean 3D deviation vector was 15.5 mm (SD 8.5; 4 to 35). There was no significant influence in malpositioning found for femoral stem retention, surgical approach, or fixation method. Conclusion At short-term follow-up, we found that PPR offers a viable solution for rTHA in cases with massive acetabular bone loss, as highly accurate positioning can be accomplished with meticulous planning, achieving anatomical reconstruction. Accuracy of achieved placement contributed to reduced complications with no injury to vital structures by screw fixation. Cite this article: Bone Joint J 2022;104-B(10):1110–1117.
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Kieser, David C., Ramez Ailabouni, Sandra C. J. Kieser, Michael C. Wyatt, Paul C. Armour, Mark H. Coates, and Gary J. Hooper. "The use of an Ossis custom 3D-printed tri-flanged acetabular implant for major bone loss: minimum 2-year follow-up." HIP International 28, no. 6 (May 21, 2018): 668–74. http://dx.doi.org/10.1177/1120700018760817.
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Introduction: Custom 3D-printed acetabular implants are a new technology used in hip surgery with ever-increasing frequency. They offer patient-specific implants to optimise filling of bone defects and implant-bone contact, without the need for excessive bone resection. Methods: This is a retrospective cohort study of 46 consecutive patients who underwent an Ossis unilateral custom 3D-printed acetabular implant. Clinical (Oxford Hip Score OHS-60), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Harris Hip Score (HHS) and radiological (restoration of biomechanical hip centre, osteointegration, wear, heterotrophic ossification) results were assessed. Results: Patient mean age was 68 years and follow-up was 38 months (minimum 24 months). 10 patients were excluded from the outcome analysis; 2 patients died, 1 required revision for deep infection and 7 were lost to follow-up. Of the 36 patients included, 21 had severe osteolysis. 7 were revised for infection, 3 for tumoural defects, 3 for metallosis, 1 for dysplasia and 1 for trauma (Paprosky 2a [n=6], 2b [n=2], 2c [n=5], 3a [n=6], 3b [n=11], pelvic dissociation [n=6]). OHS significantly improved postoperatively (16-8-48.4 p=0.027). Postoperative functional scores were good (WOMAC 98; HHS 79). The biomechanical hip centre was restored in all patients. 1 patient had early implant migration with subsequent stabilisation. 2 patients had radiographs concerning for failure of osteointegration. 1 patient had recurrent dislocations. Conclusions: The mid-term results of the Ossis custom 3D-printed tri-flanged acetabular implant for the management of severe acetabular defects are encouraging. The improvement in functional scores and radiographic outcomes are comparable to similar designs. In addition, no cases have required revision for aseptic loosening.
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Bejarano-Pineda, Lorena, Samuel B. Adams, and Selene G. Parekh. "3D Printed Cage in Patients with Tibiotalocalcaneal Arthrodesis Using a Retrograde Intramedullary Nail: Early Outcomes." Foot & Ankle Orthopaedics 4, no. 4 (October 1, 2019): 2473011419S0010. http://dx.doi.org/10.1177/2473011419s00104.
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Category: Diabetes, Hindfoot, Trauma, salvage procedure Introduction/Purpose: Segmental bone loss in the hindfoot hinders the chance of successful outcomes. Tibiotalocalcaneal arthrodesis is a reliable option; however, the risk of nonunion is high. Structural graft is needed to fill the gap, but the use of bone grafts are limited by the availability, risk of collapse, and disease transmission. Three-dimensional (3D) printed titanium implants offer a strong scaffold that can be customized and present similar healing rates. The purpose of the study was to describe the clinical outcomes and the radiologic union rate of a case series of patients with hindfoot arthrodesis, using a retrograde intramedullary nail associated to a 3D printed titanium cage. Methods: After obtaining approval from our institution review board, a retrospective chart review was performed on seven patients undergoing hindfoot arthrodesis, using a retrograde intramedullary nail associated to a custom 3D printed titanium cage from March 2015 to December 2017. Demographic and clinical data were collected. Functional outcomes were assessed using The American Orthopedic Foot and Ankle Score (AOFAS) and the Visual Analog Scale (VAS) for pain. Hindfoot alignment was evaluated using preoperative and postoperative weightbearing radiographs that included anteroposterior, lateral and Saltzman views. Radiographic union was assessed using computed tomography scan at 6 and 12 months postoperatively. Results: All patients had ankle arthritis and six of them (85%) had prior surgery in the compromised hindfoot. The average age at TTC fusion was 57 (range, 29 to 71) years. The mean follow-up time was 21 (range, 12 to 32) months. Six patients had a healed fusion and one patient underwent below knee amputation due to recurrence of chronic osteomyelitis in the ankle. Two additional patients had minor complications. The average AOFAS at pre-op was 35 (range, 20 to 42) points as compared to 68 (range, 53 to 78) points at final follow-up; P=0.004. Preoperative VAS pain was 80.4 (range, 70 to 85) points as compared to 26.8 (range, 6 to 60) points; P=0.002. Conclusion: Tibiotalocalcaneal arthrodesis using customized titanium cages for patients with large bone defects has shown a high rate of union in those at high risk of nonunion. Further research is needed to monitor the development of late complications.
