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van Veldhuizen WA, van Noortwijk R, Meesters A, Duis KT, Schuurmann R, de Vries J, Wolterink JM, IJpma F. Automatic virtual reconstruction of acetabular fractures using a statistical shape model. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02615-7. [PMID: 39190061 DOI: 10.1007/s00068-024-02615-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/17/2024] [Indexed: 08/28/2024]
Abstract
PURPOSE Automatic virtual reconstruction of complex fractures would be helpful for pre-operative surgical planning. We developed a statistical shape model (SSM) which contains data of 200 intact 3D hemipelves. It allows for quantification of shape differences and is able to reconstruct abnormal shaped pelvises. We applied our SSM to reconstruct elementary and associate type acetabular fractures and assessed the reconstruction performance of the SSM, by comparing the reconstructed shape with the intact contralateral hemipelvis. METHODS In this retrospective diagnostic imaging study, we used our SSM to virtually reconstruct fractured hemipelves of eighty-three patients with an acetabular fracture. A root mean square error (RMSE) was computed between the reconstructed shape and intact contralateral shape for the whole hemipelvis and for regions relevant for plate-fitting. These plate-fitting relevant regions were defined as: (1) Iliopectineal line length and radius; (2) ischial body line length and radius; (3) acetabular diameter, (4) quadrilateral slope and (5) weight-bearing acetabular dome. RESULTS The median RMSE of the whole hemipelvis of the elementary type fractures was 2.2 (1.7-2.5) mm versus 3.2 (2.2-3.9) mm for the associate type fractures (p < 0.001). The median RMSE for the plate-fitting regions of elementary type fractures was 1.7 (1.4-2.1) mm versus 2.7 (2.0-4.1) mm for associate type fractures (p < 0.001). CONCLUSION Using a statistical shape model allows for accurate virtual reconstructions of elementary and associate type acetabular fractures within a clinically acceptable range, especially within regions important for plate-fitting. SSM-based reconstructions can serve as a valuable tool for pre-operative planning in clinical practice, when a template of the contralateral hemipelvis is unavailable.
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Affiliation(s)
- W A van Veldhuizen
- Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands.
| | - R van Noortwijk
- Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - Aml Meesters
- Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands
- 3D lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - K Ten Duis
- Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - Rcl Schuurmann
- Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands
- Multimodality Medical Imaging Group, Technical Medical Center, University of Twente, Enschede, The Netherlands
| | - Jppm de Vries
- Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - J M Wolterink
- Department of Applied Mathematics, Technical Medical Center, University of Twente, Enschede, The Netherlands
| | - Ffa IJpma
- Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands
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Chu JH, Zhang Y, Jiang Y, Wu HF, Wang WY, Wang M, Zhang JH, Yan K, Yao XM. Research trends of bone tumor treatment with 3D printing technology from 2013 to 2022: a bibliometric analysis. Discov Oncol 2024; 15:359. [PMID: 39160379 PMCID: PMC11333674 DOI: 10.1007/s12672-024-01207-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 07/30/2024] [Indexed: 08/21/2024] Open
Abstract
OBJECTIVE Bibliometrics was employed in this study to determine the research trends in the worldwide application of 3D printing technology to treat bone tumors over the previous 10 years. METHODS Published from 2013 to 2022, the papers related to bone tumors treated with 3D printing were located in Web of Science Core Collection (WoSCC), PubMed, and Scopus. The screened articles were included in this bibliometric study. From these papers in WoSCC, information on annual publications, journals, keywords, countries, authors, institutions, and cited references were extracted and visualized with CiteSpace (version 6.1.R6) software to investigate the state of bone tumor treatment using 3D printing as well as research hotspots. The Carrot2 online visualization tool and Vosviewer software (version 1.6.20) were employed to visualize the publications from PubMed and Scopus, respectively, in order to ascertain the most popular research topics from both databases. RESULTS A total of 606, 233, and 364 publications were obtained from WoSCC, PubMed, and Scopus, respectively, between the years 2013 and 2022. In WoSCC, the peak number of publications was found in 2021, with 145 publications published. Acta Biomaterialia (11 publications) and World Neurosurgery (10 publications) were the most prolific journals, and Biomaterials was the journal cited the most (244 times). Yong Zhou was the most productive author with 14 publications, while Kwok-Chuen Wong (69 citations) and William F Enneking, (69 citations) possessed the most citations. The country with the largest quantity of publications was China (207). Among all institutions, Shanghai Jiao Tong University produced the most publications (29). Rapid prototyping was the keyword with the strongest citation burst (4.73). 'Reconstruction', 'surgery', 'resection', and 'design' caught the significant attention of researchers. 3D-printed materials, pelvic reconstruction, mandibular reconstruction, computer-assisted surgical techniques, photothermal therapy, and in vitro experiments were recognized as hot subjects and trends in current research. The most frequently occurring topics in Scopus are not significantly different from those found in WoSCC. The most prevalent research areas in PubMed encompass implant, patient-specific, bioceramic, models, and pelvic.
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Affiliation(s)
- Jia-Hao Chu
- Third Clinical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yang Zhang
- Third Clinical College, Zhejiang Chinese Medical University, Hangzhou, China
- Zhejiang Chinese Medical University's Third Affiliated Hospital, Hangzhou, China
| | - Yi Jiang
- Third Clinical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Hai-Fan Wu
- Third Clinical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Wen-Yi Wang
- Third Clinical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Min Wang
- Third Clinical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jia-Hui Zhang
- Third Clinical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Kun Yan
- Zhejiang Chinese Medical University's Third Affiliated Hospital, Hangzhou, China
| | - Xin-Miao Yao
- Third Clinical College, Zhejiang Chinese Medical University, Hangzhou, China.
- Zhejiang Chinese Medical University's Third Affiliated Hospital, Hangzhou, China.
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Chui ECS, Mak KKK, Ng RHT, Fung ECH, Mak HHK, Chan MS, Zhao W, Su X, Zhang J, Xu J, Sang H, Pei G, Ong MTY, Cheung WH, Law SW, Wong RMY, Yung PSH. Application of image recognition-based tracker-less augmented reality navigation system in a series of sawbone trials. ARTHROPLASTY 2024; 6:39. [PMID: 39090719 PMCID: PMC11295607 DOI: 10.1186/s42836-024-00263-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/16/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND This study introduced an Augmented Reality (AR) navigation system to address limitations in conventional high tibial osteotomy (HTO). The objective was to enhance precision and efficiency in HTO procedures, overcoming challenges such as inconsistent postoperative alignment and potential neurovascular damage. METHODS The AR-MR (Mixed Reality) navigation system, comprising HoloLens, Unity Engine, and Vuforia software, was employed for pre-clinical trials using tibial sawbone models. CT images generated 3D anatomical models, projected via HoloLens, allowing surgeons to interact through intuitive hand gestures. The critical procedure of target tracking, essential for aligning virtual and real objects, was facilitated by Vuforia's feature detection algorithm. RESULTS In trials, the AR-MR system demonstrated significant reductions in both preoperative planning and intraoperative times compared to conventional navigation and metal 3D-printed surgical guides. The AR system, while exhibiting lower accuracy, exhibited efficiency, making it a promising option for HTO procedures. The preoperative planning time for the AR system was notably shorter (4 min) compared to conventional navigation (30.5 min) and metal guides (75.5 min). Intraoperative time for AR lasted 8.5 min, considerably faster than that of conventional navigation (31.5 min) and metal guides (10.5 min). CONCLUSIONS The AR navigation system presents a transformative approach to HTO, offering a trade-off between accuracy and efficiency. Ongoing improvements, such as the incorporation of two-stage registration and pointing devices, could further enhance precision. While the system may be less accurate, its efficiency renders it a potential breakthrough in orthopedic surgery, particularly for reducing unnecessary harm and streamlining surgical procedures.
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Affiliation(s)
- Elvis Chun-Sing Chui
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
| | - Kyle Ka-Kwan Mak
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Randy Hin-Ting Ng
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Ericsson Chun-Hai Fung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Harold Hei-Ka Mak
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Mei-Shuen Chan
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Wei Zhao
- Department of Orthopaedics, Southern University of Science and Technology Hospital, Shenzhen, 518055, China
| | - Xiuyun Su
- Department of Orthopaedics, Southern University of Science and Technology Hospital, Shenzhen, 518055, China
| | - Jin Zhang
- Department of Orthopaedics, Shenzhen Hospital of Southern Medical University, Shenzhen, 510086, China
| | - Jianglong Xu
- Department of Orthopaedics, Shenzhen Children's Hospital, Shenzhen, 518026, China
| | - Hongxun Sang
- Department of Orthopaedics, Shenzhen Hospital of Southern Medical University, Shenzhen, 510086, China
| | - Guoxian Pei
- Department of Orthopaedics, Southern University of Science and Technology Hospital, Shenzhen, 518055, China
| | - Michael Tim-Yun Ong
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Wing-Hoi Cheung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Sheung-Wai Law
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Ronald Man Yeung Wong
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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Hu X, Lu M, Wang Y, Luo Y, Zhou Y, Yang X, Tu C, Min L. Advanced Pelvic Girdle Reconstruction with three dimensional-printed Custom Hemipelvic Endoprostheses following Pelvic Tumour Resection. INTERNATIONAL ORTHOPAEDICS 2024; 48:2217-2231. [PMID: 38775826 PMCID: PMC11246265 DOI: 10.1007/s00264-024-06207-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 04/12/2024] [Indexed: 07/14/2024]
Abstract
PURPOSE Resection of pelvic bone tumours and subsequent pelvic girdle reconstruction pose formidable challenges due to the intricate anatomy, weight-bearing demands, and significant defects. 3D-printed implants have improved pelvic girdle reconstruction by enabling precise resections with customized guides, offering tailored solutions for diverse bone defect morphology, and integrating porous surface structures to promote osseointegration. Our study aims to evaluate the long-term efficacy and feasibility of 3D-printed hemipelvic reconstruction following resection of malignant pelvic tumours. METHODS A retrospective review was conducted on 96 patients with primary pelvic malignancies who underwent pelvic girdle reconstruction using 3D-printed custom hemipelvic endoprostheses between January 2017 and May 2022. Follow-up duration was median 48.1 ± 17.9 months (range, 6 to 76 months). Demographic data, imaging examinations, surgical outcomes, and oncological evaluations were extracted and analyzed. The primary endpoints included oncological outcomes and functional status assessed by the Musculoskeletal Tumor Society (MSTS-93) score. Secondary endpoints comprised surgical duration, intraoperative bleeding, pain control and complications. RESULTS In 96 patients, 70 patients (72.9%) remained disease-free, 15 (15.6%) had local recurrence, and 11 (11.4%) succumbed to metastatic disease. Postoperatively, function improved with MSTS-93 score increasing from 12.2 ± 2.0 to 23.8 ± 3.8. The mean operating time was 275.1 ± 94.0 min, and the mean intraoperative blood loss was 1896.9 ± 801.1 ml. Pain was well-managed, resulting in substantial improvements in VAS score (5.3 ± 1.8 to 1.4 ± 1.1). Complications occurred in 13 patients (13.5%), including poor wound healing (6.3%), deep prosthesis infection (4.2%), hip dislocation (2.1%), screw fracture (1.0%), and interface loosening (1.0%). Additionally, all patients achieved precise implantation of customized prosthetics according to preoperative plans. T-SMART revealed excellent integration at the prosthesis-bone interface for all patients. CONCLUSION The use of a 3D-printed custom hemipelvic endoprosthesis, characterized by anatomically designed contours and a porous biomimetic surface structure, offers a potential option for pelvic girdle reconstruction following internal hemipelvectomy in primary pelvic tumor treatment. Initial results demonstrate stable fixation and satisfactory mid-term functional and radiographic outcomes.
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Affiliation(s)
- Xin Hu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, China
| | - Minxun Lu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, China
| | - Yitian Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, China
| | - Yi Luo
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, China
| | - Yong Zhou
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, China
| | - Xiao Yang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, 610064, China.
- Provincial Engineering Research Center for Biomaterials Genome of Sichuan, Sichuan University, Chengdu, 610064, China.
| | - Chongqi Tu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, China.
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, China.
| | - Li Min
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, China.
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, China.
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Liu B, Wang L, Li X, Chen Z, Hou G, Zhou F, Wang C, Tian Y. Applying 3D-printed prostheses to reconstruct critical-sized bone defects of tibial diaphysis (> 10 cm) caused by osteomyelitis and aseptic non-union. J Orthop Surg Res 2024; 19:418. [PMID: 39033286 PMCID: PMC11264997 DOI: 10.1186/s13018-024-04926-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 07/16/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Clinical repair of critical-sized bone defects (CBDs) in the tibial diaphysis presents numerous challenges, including inadequate soft tissue coverage, limited blood supply, high load-bearing demands, and potential deformities. This study aimed to investigate the clinical feasibility and efficacy of employing 3D-printed prostheses for repairing CBDs exceeding 10 cm in the tibial diaphysis. METHODS This retrospective study included 14 patients (11 males and 3 females) with an average age of 46.0 years. The etiologies of CBDs comprised chronic osteomyelitis (10 cases) and aseptic non-union (4 cases), with an average defect length of 16.9 cm. All patients underwent a two-stage surgical approach: (1) debridement, osteotomy, and cement spacer implantation; and (2) insertion of 3D-printed prostheses. The interval between the two stages ranged from 8 to 12 weeks, during which the 3D-printed prostheses and induced membranes were meticulously prepared. Subsequent to surgery, patients engaged in weight-bearing and functional exercises under specialized supervision. Follow-up assessments, including gross observation, imaging examinations, and administration of the Lower Extremity Functional Scale (LEFS), were conducted at 3, 6, and 12 months postoperatively, followed by annual evaluations thereafter. RESULTS The mean postoperative follow-up duration was 28.4 months, with an average waiting period between prosthesis implantation and weight-bearing of 10.4 days. At the latest follow-up, all patients demonstrated autonomous ambulation without assistance, and their LEFS scores exhibited a significant improvement compared to preoperative values (30.7 vs. 53.1, P < 0.001). Imaging assessments revealed progressive bone regeneration at the defect site, with new bone formation extending along the prosthesis. Complications included interlocking screw breakage in two patients, interlocking screw loosening in one patient, and nail breakage in another. CONCLUSIONS Utilization of 3D-printed prostheses facilitates prompt restoration of CBDs in the tibial diaphysis, enabling early initiation of weight-bearing activities and recovery of ambulatory function. This efficacious surgical approach holds promise for practical application.