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Girolami, Marco, Cristiana Griffoni, Emanuela Asunis, Luigi Falzetti, Stefano Bandiera, Giovanni Barbanti Brodano, Riccardo Ghermandi, et al. "Custom-Made 3D-Printed Implants for Anterior Column Reconstruction in the Upper Cervical Spine after Intralesional Extracapsular Excision—Report of 2 Cases and Literature Review." Journal of Clinical Medicine 11, no. 20 (October 13, 2022): 6058. http://dx.doi.org/10.3390/jcm11206058.
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The use of three-dimensional (3D)-printed custom-made implants is spreading in the orthopedics field for the reconstruction of bone losses or for joint replacement, thanks to their unparalleled versatility. In particular, this novel technology opens new perspectives to formulate custom-made fixation strategies for the upper cervical region, sacrum and pelvis, where reconstruction is challenging. We report and analyze the literature concerning upper cervical reconstruction with 3D-printed personalized implants after tumor surgery, and discuss two cases of patients where this technology was used to reconstruct the anterior column after extracapsular debulking of C2 recurrent chordoma at our institution.
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Schröder e Souza, Bruno, Thiago Leite, Tarsis Silva, Carlos Candido, Felipe de Almeida, and Valdeci de Oliveira. "Função e qualidade de vida de pacientes com fratura do planalto tibial operados com placa bloqueada ou convencional: estudo comparativo." Revista Brasileira de Ortopedia 54, no. 01 (February 2019): 037–44. http://dx.doi.org/10.1016/j.rbo.2017.09.004.
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ResumoComparar resultados clínicos, funcionais e de qualidade de vida de pacientes com fratura do planalto tibial operados com placa bloqueada ou convencional e comparar os custos hospitalares dos implantes.Estudo comparativo de coortes transversal, retrospectivo, em uma série consecutiva de pacientes com fratura do planalto tibial tratados cirurgicamente entre agosto de 2015 e junho de 2016. Foram excluídos: menores de 18 anos; indivíduos incapazes de responder os questionários ou de comparecer para reavaliação; politraumatizados ou com lesões associadas no mesmo membro; pacientes não tratados com placa ou conservadoramente. Os autores compararam os custos dos implantes, a qualidade de vida (SF-12), o escore de Lysholm, a escala visual de dor e os parâmetros clínicos e radiográficos.Foram observadas 45 fraturas no período, das quais 11 foram excluídas. Dos 34 pacientes, dois não compareceram à entrevista (seguimento de 94%). O tempo de seguimento foi 15,1 ± 4,8 meses. O grupo A (placa bloqueada) incluiu 22 pacientes (69%), com custo hospitalar médio dos implantes de R$ 4.125,39 (dp = R$1.634,79/paciente). O grupo B (placa convencional) incluiu dez pacientes (31%), a um custo médio de R$ 438,53 (dp = R$ 161,8/paciente; p < 0,00001). Para os demais parâmetros avaliados, não foram observadas diferenças significativas entre os grupos, exceto por um maior degrau articular no grupo A (2,7 mm ± 3,3 mm vs. 0,5 mm ± 1,6 mm; p = 0,02; TE = 0,90).O custo dos implantes bloqueados para o tratamento das fraturas do planalto tibial é significativamente superior aos implantes convencionais, embora não tenham apresentado vantagem clínica, radiográfica, funcional ou de qualidade de vida, nos pacientes dessa amostra.
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Tikhilov, R. M., A. A. Dzhavadov, A. O. Denisov, A. M. Сhililov, M. A. Cherkasov, S. S. Bilyk, I. E. Khujanazarov, and I. I. Shubnyakov. "Cost-effectiveness analysis of custom-made and serial acetabular components in revision hip arthroplasty." Genij Ortopedii 28, no. 2 (April 29, 2022): 234–40. http://dx.doi.org/10.18019/1028-4427-2022-28-2-234-240.