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Affiliation(s)
- Bingchuan Liu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Liwei Wang
- Department of Anesthesiology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, China
| | - Xingcai Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Zhuo Chen
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Guojin Hou
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Fang Zhou
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Caimei Wang
- Beijing AKEC Medical Co., Ltd, Beijing, China
| | - Yun Tian
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China.
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China.
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Fernández-Fernández T, Mediavilla-Santos L, Cuervo-Dehesa M, Gómez-Larrén E, Pérez-Mañanes R, Calvo-Haro J. Can 3D-printed patient-specific instruments improve local control and overall survival in pelvic sarcoma? A clinical validation study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024:S1888-4415(24)00129-2. [PMID: 39029899 DOI: 10.1016/j.recot.2024.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/24/2024] [Accepted: 07/01/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND AND OBJECTIVES 3D-printed patient-specific instruments (PSIs), also known as 3D guides, have been shown to improve accuracy in resection of pelvic tumors in cadaver studies and achieve better surgical margins in vivo. This study evaluates the clinical impact of 3D-printed guides on medium-term local and distant disease control, as well as disease-free and overall survival in patients. MATERIAL AND METHODS A cohort study included 25 patients with primary pelvic or sacral sarcomas: 10 in the 3D group and 15 in the control group, with a median follow-up of 47 months. Demographic and clinical data, including tumor histology, stage, resection technique, associated reconstruction, adjuvant therapies, and complications, were evaluated. Surgical margins (free, marginal, and contaminated) and relapse-free and overall survival curves were analyzed. RESULTS The 3D group achieved a higher rate of free margins (80% vs 66.7%, p = 0.345). Local recurrence (50% vs 60%, P=.244) and distant disease relapse (20% vs 47%, p = 0.132) rates were lower in the 3D group. At the end of the follow-up, the 3D group had a higher overall survival rate (60% vs 40%, p = 0.327). The complication rate was similar in both groups, with a deep infection rate of 40%. CONCLUSIONS The use of 3D guides in resecting primary pelvic tumors not only achieves a higher rate of free margins compared to conventional techniques but also shows a trend towards higher local, distant, and overall disease-free survival. Further studies with larger sample sizes and higher levels of evidence are necessary to validate these clinical trends.
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Affiliation(s)
- T Fernández-Fernández
- Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - L Mediavilla-Santos
- Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - M Cuervo-Dehesa
- Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - E Gómez-Larrén
- Unidad de Planificación Avanzada y Manufactura 3D, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - R Pérez-Mañanes
- Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, España; Unidad de Planificación Avanzada y Manufactura 3D, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J Calvo-Haro
- Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, España; Unidad de Planificación Avanzada y Manufactura 3D, Hospital General Universitario Gregorio Marañón, Madrid, España
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Barakeh W, Zein O, Hemdanieh M, Sleem B, Nassereddine M. Enhancing Hip Arthroplasty Outcomes: The Multifaceted Advantages, Limitations, and Future Directions of 3D Printing Technology. Cureus 2024; 16:e60201. [PMID: 38868274 PMCID: PMC11167579 DOI: 10.7759/cureus.60201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 06/14/2024] Open
Abstract
In the evolving field of orthopedic surgery, the integration of three-dimensional printing (3D printing) has emerged as a transformative technology, particularly in addressing the rising incidence of degenerative joint diseases. The integration of 3D printing technology in hip arthroplasty offers substantial advantages throughout the surgical process. In preoperative planning, 3D models enable meticulous assessments, aiding in accurate implant selection and precise surgical strategies. Intraoperatively, the technology contributes to precise prosthesis design, reducing operation duration, X-ray exposures, and blood loss. Beyond surgery, 3D printing revolutionizes medical equipment production, imaging, and implant design, showcasing benefits such as enhanced osseointegration and reduced stress shielding with titanium cups. Challenges include a higher risk of postoperative infection due to the porous surfaces of 3D-printed implants, technical complexities in the printing process, and the need for skilled manpower. Despite these challenges, the evolving nature of 3D printing technologies underscores the importance of relying on existing orthopedic surgical practices while emphasizing the need for standardized guidelines to fully harness its potential in improving patient care.
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Affiliation(s)
- Wael Barakeh
- Orthopedic Surgery, American University of Beirut, Beirut, LBN
| | - Omar Zein
- Orthopedic Surgery, American University of Beirut, Beirut, LBN
| | - Maya Hemdanieh
- Orthopedic Surgery, American University of Beirut, Beirut, LBN
| | - Bshara Sleem
- Orthopedic Surgery, American University of Beirut, Beirut, LBN
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Hu X, Wen Y, Lu M, Luo Y, Zhou Y, Yang X, Tu C, Min L. Biomechanical and clinical outcomes of 3D-printed versus modular hemipelvic prostheses for limb-salvage reconstruction following periacetabular tumor resection: a mid-term retrospective cohort study. J Orthop Surg Res 2024; 19:258. [PMID: 38654343 DOI: 10.1186/s13018-024-04697-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/22/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Debates persist over optimal pelvic girdle reconstruction after acetabular tumor resection, with surgeons grappling between modular and 3D-printed hemipelvic endoprostheses. We hypothesize superior outcomes with 3D-printed versions, yet scarce comparative research exists. This study fills the gap, examining biomechanics and clinical results retrospectively. METHODS From February 2017 to June 2021, we retrospectively assessed 32 patients undergoing en bloc resection for malignant periacetabular tumors at a single institution. PRIMARY OUTCOME limb function. SECONDARY OUTCOMES implant precision, hip joint rotation center restoration, prosthesis-bone osteointegration, and complications. Biomechanical characteristics were evaluated through finite element analysis on pelvic defect models. RESULTS In the 3D-printed group, stress distribution mirrored a normal pelvis, contrasting the modular group with elevated overall stress, unstable transitions, and higher stress peaks. The 3D-printed group exhibited superior functional scores (MSTS: 24.3 ± 1.8 vs. 21.8 ± 2.0, p < 0.05; HHS: 79.8 ± 5.2 vs. 75.3 ± 3.5, p < 0.05). Prosthetic-bone interface osteointegration, measured by T-SMART, favored 3D-printed prostheses, but surgery time (426.2 ± 67.0 vs. 301.7 ± 48.6 min, p < 0.05) and blood loss (2121.1 ± 686.8 vs. 1600.0 ± 505.0 ml, p < 0.05) were higher. CONCLUSIONS The 3D-printed hemipelvic endoprosthesis offers precise pelvic ring defect matching, superior stress transmission, and function compared to modular endoprostheses. However, complexity, fabrication expertise, and challenging surgical implantation result in prolonged operation times and increased blood loss. A nuanced consideration of functional outcomes, complexity, and patient conditions is crucial for informed treatment decisions. LEVEL OF EVIDENCE Level III, therapeutic study (Retrospective comparative study).
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Affiliation(s)
- Xin Hu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xang, Chengdu, 610041, Sichuan, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yang Wen
- Department of Orthopedics, Zigong Fourth People's Hospital, Zigong, 643000, People's Republic of China
| | - Minxun Lu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xang, Chengdu, 610041, Sichuan, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yi Luo
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xang, Chengdu, 610041, Sichuan, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yong Zhou
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xang, Chengdu, 610041, Sichuan, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xiao Yang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, 610064, Sichuan, People's Republic of China.
- Provincial Engineering Research Center for Biomaterials Genome of Sichuan, Sichuan University, Chengdu, 610064, People's Republic of China.
| | - Chongqi Tu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xang, Chengdu, 610041, Sichuan, People's Republic of China.
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Li Min
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xang, Chengdu, 610041, Sichuan, People's Republic of China.
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China.
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9
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Hirase T, McChesney GR, Garvin L, Tappa K, Satcher RL, Mericli AF, Rhines LD, Bird JE. Advances in Virtual Cutting Guide and Stereotactic Navigation for Complex Tumor Resections of the Sacrum and Pelvis: Case Series with Short-Term Follow-Up. Bioengineering (Basel) 2023; 10:1342. [PMID: 38135933 PMCID: PMC10740571 DOI: 10.3390/bioengineering10121342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/15/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
Primary malignancies of the sacrum and pelvis are aggressive in nature, and achieving negative margins is essential for preventing recurrence and improving survival after en bloc resections. However, these are particularly challenging interventions due to the complex anatomy and proximity to vital structures. Using virtual cutting guides to perform navigated osteotomies may be a reliable method for safely obtaining negative margins in complex tumor resections of the sacrum and pelvis. This study details the technique and presents short-term outcomes. Patients who underwent an en bloc tumor resection of the sacrum and/or pelvis using virtual cutting guides with a minimum follow-up of two years were retrospectively analyzed and included in this study. Preoperative computer-assisted design (CAD) was used to design osteotomies in each case. Segmentation, delineating the tumor from normal tissue, was performed by the senior author using preoperative CT scans and MRI. Working with a team of biomedical engineers, virtual surgical planning was performed to create osteotomy lines on the preoperative CT and overlaid onto the intraoperative CT. The pre-planned osteotomy lines were visualized as "virtual cutting guides" providing real-time stereotactic navigation. A precision ultrasound-powered cutting tool was then integrated into the navigation system and used to perform the osteotomies in each case. Six patients (mean age 52.2 ± 17.7 years, 2 males, 4 females) were included in this study. Negative margins were achieved in all patients with no intraoperative complications. Mean follow-up was 38.0 ± 6.5 months (range, 24.8-42.2). Mean operative time was 1229 min (range, 522-2063). Mean length of stay (LOS) was 18.7 ± 14.5 days. There were no cases of 30-day readmissions, 30-day reoperations, or 2-year mortality. One patient was complicated by flap necrosis, which was successfully treated with irrigation and debridement and primary closure. One patient had local tumor recurrence at final follow-up and two patients are currently undergoing treatment for metastatic disease. Using virtual cutting guides to perform navigated osteotomies is a safe technique that can facilitate complex tumor resections of the sacrum and pelvis.
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Affiliation(s)
- Takashi Hirase
- Department of Orthopedic Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; (T.H.); (G.L.II)
| | - Grant R. McChesney
- Department of Orthopedic Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; (T.H.); (G.L.II)
| | - Lawrence Garvin
- Department of Orthopedic Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; (T.H.); (G.L.II)
| | - Karthik Tappa
- Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA;
| | - Robert L. Satcher
- Department of Orthopedic Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; (T.H.); (G.L.II)
| | - Alexander F. Mericli
- Department of Plastic Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA;
| | - Laurence D. Rhines
- Department of Neurosurgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Justin E. Bird
- Department of Orthopedic Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; (T.H.); (G.L.II)
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10
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Hu X, Lu M, Zhang Y, Li Z, Wang J, Wang Y, Xing Z, Yang X, Tu C, Min L. Pelvic-girdle reconstruction with three-dimensional-printed endoprostheses after limb-salvage surgery for pelvic sarcomas: current landscape. Br J Surg 2023; 110:1712-1722. [PMID: 37824784 PMCID: PMC10638540 DOI: 10.1093/bjs/znad310] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/25/2023] [Accepted: 09/09/2023] [Indexed: 10/14/2023]
Abstract
Resection of pelvic bone tumors and the subsequent reconstruction of the pelvic girdle pose challenges due to complex anatomy, load-bearing demands, and significant defects. 3D-printed implants have revolutionized pelvic girdle reconstruction by offering customized solutions, porous surface structures for precise resection with custom guides, and improved integration. Many tertiary medical centers have adopted 3Dprinted hemipelvic endoprostheses, leading to enhanced outcomes. However, most studies are limited to single centers, with a small number of cases and short follow-up periods. Additionally, the design of these implants often relies heavily on individual experience, resulting in a lack of uniformity and significant variation. To provide a comprehensive assessment of this technology, we conducted an analysis of existing literature, encompassing tumor resection classification, various types of prosthesis design, reconstruction concepts, and post-reconstruction functional outcomes.
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Affiliation(s)
- Xin Hu
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Minxun Lu
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Yuqi Zhang
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Zhuangzhuang Li
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Jie Wang
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Yitian Wang
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Zhengyi Xing
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
- Provincial Engineering Research Center for Biomaterials Genome of Sichuan, Sichuan University, Chengdu, China
| | - Xiao Yang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
- Provincial Engineering Research Center for Biomaterials Genome of Sichuan, Sichuan University, Chengdu, China
| | - Chongqi Tu
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Li Min
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
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11
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Babazadeh-Naseri A, Li G, Shourijeh MS, Akin JE, Higgs Iii CF, Fregly BJ, Dunbar NJ. Stress-shielding resistant design of custom pelvic prostheses using lattice-based topology optimization. Med Eng Phys 2023; 121:104012. [PMID: 37985018 DOI: 10.1016/j.medengphy.2023.104012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 05/20/2023] [Accepted: 06/22/2023] [Indexed: 11/22/2023]
Abstract
Endoprosthetic reconstruction of the pelvic bone using 3D-printed, custom-made implants has delivered early load-bearing ability and good functional outcomes in the short term to individuals with pelvic sarcoma. However, excessive stress-shielding and subsequent resorption of peri‑prosthetic bone can imperil the long-term stability of such implants. To evaluate the stress-shielding performance of pelvic prostheses, we developed a sequential modeling scheme using subject-specific finite element models of the pelvic bone-implant complex and personalized neuromusculoskeletal models for pre- and post-surgery walking. A new topology optimization approach is introduced for the stress-shielding resistant (SSR) design of custom pelvic prostheses, which uses 3D-printable porous lattice structures. The SSR optimization was applied to a typical pelvic prosthesis to reconstruct a type II+III bone resection. The stress-shielding performance of the optimized implant based on the SSR approach was compared against the conventional optimization. The volume of the peri‑prosthetic bone predicted to undergo resorption post-surgery decreased from 44 to 18%. This improvement in stress-shielding resistance was achieved without compromising the structural integrity of the prosthesis. The SSR design approach has the potential to improve the long-term stability of custom-made pelvic prostheses.
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Affiliation(s)
| | - Geng Li
- Department of Mechanical Engineering, Rice University, Houston, TX 77005, USA
| | | | - John E Akin
- Department of Mechanical Engineering, Rice University, Houston, TX 77005, USA
| | - C Fred Higgs Iii
- Department of Mechanical Engineering, Rice University, Houston, TX 77005, USA
| | - Benjamin J Fregly
- Department of Mechanical Engineering, Rice University, Houston, TX 77005, USA
| | - Nicholas J Dunbar
- Department of Orthopedic Surgery, University of Texas Health Science Center, Houston, TX 77030, USA.