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Introduction Custom-made acetabular componenents demonstrate a higher clinical efficiency in revision hip arthroplasty for 3A and 3B uncontained acetabular defects and pelvic discontinuity in comparison with serial implants. However, the cost of customized implants still outweighs the cost of serial implants. Accordingly, the level of economic feasibility of using different implants for various defects of the acetabulum seems to be interesting to investigate. Purpose To analyze the economic efficiency of using customized acetabular implants for 3A and 3B uncontained acetabular defects and pelvic discontinuity in comparison with serial implants. Materials and methods To assess the economic efficiency, the Markov model was applied. The model was built on the basis of 4-year survival data for aseptic loosening, infection, and dislocation in 133 cases of revision hip arthroplasty. Results According to the results of modeling, over a 5-year cycle, customized implants showed a reduction in costs by 11.7 % and an increase in the quality of life of patients by 0.2 QALY in the group of patients with 3A uncontained defects in comparison with serial implants. In patients with 3B uncontained defects and pelvic discontinuity, custom-made implants also showed a reduction in costs by 20.8 % and 41.1 %, and QALY values were also higher in the groups of patients who had custom-made implants at 0.6 and 1.4 QALY units, respectively. Conclusion The use of custom-made implants is a more cost-effective strategy in comparison with the implantation of serial acetabular components.
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O'brien, S., R. K. Wilson, B. M. Hanratty, N. W. Thompson, M. E. Wallace, J. R. Nixon, D. W. Engela, J. F. Orr, G. H. Isaac, and D. E. Beverland. "The Cemented Custom Femoral Stem - a 10 Year Review." HIP International 17, no. 4 (October 2007): 194–204. http://dx.doi.org/10.1177/112070000701700402.
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We report a series of 706 patients (759 hip implants) with an average follow up of 10.5 years (range, 10 - 11 years) following total hip replacement (THR) using a cemented custom-made femoral stem and a cemented HDP acetabular component. The fate of every implant is known. One hundred and seventy-four patients (23%) were deceased at the time of their 10-year review - all died with a functioning THR in situ. Four hundred and sixty-two patients (61%) were subsequently reviewed. One hundred and twenty three patients (16%) were assessed by telephone review, as they were too ill or unwilling to attend. Kaplan-Meier survival analysis (all components) demonstrated a median survival at 10 years of 96.05% or 95% Confidence Intervals (CI) for median survival of (94.41% to 97.22%). Revision surgery occurred in 30 cases (3.9%). Seventeen had full revisions (2.2%) and 13 (1.7%) socket revisions only. Twenty-one out of 30 revisions were for infection or dislocation. There were 2 cases (0.3%) of revision for aseptic loosening of the stem. The 10-year results of the custom femoral titanium stem are encouraging and compare well with other cemented systems.
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Aamodt, A., J. Lund-Larsen, J. Eine, E. Andersen, P. Benum, and O. Schnell Husby. "Mechanical Stability of Custom and Anatomical Femoral Stems: An Experimental Study in Human Femora." HIP International 12, no. 3 (July 2002): 263–73. http://dx.doi.org/10.1177/112070000201200301.
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In this study we have compared the mechanical stability of custom (n=8) and anatomical (n=8) uncemented femoral components, following insertion into human cadaveric femurs, during simulated single leg stance and stair climbing. In the custom group two specimens were excluded from the study due to detachment of the greater trochanter during cyclical loading. As a consequence of their mechanical behaviour both types of stems could be divided into subgroups of “unstable” and “stable” implants. In the course of one thousand loading cycles three anatomical stems and one custom stem migrated more than 1 mm, which was interpreted as mechanical loosening. This difference in rate of mechanical loosening was not significant. However, the majority of the stems were remarkably stable and showed micromotion of less than 18 μm and migration of less than 35 μm at the proximal implant-bone interface. The corresponding figures for the tip of the stems were 243 μm and 170 μm, respectively. During torsional loading the custom stems showed less rotatory motion than the anatomical stem (p<0.05). There were no significant differences in the magnitude of cyclical micromotion or migration for the two types of femoral stems.
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Dekker, Travis J., John R. Steele, Andrew E. Federer, Kamran S. Hamid, and Samuel B. Adams. "Use of Patient-Specific 3D-Printed Titanium Implants for Complex Foot and Ankle Limb Salvage, Deformity Correction, and Arthrodesis Procedures." Foot & Ankle International 39, no. 8 (April 12, 2018): 916–21. http://dx.doi.org/10.1177/1071100718770133.