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12
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Richard RD, Heare A, Mauffrey C, McGinley B, Lencioni A, Chandra A, Nasib V, Chaiken BL, Trompeter A. Use of 3D Printing Technology in Fracture Management: A Review and Case Series. J Orthop Trauma 2023; 37:S40-S48. [PMID: 37828701 DOI: 10.1097/bot.0000000000002693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 10/14/2023]
Abstract
SUMMARY Three-dimensional (3D) offers exciting opportunities in medicine, particularly in orthopaedics. The boundaries of 3D printing are continuously being re-established and have paved the way for further innovations, including 3D bioprinting, custom printing refined methods, 4D bioprinting, and 5D printing potential. The quality of these applications have been steadily improving, increasing their widespread use among clinicians. This article provides a review of the current literature with a brief introduction to the process of additive manufacturing, 3D printing, and its applications in fracture care. We illustrate this technology with a case series of 3D printing used for correction of complex fractures/nonunion. Factors limiting the use of this technology, including cost, and potential solutions are discussed. Finally, we discuss 4D bioprinting and 5D printing and their potential role in fracture surgery.
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Affiliation(s)
- Raveesh D Richard
- Department of Orthopedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO; and
| | - Austin Heare
- Department of Orthopedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO; and
| | - Cyril Mauffrey
- Department of Orthopedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO; and
| | - Beau McGinley
- Department of Orthopedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO; and
| | - Alex Lencioni
- Department of Orthopedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO; and
| | - Arjun Chandra
- Trauma and Orthopaedic Department, St. Georges University Hospital, London, England
| | - Vareesha Nasib
- Trauma and Orthopaedic Department, St. Georges University Hospital, London, England
| | - Brian L Chaiken
- Department of Orthopedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO; and
| | - Alex Trompeter
- Trauma and Orthopaedic Department, St. Georges University Hospital, London, England
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13
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van Veldhuizen WA, van der Wel H, Kuipers HY, Kraeima J, Ten Duis K, Wolterink JM, de Vries JPPM, Schuurmann RCL, IJpma FFA. Development of a Statistical Shape Model and Assessment of Anatomical Shape Variations in the Hemipelvis. J Clin Med 2023; 12:jcm12113767. [PMID: 37297962 DOI: 10.3390/jcm12113767] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
Knowledge about anatomical shape variations in the pelvis is mandatory for selection, fitting, positioning, and fixation in pelvic surgery. The current knowledge on pelvic shape variation mostly relies on point-to-point measurements on 2D X-ray images and computed tomography (CT) slices. Three-dimensional region-specific assessments of pelvic morphology are scarce. Our aim was to develop a statistical shape model of the hemipelvis to assess anatomical shape variations in the hemipelvis. CT scans of 200 patients (100 male and 100 female) were used to obtain segmentations. An iterative closest point algorithm was performed to register these 3D segmentations, so a principal component analysis (PCA) could be performed, and a statistical shape model (SSM) of the hemipelvis was developed. The first 15 principal components (PCs) described 90% of the total shape variation, and the reconstruction ability of this SSM resulted in a root mean square error of 1.58 (95% CI: 1.53-1.63) mm. In summary, an SSM of the hemipelvis was developed, which describes the shape variations in a Caucasian population and is able to reconstruct an aberrant hemipelvis. Principal component analyses demonstrated that, in a general population, anatomical shape variations were mostly related to differences in the size of the pelvis (e.g., PC1 describes 68% of the total shape variation, which is attributed to size). Differences between the male and female pelvis were most pronounced in the iliac wing and pubic rami regions. These regions are often subject to injuries. Future clinical applications of our newly developed SSM may be relevant for SSM-based semi-automatic virtual reconstruction of a fractured hemipelvis as part of preoperative planning. Lastly, for companies, using our SSM might be interesting in order to assess which sizes of pelvic implants should be produced to provide proper-fitting implants for most of the population.
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Affiliation(s)
| | - Hylke van der Wel
- Department of Oral and Maxillofacial Surgery/3D Lab, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Hennie Y Kuipers
- Department of Surgery, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Joep Kraeima
- Department of Oral and Maxillofacial Surgery/3D Lab, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Kaj Ten Duis
- Department of Surgery, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Jelmer M Wolterink
- Department of Applied Mathematics, Technical Medical Centre, 7500 AE Enschede, The Netherlands
| | - Jean-Paul P M de Vries
- Department of Surgery, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Richte C L Schuurmann
- Department of Surgery, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
- Multimodality Medical Imaging Group, Technical Medical Centre, University of Twente, 7500 AE Enschede, The Netherlands
| | - Frank F A IJpma
- Department of Surgery, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
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14
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Zamri MF, Ng BW, Jamil K, Abd Rashid AH, Abd Rasid AF. Office Three-Dimensional Printed Osteotomy Guide for Corrective Osteotomy in Fibrous Dysplasia. Cureus 2023; 15:e36384. [PMID: 37090315 PMCID: PMC10115740 DOI: 10.7759/cureus.36384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 03/22/2023] Open
Abstract
Fibrous dysplasia is a benign condition but can lead to severe long-bone deformities. Three-dimensional (3D) printing technology is a rapidly developing field that has now been popularized to aid surgeons in preoperative planning. We report a case of hip deformity in a 21-year-old woman who suffered from fibrous dysplasia and underwent a corrective osteotomy. We utilized open-source 3D computing software for preoperative planning before producing an osteotomy guide to aid in the operation.
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15
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Lim WS, Kim HW, Lee MH, Park HJ. Improved printability of pea protein hydrolysates for protein-enriched 3D printed foods. J FOOD ENG 2023. [DOI: 10.1016/j.jfoodeng.2023.111502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
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16
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Klasan A, Bayan A, Holdaway I, Farrington WJ. Liner type has no impact on bone mineral density changes around a 3D printed trabecular titanium acetabular component. Orthop Traumatol Surg Res 2023; 109:103136. [PMID: 34715391 DOI: 10.1016/j.otsr.2021.103136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 05/12/2021] [Accepted: 09/02/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Three-dimensional printing of implants allows the ability to produce implants and interfaces which theoretically better mimic "normal" bone behaviour, leading to a possible reduction in stress shielding thus maintaining bone mineral density (BMD). This issue was not investigated in vivo using bone scan and different bearings; therefore, we did a prospective study aiming to answer: 1) is there a loss of BMD around the 3D printed trabecular titanium cup, when compared to the native hip?; 2) does liner type influence the BMD changes around the acetabulum when a 3D printed trabecular titanium cup is used? HYPOTHESIS BMD changes around the acetabulum are not influenced by the liner type, and the cup will be associated with a reduction in BMD when compared to the native hip. MATERIAL AND METHODS This is a prospective observational study of patients receiving a primary total hip arthroplasty. A 3D printed trabecular titanium uncemented acetabular component was used in all cases. All patients received a ceramic femoral head, with either a ceramic or polyethylene acetabular liner. BMD measurements using DXA were performed at 6 weeks, 6, 12 and 24 months after surgery to evaluate remodeling changes. The 3 acetabular regions of interest (ROI) of DeLee and Charnley were used for serial comparisons of peri-acetabular BMD. The study was powered as a non-inferiority study with the principle variables compared using a two-step repeated analysis of variance. RESULTS A total of 48 consecutive patients were included in the study, with all patients completing their 2 year follow-up. There were no failures, revisions or complications within this cohort. We found no statistically significant difference in the BMD change scores between the operated and the native hip in any of the 3 ROI zones. We found no differences in BMD scores when comparing ceramic to polyethylene acetabular liners, head sizes and BMI. DISCUSSION This study shows a similar pattern of BMD behaviour around a 3D printed cup when compared to the contralateral native hip. We were unable to show a clinical or radiological difference between the bearing material, head size, or BMI when used with this type of acetabular component. LEVEL OF EVIDENCE III; prospective comparative study.
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Affiliation(s)
- Antonio Klasan
- North Shore Hospital, 124, Shakespeare Road, Takapuna, 0620 Auckland, New Zealand; Kepler University Hospital Linz, Krankenhausstr. 9, 4020 Linz, Austria; Johannes-Kepler University Linz, Altenbergerstr. 69, 4040 Linz, Austria.
| | - Ali Bayan
- North Shore Hospital, 124, Shakespeare Road, Takapuna, 0620 Auckland, New Zealand
| | - Ian Holdaway
- Auckland City Hospital, 2, Park Road, Grafton, 1023 Auckland, New Zealand
| | - William J Farrington
- North Shore Hospital, 124, Shakespeare Road, Takapuna, 0620 Auckland, New Zealand
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Fidvi S, Holder J, Li H, Parnes GJ, Shamir SB, Wake N. Advanced 3D Visualization and 3D Printing in Radiology. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1406:103-138. [PMID: 37016113 DOI: 10.1007/978-3-031-26462-7_6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
Since the discovery of X-rays in 1895, medical imaging systems have played a crucial role in medicine by permitting the visualization of internal structures and understanding the function of organ systems. Traditional imaging modalities including Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and Ultrasound (US) present fixed two-dimensional (2D) images which are difficult to conceptualize complex anatomy. Advanced volumetric medical imaging allows for three-dimensional (3D) image post-processing and image segmentation to be performed, enabling the creation of 3D volume renderings and enhanced visualization of pertinent anatomic structures in 3D. Furthermore, 3D imaging is used to generate 3D printed models and extended reality (augmented reality and virtual reality) models. A 3D image translates medical imaging information into a visual story rendering complex data and abstract ideas into an easily understood and tangible concept. Clinicians use 3D models to comprehend complex anatomical structures and to plan and guide surgical interventions more precisely. This chapter will review the volumetric radiological techniques that are commonly utilized for advanced 3D visualization. It will also provide examples of 3D printing and extended reality technology applications in radiology and describe the positive impact of advanced radiological image visualization on patient care.
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Affiliation(s)
- Shabnam Fidvi
- Department of Radiology, Montefiore Medical Center, Bronx, NY, USA.
| | - Justin Holder
- Department of Radiology, Montefiore Medical Center, Bronx, NY, USA
| | - Hong Li
- Department of Radiology, Jacobi Medical Center, Bronx, NY, USA
| | | | | | - Nicole Wake
- GE Healthcare, Aurora, OH, USA
- Center for Advanced Imaging Innovation and Research, NYU Langone Health, New York, NY, USA
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Management of Complex Acetabular Fractures by Using 3D Printed Models. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121854. [PMID: 36557056 PMCID: PMC9785751 DOI: 10.3390/medicina58121854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
Background and Objectives: Using 3D printed models in orthopaedics and traumatology contributes to a better understanding of injury patterns regarding surgical approaches, reduction techniques, and fracture fixation methods. The aim of this study is to evaluate the effectiveness of a novel technique implementing 3D printed models to facilitate the optimal preoperative planning of the surgical treatment of complex acetabular fractures. Materials and Methods: Patients with complex acetabular fractures were assigned to two groups: (1) conventional group (n = 12) and (2) 3D printed group (n = 10). Both groups included participants with either a posterior column plus posterior wall fracture, a transverse plus posterior wall fracture, or a both-column acetabular fracture. Datasets from CT scanning were segmented and converted to STL format, with separated bones and fragments for 3D printing in different colors. Comparison between the two groups was performed in terms of quality of fracture reduction (good: equal to, or less than 2 mm displacement, and fair: larger than 2 mm displacement), functional assessment, operative time, blood loss, and number of intraoperative x-rays. Results: A significant decrease in operative time, blood loss, and number of intraoperative x-rays was registered in the 3D printed group versus the conventional one (p < 0.01), with 80% of the patients in the former having good fracture reduction and 20% having fair reduction. In contrast, 50% of the patients in the conventional group had good reduction and 50% had fair reduction. The functional score at 18-month follow-up was better for patients in the 3D printed group. Conclusions: The 3D printing technique can be considered a highly efficient and patient-specific approach for management of complex acetabular fractures, helping to restore patient′s individual anatomy after surgery.
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19
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Fang C, Cai L, Chu G, Jarayabhand R, Kim JW, O'Neill G. 3D printing in fracture treatment : Current practice and best practice consensus. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2022; 125:1-7. [PMID: 35817874 PMCID: PMC9722822 DOI: 10.1007/s00113-022-01159-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 06/10/2023]
Abstract
The use of 3D printing in orthopedic trauma is supported by clinical evidence. Existing computed tomography (CT) data are exploited for better stereotactic identification of morphological features of the fracture and enhanced surgical planning. Due to complex logistic, technical and resource constraints, deployment of 3D printing is not straightforward from the hospital management perspective. As a result not all trauma surgeons are able to confidently integrate 3D printing into the daily practice. We carried out an expert panel survey on six trauma units which utilized 3D printing routinely. The most frequent indications are acetabular and articular fractures and malalignments. Infrastructure and manpower structure varied between units. The installation of industrial grade machines and dedicated software as well as the use of trained personnel can enhance the capacity and reliability of fracture treatment. Setting up interdisciplinary jointly used 3d printing departments with sound financial and management structures may improve sustainability. The sometimes substantial logistic and technical barriers which impede the rapid delivery of 3D printed models are discussed.
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Affiliation(s)
- Christian Fang
- Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China.