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Background: The advancement of 3D printing technology has allowed for the use of custom-designed implants for difficult-to-treat foot and ankle pathologies. This study reports on the radiographic and functional outcomes of a case series of patients treated with patient-specific 3D-printed titanium implants. Methods: Fifteen consecutive patients treated with custom-designed 3D-printed implant cages for severe bone loss, deformity correction, and/or arthrodesis procedures were included in this study. A minimum of 1 year of clinical and radiographic follow-up was required. No patients were lost to follow-up. Patients completed a visual analog scale for pain, the Foot and Ankle Ability Measure Activities of Daily Living score, and the American Orthopaedic Foot & Ankle Society Score outcomes questionnaires preoperatively and at most recent follow-up. All patients had postoperative radiographs and computed tomography (CT) scans to assess bony incorporation. The mean age was 53.3 years (range, 22-74 years) with a mean follow-up of 22 months (range, 12-48 months) for these 15 patients. Results: Radiographic fusion verified by CT scan occurred in 13 of 15 patients. There was significant improvement in pain and all functional outcome score measures. All patients who went on to fusion were satisfied with their surgery. There were 2 failures, consisting of 1 infection and 1 nonunion, with an overall clinical success rate of 87%. Conclusion: These patients demonstrated the successful use of patient-specific 3D-printed titanium implants to treat complex large bony defects, deformities, and arthrodesis procedures. These implants offer surgeons a novel and promising approach to treat both lower extremity pain and deformity that is not always available with current techniques. Level of Evidence: Level IV, retrospective case series.
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Dion, C., M. Pollock, J. Howard, L. Somerville, and B. Lanting. "SURGICAL OUTCOMES OF 3D PRINTED MUSCULOSKELETAL METAL IMPLANTS: A SYSTEMATIC REVIEW." Journal of Musculoskeletal Research 21, no. 03n04 (September 2018): 1840001. http://dx.doi.org/10.1142/s0218957718400018.
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Introduction: Additive manufacturing, also known as 3D printing (3DP), is becoming increasingly available to surgeons throughout the world due to recent advancements in technology. 3D printing can produce complex free-form structures that would be impossible using conventional subtractive manufacturing. This offers the possibility to create implants that are better suited to the irregular anatomic shapes found in the human body. The present study aims to examine the surgical outcomes associated with the use of 3D printed metal implants and uncover the value of 3D printing in musculoskeletal surgery. Methods: A systematic review of published literature was performed in June 2017 using the PRISMA protocol. Online bibliographic databases such as MEDLINE, Embase, Scopus, CINAHL, and Cochrane were used to identify studies involving surgical implantation of 3D printed metal implants in musculoskeletal surgery. References from relevant studies were scanned for additional articles. Two reviewers independently screened results. Full-text articles were analyzed for eligibility. A total of 24 studies were included for data abstraction. Results were collected and qualitatively analyzed. Results: Of the 25 articles included, there were 17 case reports, 4 case series, 2 retrospective cohorts and 3 prospective cohorts. Of these articles, the majority of 3DP was done with electron beam melting (EBM) with Ti6Al4V. Orthopaedic, neurosurgical, plastic, and maxillofacial surgery articles were included in the review. All studies concluded that 3D printed implants had favourable post-operative outcomes. Some advantages included the reduction of operative time, improved osseointegration through custom implant porosity, improved fixation, decreased stress shielding, better cosmetic appearance, improved functional outcome, and limb salvage. Additional cost and time required to design and print the implants were reported as potential drawbacks to 3D printing. Discussion/Conclusions. The applications of 3D printing in musculoskeletal surgery are promising and have the potential to alter future surgical practice. However, there is a lack of quality research in the literature assessing the use of 3D printed implants. Further research is needed to evaluate the use of 3D printing in musculoskeletal surgery to understand its potential effects on surgical practice.
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Hua, J., P. S. Walker, W. Muirhead-Allwood, G. Bentley, and C. J. McCullough. "The Rationale for CAD-CAM Uncemented Custom Hips: An Interim Assessment." HIP International 5, no. 2 (April 1995): 52–62. http://dx.doi.org/10.1177/112070009500500202.