| | - Leyi Cai
- First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Gabriel Chu
- United Christian Hospital, Hong Kong SAR, China
| | | | - Ji Wan Kim
- Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea (Republic of)
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Hsu CL, Yeh TT, Shen PH, Yang JJ, Chu WC, Wu CC. Precise joint preserving surgery by using Three-Dimensional Printing Technology for metastatic periacetabular bone tumor: A technique note and preliminary report. J Formos Med Assoc 2022:S0929-6646(22)00397-7. [DOI: 10.1016/j.jfma.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 09/20/2022] [Accepted: 10/31/2022] [Indexed: 11/13/2022]
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21
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Davoodi E, Montazerian H, Mirhakimi AS, Zhianmanesh M, Ibhadode O, Shahabad SI, Esmaeilizadeh R, Sarikhani E, Toorandaz S, Sarabi SA, Nasiri R, Zhu Y, Kadkhodapour J, Li B, Khademhosseini A, Toyserkani E. Additively manufactured metallic biomaterials. Bioact Mater 2022; 15:214-249. [PMID: 35386359 PMCID: PMC8941217 DOI: 10.1016/j.bioactmat.2021.12.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/17/2021] [Accepted: 12/21/2021] [Indexed: 02/06/2023] Open
Abstract
Metal additive manufacturing (AM) has led to an evolution in the design and fabrication of hard tissue substitutes, enabling personalized implants to address each patient's specific needs. In addition, internal pore architectures integrated within additively manufactured scaffolds, have provided an opportunity to further develop and engineer functional implants for better tissue integration, and long-term durability. In this review, the latest advances in different aspects of the design and manufacturing of additively manufactured metallic biomaterials are highlighted. After introducing metal AM processes, biocompatible metals adapted for integration with AM machines are presented. Then, we elaborate on the tools and approaches undertaken for the design of porous scaffold with engineered internal architecture including, topology optimization techniques, as well as unit cell patterns based on lattice networks, and triply periodic minimal surface. Here, the new possibilities brought by the functionally gradient porous structures to meet the conflicting scaffold design requirements are thoroughly discussed. Subsequently, the design constraints and physical characteristics of the additively manufactured constructs are reviewed in terms of input parameters such as design features and AM processing parameters. We assess the proposed applications of additively manufactured implants for regeneration of different tissue types and the efforts made towards their clinical translation. Finally, we conclude the review with the emerging directions and perspectives for further development of AM in the medical industry.
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Affiliation(s)
- Elham Davoodi
- Multi-Scale Additive Manufacturing (MSAM) Laboratory, Mechanical and Mechatronics Engineering Department, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada
- Department of Bioengineering, University of California, Los Angeles, California 90095, United States
- California NanoSystems Institute (CNSI), University of California, Los Angeles, California 90095, United States
- Terasaki Institute for Biomedical Innovation, Los Angeles, California 90024, United States
| | - Hossein Montazerian
- Department of Bioengineering, University of California, Los Angeles, California 90095, United States
- California NanoSystems Institute (CNSI), University of California, Los Angeles, California 90095, United States
- Terasaki Institute for Biomedical Innovation, Los Angeles, California 90024, United States
| | - Anooshe Sadat Mirhakimi
- Department of Mechanical Engineering, Isfahan University of Technology, Isfahan, Isfahan 84156-83111, Iran
| | - Masoud Zhianmanesh
- School of Biomedical Engineering, University of Sydney, Sydney, New South Wales 2006, Australia
| | - Osezua Ibhadode
- Multi-Scale Additive Manufacturing (MSAM) Laboratory, Mechanical and Mechatronics Engineering Department, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada
| | - Shahriar Imani Shahabad
- Multi-Scale Additive Manufacturing (MSAM) Laboratory, Mechanical and Mechatronics Engineering Department, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada
| | - Reza Esmaeilizadeh
- Multi-Scale Additive Manufacturing (MSAM) Laboratory, Mechanical and Mechatronics Engineering Department, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada
| | - Einollah Sarikhani
- Department of Nanoengineering, Jacobs School of Engineering, University of California, San Diego, California 92093, United States
| | - Sahar Toorandaz
- Multi-Scale Additive Manufacturing (MSAM) Laboratory, Mechanical and Mechatronics Engineering Department, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada
| | - Shima A. Sarabi
- Mechanical and Aerospace Engineering Department, University of California, Los Angeles, California 90095, United States
| | - Rohollah Nasiri
- Terasaki Institute for Biomedical Innovation, Los Angeles, California 90024, United States
| | - Yangzhi Zhu
- Terasaki Institute for Biomedical Innovation, Los Angeles, California 90024, United States
| | - Javad Kadkhodapour
- Department of Mechanical Engineering, Shahid Rajaee Teacher Training University, Tehran, Tehran 16785-163, Iran
- Institute for Materials Testing, Materials Science and Strength of Materials, University of Stuttgart, Stuttgart 70569, Germany
| | - Bingbing Li
- Terasaki Institute for Biomedical Innovation, Los Angeles, California 90024, United States
- Department of Manufacturing Systems Engineering and Management, California State University, Northridge, California 91330, United States
| | - Ali Khademhosseini
- Terasaki Institute for Biomedical Innovation, Los Angeles, California 90024, United States
| | - Ehsan Toyserkani
- Multi-Scale Additive Manufacturing (MSAM) Laboratory, Mechanical and Mechatronics Engineering Department, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada
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22
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Computer-Aided Design and 3D Printing of Hemipelvic Endoprosthesis for Personalized Limb-Salvage Reconstruction after Periacetabular Tumor Resection. Bioengineering (Basel) 2022; 9:bioengineering9080400. [PMID: 36004925 PMCID: PMC9405276 DOI: 10.3390/bioengineering9080400] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/14/2022] [Accepted: 08/16/2022] [Indexed: 12/31/2022] Open
Abstract
3D-printed hemipelvic endoprosthesis is an emerging solution for personalized limb-salvage reconstruction after periacetabular tumor resection. Further clinical studies are still required to report its surgical characteristics, outcomes, benefits and drawbacks. Sixteen consecutive patients underwent periacetabular tumor wide resection and pelvic reconstruction with a 3D-printed hemipelvic endoprosthesis from 2018 to 2021. The surgical characteristics and outcomes are described. The mean follow-up duration was 17.75 months (range, 6 to 46 months). Five patients underwent surgery for type I + II resection and reconstruction, seven for type II + III resection and reconstruction, three for type II resection and reconstruction, and one for type I + II + IV resection and reconstruction. The incidence of postoperative complication was 12.5% (2/16) for deep venous thrombosis (DVT), 12.5% (2/16) for pneumonia, and 12.5% (2/16) for would deep or superficial infection. During follow-up, two patients (12.5%) suffered hip dislocation and underwent revision surgery. CT demonstrated an obvious prosthetic porous structure–bone fusion after follow-up of at least 6 months. At the final follow-up, 12 lived with no evidence of disease while four lived with disease; no patients experienced pain; and 15 had independent ambulation, with a mean Musculoskeletal Tumor Society (MSTS) score of 85.8% (range, 26.7% to 100%). 3D-printed hemipelvic endoprosthesis facilitates wide resection of periacetabular tumor and limb-salvage reconstruction, thus resulting in good oncological and functional outcomes. The custom-made nature is able to well mimic the skeletal anatomy and microstructure and promote osseointegration. Perioperative complications and rehabilitation exercise still need to be stressed for this engineering technology-assisted major orthopedic surgery.
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Bruschi A, Cevolani L, Spazzoli B, Focaccia M, Pasini S, Frisoni T, Donati DM. Periacetabular Tumour Resection under Anterosuperior Iliac Spine Allows Better Alloprosthetic Reconstruction than Above: Bone Contact Matters. J Clin Med 2022; 11:jcm11154499. [PMID: 35956114 PMCID: PMC9369579 DOI: 10.3390/jcm11154499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/26/2022] [Accepted: 07/30/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Periacetabular resections are more affected by late complications than other pelvic resections. Reconstruction using bone allograft is considered a suitable solution. However, it is still not clear how the bone-allograft contact surface impacts on mechanical and functional outcome. Materials and methods: This paper presents the results of a retrospective analysis of 33 patients with resection of the entire acetabulum and reconstruction with an allograft-prosthetic composite for the period 1999 to 2010. Patients were divided in two groups, based on type of resection. In Group 1. patients had resections under anterosuperior iliac spine allowing the highest bone-allograft surface contact in reconstruction, while in Group 2 patients had resections over it. Results: Mechanical survival of the implant and Musculoskeletal Tumor Society functional score were calculated. Impact of age and artificial ligament were investigated as well. Patients in Group 1 had 38% mechanical failure rate of the implant while patients in Group 2 had 88%. Average functional score was higher in Group 1 compared with patients in Group 2. An artificial ligament was shown to have non-significant impact on survival of the reconstruction in Group 1, while significantly improving survival of reconstruction in Group 2. Conclusion: Bone-allograft contact matters: resection under anterosuperior iliac spine allows better mechanical survival and offers better reconstruction functional scores.