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The purpose of this paper is to examine whether the rationale for CAD-CAM Custom Hips is realised in clinical practice. Previous studies demonstrated that custom uncemented stems, with a close fit proximally and a sliding fit distally, produced stresses closer to normal than for other stem types, which should result in the preservation of proximal bone. Custom stems showed less micromotion, especially in torsional loading, and hence should demonstrate interface osseointegration. The hips are designed and manufactured using specially written software. The standard design includes proximal macro-grooves with HA coating, an anterior flare, a lateral flare, a collar, and a smooth distal stem for a sliding fit. Elective features are added such as proximal stem twist and neck retroversion in CDH, increased stem length to bypass defects, curvatures in AP and ML views, and distal cutting flutes when extra torsional stability is required. From 1989 to 1994, 411 cases were carried out, approximately one-third in each of the categories of OA, JCA/CDH, and revision. Studies were made of the available radiographs at yearly intervals, while DEXA scans were taken of the RNOHT patients pre-operatively, at 6 months and then yearly. There were four failures requiring revision, three of the early primary design without HA coating, and one a revision design. The radiographs in primary hips showed complete proximal bone-implant apposition in 81% of all cases. The DEXA scans showed that the mean bone mass after two years for all seven Gruen zones was greater than 90%. It was concluded that the CAD-CAM HA-coated Custom Hips showed bone and interface stability up to this time. The hip has played a useful role in providing the ideal stem for each particular case, which may result in an improvement of long-term results, compared with the use of off-the-shelf implants.
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Cotton, R., A. Harkara, C. Lawrie, and C. Whittington. "B-7 Developing and Manufacturing Custom-Made Medical Implants." Journal of Biomechanics 43 (June 2010): S26. http://dx.doi.org/10.1016/s0021-9290(10)70044-0.
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Tracey, Joseph, Danny Arora, Christopher E. Gross, and Selene G. Parekh. "Custom 3D-Printed Total Talar Prostheses Restore Normal Joint Anatomy Throughout the Hindfoot." Foot & Ankle Specialist 12, no. 1 (March 14, 2018): 39–48. http://dx.doi.org/10.1177/1938640018762567.
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Background: Third generation total talar prostheses (TTPs) are viable options for talar avascular necrosis (AVN) in the absence of neighboring joint pathology. The use of modern three-dimensional (3D) printing allows the production of custom implants that exactly mimic the patient’s anatomy. The aim of this study is to determine the accuracy of 3D printing in reproducing a synthetic talus and, in doing so, restoring more normal anatomical relationships. We hypothesize that this mode of replication will restore and maintain normal radiographic alignment of the ankle, subtalar, and forefoot joints in the setting of talar AVN. Methods: A retrospective analysis was performed on all patients undergoing TTP implantation for the treatment of talar AVN between 2016 and 2017. Radiographic measurements were taken preoperatively and postoperatively to determine native talar dimensions, TTP implant dimensions, and the corresponding radiographic alignment about the forefoot, hindfoot, and ankle. Results: A total of 14 patients were identified in our cohort. Talar arc length and width were not found to be significantly changed; however, talar height was significantly increased with use of TTP. Five alignment dimensions were measured, of which, only talar tilt angle was significantly changed. Instances of Meary’s angle correction were observed in cavus and planus foot deformity. Conclusion: As a proof of concept, 3D-printed TTP was successful in restoring talar height and talar tilt in the setting of AVN. Additionally, the procedure maintained normal alignment in nonpathological joints. TTPs, based on our cohort, are a viable option to restore more normal anatomical alignment. Levels of Evidence: Level IV: Case series
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Northmore-Ball, M. D. "How Often are Custom Implants Actually Needed in Hip Revision Surgery?" HIP International 5, no. 1 (January 1995): 1–7. http://dx.doi.org/10.1177/112070009500500101.
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Gohlke, Frank, Ayman A. Abdelkawi, Hani Eltair, Mohamed Aboalata, Walid Hussein, Mohamed S. Abdrabo, and Tina Jasper. "Revision of failed reverse shoulder arthroplasty—a point of no return?" Obere Extremität 15, no. 3 (August 19, 2020): 187–98. http://dx.doi.org/10.1007/s11678-020-00598-6.
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Abstract Background The rate of complications after revision of reverse shoulder arthroplasty (RSA) is higher than it is in primary RSA, depending on the type of surgical intervention, the follow-up time, the preoperative condition of the patient, and the experience of the surgeon. Objective The current article represents an evaluation of the authors’ experiences with revisions of RSA and a review of literature, in order to define prognostic parameters and surgical options for the most common modes of failure. Materials and methods Between 2010 and 2019, 136 revisions of RSA were performed. Mean age of the patients at surgery was 68.3 years (29–88 years). The main indication was instability in 24 patients and chronic infection in 34. Aseptic loosening of the stem was the main indication in 15 and aseptic loosening of the baseplate in 23 patients. Periprosthetic fractures were present in 21 patients. Fractures of the scapular spine were operated on in 6 and surgery was performed for progressive notching due to malposition of the glenosphere in 4 patients. Results Staged procedures, use of allografts, and custom-made implants are common, especially for chronic infections and severe bone loss. Most of the patients (88.2%) were treated successfully. Two salvage procedures and two retentions of spacers occurred. We identified risk groups for re-revision: chronic dislocations, chronic infections, advanced bone loss, and scapular spine fractures. We observed a shift of indications and techniques, often related to the design of the implants. Conclusion These results confirm that careful preoperative planning, special implants, and a high level of experience are mandatory. With time, the authors developed an algorithm for certain indications because it was recognized that failures are often of multifactorial origin. Today, numerous implant designs which differ considerably in biomechanical features and failure modes are available. This makes revisions of RSA more complex than it was in the past.
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Isaacson, Mark, Kevin Bunn, and Stephen Incavo. "Patient-specific instrumentation and custom total knee implants in total knee arthroplasty." Current Orthopaedic Practice 26, no. 3 (2015): 224–27. http://dx.doi.org/10.1097/bco.0000000000000228.
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Jaecques, S. V. N., C. Van Lierde, J. Vander Sloten, and I. Naert. "Custom suprastructures for immediately loaded, implant-supported dental prostheses." Journal of Biomechanics 39 (January 2006): S205. http://dx.doi.org/10.1016/s0021-9290(06)83747-4.
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Madi, Naji S., Amanda N. Fletcher, Aman Chopra, and Selene G. Parekh. "Early Results with the Use of Synthetic Cartilage Implant Augmented with 3D Printed Baseplate to Prevent Implant Subsidence for Treatment of Hallux Rigidus." Foot & Ankle Orthopaedics 7, no. 4 (October 2022): 2473011421S0076. http://dx.doi.org/10.1177/2473011421s00763.
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Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus (HR) of the first metatarsophalangeal joint (MTPJ) is a common arthritic disease which causes pain and stiffness. Synthetic cartilage implant (SCI) resurfacing has become a popular treatment option since it has similar biomechanical properties as native cartilage, reduces pain, and preserves MTPJ motion. However, recent studies have reported on implant subsidence leading to SCI treatment failure and subsequent revision surgery. A novel solution involves proximally inserting a custom 3D printed baseplate in the metatarsal head to prevent SCI subsidence. The purpose of this study is to evaluate the clinical and radiographic outcomes of patients who underwent SCI resurfacing augmented with a 3D printed beasplate for the treatment of HR by a single surgeon. Methods: Electronic health records were queried from August 2017 to August 2021 for patients who were treated with SCI (Cartiva Synthetic Cartilage Implant; Cartiva Inc., Alpharetta, GA) augmented with a custom 3D printed baseplate by a single surgeon. Through a dorsal approach to the MTPJ, the custom 3D printed baseplate is inserted in the metatarsal head and the SCI implant is positioned two millimeters proud from the cortex. An akin osteotomy is then performed and fixed with a staple. For the study, surgical indications included symptomatic HR and revision of previously failed SCI treatment. Patient demographics, body mass index (BMI), medical comorbidities, and followup periods were recorded. Preoperative and postoperative range of motion, visual analog scale (VAS) pain scores, and x-ray imaging were compared. Descriptive and univariate statistics were used to analyze data. Results: Twenty-one patients underwent SCI resurfacing augmented with a 3D printed baseplate. The cohort consisted of 18 females, and presented with a mean BMI of 30.4+-5 Kg/m2, mean age of 56.4+-10 years, and mean followup of 9.8+-13 months since the procedure. Patients experienced a significant improvement in VAS pain (P=0.002) scores. The SCI augmented with 3D printed baseplate survivorship was 90.4%, with only two (9.5%) patients requiring revision to first MTPJ arthrodesis for SCI subsidence and sesamoidal arthritis. Two (9.5%) patients additionally underwent reoperation for staple removal and infection. The first MTPJ space was maintained on x-ray imaging for 19 (90.5%) patients, with only two (9.5%) patients demonstrating implant subsidence. Conclusion: SCI resurfacing augmented with a custom 3D printed baseplate demonstrated significant improvements in pain and prevented implant subsidence in patients suffering from symptomatic HR. Future prospective studies should be performed to expand upon the clinical outcomes data analyzing this novel technique to prevent SCI subsidence in the treatment for HR.
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Gunther, Stephen B., and Tennyson L. Lynch. "Total shoulder replacement surgery with custom glenoid implants for severe bone deficiency." Journal of Shoulder and Elbow Surgery 21, no. 5 (May 2012): 675–84. http://dx.doi.org/10.1016/j.jse.2011.03.023.
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Babis, George C., and Vasileios S. Nikolaou. "Pelvic discontinuity: a challenge to overcome." EFORT Open Reviews 6, no. 6 (June 2021): 459–71. http://dx.doi.org/10.1302/2058-5241.6.210022.
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Pelvic discontinuity (PD) has been a considerable challenge for the hip revision arthroplasty surgeon. However, not all PDs are the same. Some occur during primary cup insertion, resembling a fresh periprosthetic fracture that separates the superior and inferior portions of the pelvis, while others are chronic as a result of gradual acetabular bone loss due to osteolysis and/or acetabular implant loosening. In the past, ORIF, various types of cages, bone grafts and bone cement were utilized with little success. Today, the biomechanics and biology of PD as well as new diagnostic tools and especially a variety of new implants and techniques are available to hip revision surgeons. Ultraporous cups and augments, cup-cage constructs and custom triflange components have revolutionized the treatment of PD when used in various combinations with ORIF and bone grafts. For chronic PD the cup-cage construct is the most popular method of reconstruction with good medium-term results. Dislocation continues to be the leading cause of failure in all situations, followed by infection. Ultimately, surgeons today have a big enough armamentarium to select the best treatment approach. Case individualization, personal experience and improvisation are the best assets to drive treatment decisions and strategies. Cite this article: EFORT Open Rev 2021;6:459-471. DOI: 10.1302/2058-5241.6.210022
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Davis, Jason J., and James V. Bono. "Surgical Strategies to Achieve a Custom-Fit TKA with Standard Implant Technique." Orthopedics 33, no. 8 (August 1, 2010): 569–76. http://dx.doi.org/10.3928/01477447-20100625-19.
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Durand‐Hill, Matthieu, Johann Henckel, Anna Di Laura, and Alister J. Hart. "Can custom 3D printed implants successfully reconstruct massive acetabular defects? A 3D‐CT assessment." Journal of Orthopaedic Research 38, no. 12 (June 5, 2020): 2640–48. http://dx.doi.org/10.1002/jor.24752.
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Wyatt, Michael C. "Custom 3D-Printed Acetabular Implants in hip Surgery–Innovative Breakthrough or Expensive Bespoke Upgrade?" HIP International 25, no. 4 (July 2015): 375–79. http://dx.doi.org/10.5301/hipint.5000294.
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Schwartz, Adam J., J. Michael Kabo, Fritz C. Eilber, Frederick R. Eilber, and Jeffrey J. Eckardt. "Cemented Distal Femoral Endoprostheses for Musculoskeletal Tumor: Improved Survival of Modular versus Custom Implants." Clinical Orthopaedics and Related Research® 468, no. 8 (December 22, 2009): 2198–210. http://dx.doi.org/10.1007/s11999-009-1197-8.
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Barjaktarovic, Radoslav, Zoran Popovic, and Dragan Radoicic. "Megaendoprosthesis in the treatment of bone tumors in the knee and hip region." Vojnosanitetski pregled 68, no. 1 (2011): 62–67. http://dx.doi.org/10.2298/vsp1101062b.
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Background/Aim. For almost two decades extremity amputation has not been the only viable option for patients with from bone cancer in the region of the hip and knee. Remarkable advances in implant technology, surgical reconstructive technique and adoption of new chemotherapy protocols provide a new option for surgeons who diagnose and treat bone tumors. Megaendoprosthesis has become widely accepted alternative in limb salvage surgery of the extremities. The aim of this study was to present an outcome of the treatment of bone tumors in the knee and hip region by the use of custom made megaendoprothesis. Methods. In the period 2006-2008 we adopted new clinical practice protocols for preoperative management in candidates for tumor megaprostheses of the hip and knee including: surgical tumor staging, histopathological verification, determinants of anatomical-mechanical defect, status of soft tissues, CT evaluation of the referent measures of pelvis, femur and tibia necessary for creation of custom made endoprosthesis and surgery plan, as well as modern, less invasive surgical approach. The patients were monitored during ? 24 months after the surgery for detecting possible complications. Results. All procedures were performed without complications during and immediately after the surgery. During the follow-up period not less than 24 months we failed to record any significant complications. Conclusion. Custom made megaendoprosthesis are the method of choice in the treatment of bone tumors in the region of the hip and knee at the Orthopedics and Traumatology Clinic, Military Medical Academy, Belgrade. The greatest challenge - ensuring longevity of a prosthesis can be achieved not only by prevention of common complications of arthroplasty procedures but, certainly, with the introduction of new methods for preoperative planning - computer-assisted technique of measuring referent sizes and software solutions for the selection and design of custom-made components of an endoprosthesis.
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Citak, Mustafa, Lilly Kochsiek, Thorsten Gehrke, Carl Haasper, Eduardo M. Suero, and Hans Mau. "Preliminary results of a 3D-printed acetabular component in the management of extensive defects." HIP International 28, no. 3 (April 12, 2017): 266–71. http://dx.doi.org/10.5301/hipint.5000561.
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Introduction: The treatment of extensive bone loss and massive acetabular defects can be compounded by several challenges and pitfalls. The survivorship following acetabular revision with extensive bone loss is still unsatisfactory. The goal of the present study was to analyse the outcomes of 3D-printed patient-specific acetabular components in the management of extensive acetabular defects and combined pelvic discontinuity (PD). Methods: 9 patients underwent revision THA using 3D-printed custom acetabular components to reconstruct extensive acetabular defects. The Paprosky classifications were determined in all patients. The primary outcome measure was the implant-associated failure rate. Results: 1 out of 9 patients suffered an implant-associated complication (11%). The overall implant-associated survival rate was 89%. The overall complication rate was 56%. Conclusions: The patient-specific acetabular component technique shows promise for the treatment of patients with severe acetabular defects in revision THA. Further research aimed at reducing costs and improving the complication rate are warranted.
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Schwartz, Adam J., and Christopher P. Beauchamp. "Compressive Osseointegration Into a Custom Acetabular Implant Masquerading as Tumor Recurrence: A Case Report." Clinical Orthopaedics and Related Research 471, no. 3 (March 2013): 878–82. http://dx.doi.org/10.1007/s11999-012-2482-5.
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Zhang, Hui, Maxwell Vogel, William M. Malarkey, and Gerard J. Cush. "Charcot Arthropathy Limb Salvage with 3D Custom Cage and Dynamic Hindfoot Fusion Nail Combination Fixation: A Case-Series." Foot & Ankle Orthopaedics 7, no. 4 (October 2022): 2473011421S0101. http://dx.doi.org/10.1177/2473011421s01018.
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Category: Diabetes; Ankle; Hindfoot Introduction/Purpose: Patients with Charcot arthropathy with hindfoot collapse present a difficult challenge for foot and ankle surgeons. While traditional limb salvage options include tibiotalocalcaneal (TTC) arthrodesis with accepted shortening, thin wire external fixation, or TTC arthrodesis with bulk femoral head allograft, new 3-dimensional (3D) custom patient specific implants offer a new treatment modality for limb salvage for this difficult issue. The purpose of this case-series is to offer one surgeon's experience with this new treatment technique for limb salvage. Methods: All patients undergoing limb salvage procedures for hindfoot collapse between 2018 and 2022 with a custom 3D hindfoot cage with TTC hindfoot fusion intramedullary nail were included for analysis. Along with patient demographics and length of follow up, patients were asked a series of questions on a telephone survey in order to measure patient reported outcomes including current ambulatory status and whether they would have elected to undergo the same treatment modality again. Complications were also tracked. Finally, radiographs were analyzed to evaluate the degree of deformity correction on both coronal and sagittal planes as well as degree of deformity correction maintenance at last radiographic follow up. Results: 13 patients were included in the analysis. 10 of the 13 patients had Charcot arthropathy. 2 patients had deep infections that ultimately required below knee amputation. 11 out of 13 patients had successful limb salvage as defined by the maintenance of a functional limb without need for amputation. Interestingly, both patients who failed limb salvage and required below knee amputations reported that they would prefer to have undergone the same attempt at limb salvage even with the resulting amputation. Radiographically, the average amount of coronal plane deformity correction was 25 degrees while the average amount of sagittal plane deformity correction was 6 degrees. The average amount of deformity correction maintenance seen at last radiographic follow up was high with a loss of only 0.5 degrees in coronal plane deformity correction loss throughout the time period and an average of 2 degrees of sagittal plane deformity correction loss. Conclusion: While still a challenging pathology to treat, custom patient specific 3D implants combined with TTC hindfoot fusion nail is a viable construct for patients with Charcot arthropathy undergoing limb salvage for hindfoot collapse.