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24
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The Influence of Laser Power and Scan Speed on the Dimensional Accuracy of Ti6Al4V Thin-Walled Parts Manufactured by Selective Laser Melting. METALS 2022. [DOI: 10.3390/met12071226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Laser Powder Bed Fusion (LPBF) technologies such as Selective Laser Melting (SLM) are being increasingly considered as viable production routes. This paradigm change demands an in-depth understanding of the fabrication process and variables, as previous studies have shown that energy density calculation alone is insufficient, because parts fabricated using similar energy density, but using different combinations of parameters, can display significantly different properties and dimensions. Thin-walled parts are particularly influenced by processing parameters; in this sense, this study explores the influence of laser power and scan speed on the dimensions of Ti6Al4V thin-walled tubes. Predictive models for manufacturing Ti6Al4V thin-walled tubes were developed using Response Surface Methodology (RSM), and the most influential (single and combined) factors were determined using Analysis of Variance (ANOVA). Three models were obtained: for the wall melt zone thickness, the total wall thickness, and the hole width.
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25
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Krishna P, Robinson DL, Bucknill A, Lee PVS. Generation of hemipelvis surface geometry based on statistical shape modelling and contralateral mirroring. Biomech Model Mechanobiol 2022; 21:1317-1324. [PMID: 35713823 PMCID: PMC9283132 DOI: 10.1007/s10237-022-01594-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 05/12/2022] [Indexed: 11/26/2022]
Abstract
Personalised fracture plates manufactured using 3D printing offer an improved treatment option for unstable pelvic ring fractures that may not be adequately secured using off-the-shelf components. To design fracture plates that secure the bone fragments in their pre-fracture positions, the fractures must be reduced virtually using medical imaging-based reconstructions, a time-consuming process involving segmentation and repositioning of fragments until surface congruency is achieved. This study compared statistical shape models (SSMs) and contralateral mirroring as automated methods to reconstruct the hemipelvis using varying amounts of bone surface geometry. The training set for the geometries was obtained from pelvis CT scans of 33 females. The root-mean-squared error (RMSE) was quantified across the entire surface of the hemipelvis and within specific regions, and deviations of pelvic landmarks were computed from their positions in the intact hemipelvis. The reconstruction of the entire hemipelvis surfaced based on contralateral mirroring had an RMSE of 1.21 ± 0.29 mm, whereas for SSMs based on the entire hemipelvis surface, the RMSE was 1.11 ± 0.29 mm, a difference that was not significant (p = 0.32). Moreover, all hemipelvis reconstructions based on the full or partial bone geometries had RMSEs and landmark deviations from contralateral mirroring that were significantly lower (p < 0.05) or statistically equivalent to the SSMs. These results indicate that contralateral mirroring tends to be more accurate than SSMs for reconstructing unilateral pelvic fractures. SSMs may still be a viable method for hemipelvis fracture reconstruction in situations where contralateral geometries are not available, such as bilateral pelvic factures, or for highly asymmetric pelvic anatomies.
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Affiliation(s)
- Praveen Krishna
- Department of Biomedical Engineering, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Dale L Robinson
- Department of Biomedical Engineering, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Andrew Bucknill
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
| | - Peter Vee Sin Lee
- Department of Biomedical Engineering, University of Melbourne, Melbourne, VIC, 3010, Australia.
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26
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Vivarelli L, Govoni M, Attala D, Zoccali C, Biagini R, Dallari D. Custom Massive Allograft in a Case of Pelvic Bone Tumour: Simulation of Processing with Computerised Numerical Control vs. Robotic Machining. J Clin Med 2022; 11:jcm11102781. [PMID: 35628908 PMCID: PMC9143408 DOI: 10.3390/jcm11102781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/04/2022] [Accepted: 05/11/2022] [Indexed: 02/01/2023] Open
Abstract
The use of massive bone allografts after the resection of bone tumours is still a challenging process. However, to overcome some issues related to the processing procedures and guarantee the best three-dimensional matching between donor and recipient, some tissue banks have developed a virtual tissue database based on the scanning of the available allografts for using their 3D shape during virtual surgical planning (VSP) procedures. To promote the use of future VSP bone-shaping protocols useful for machining applications within a cleanroom environment, in our work, we simulate a massive bone allograft machining with two different machines: a four-axes (computer numerical control, CNC) vs. a five-axes (robot) milling machine. The allograft design was based on a real case of allograft reconstruction after pelvic tumour resection and obtained with 3D Slicer and Rhinoceros software. Machining simulations were performed with RhinoCAM and graphically and mathematically analysed with CloudCompare and R, respectively. In this case, the geometrical differences of the allograft design are not clinically relevant; however, the mathematical analysis showed that the robot performed better than the four-axes machine. The proof-of-concept presented here paves the way towards massive bone allograft cleanroom machining. Nevertheless, further studies, such as the simulation of different types of allografts and real machining on massive bone allografts, are needed.
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Affiliation(s)
- Leonardo Vivarelli
- Reconstructive Orthopaedic Surgery and Innovative Techniques—Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
- Correspondence: (L.V.); (M.G.)
| | - Marco Govoni
- Reconstructive Orthopaedic Surgery and Innovative Techniques—Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
- Correspondence: (L.V.); (M.G.)
| | - Dario Attala
- Department of Oncological Orthopaedics—Musculoskeletal Tissue Bank, IRCCS—Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Carmine Zoccali
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science, University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy;
| | - Roberto Biagini
- Department of Oncological Orthopaedics, IRCCS—Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Dante Dallari
- Reconstructive Orthopaedic Surgery and Innovative Techniques—Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
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27
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Fang C, Cai L, Chu G, Jarayabhand R, Kim JW, O’Neill G. 3D-Druck in der Frakturversorgung. Unfallchirurg 2022; 125:342-350. [DOI: 10.1007/s00113-022-01158-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 01/14/2023]
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28
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Zhao Y, Wang Z, Zhao J, Hussain M, Wang M. Additive Manufacturing in Orthopedics: A Review. ACS Biomater Sci Eng 2022; 8:1367-1380. [PMID: 35266709 DOI: 10.1021/acsbiomaterials.1c01072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Additive manufacturing is an advanced manufacturing manner that seems like the industrial revolution. It has the inborn benefit of producing complex formations, which are distinct from traditional machining technology. Its manufacturing strategy is flexible, including a wide range of materials, and its manufacturing cycle is short. Additive manufacturing techniques are progressively used in bone research and orthopedic operation as more innovative materials are developed. This Review lists the recent research results, analyzes the strengths and weaknesses of diverse three-dimensional printing strategies in orthopedics, and sums up the use of varying 3D printing strategies in surgical guides, surgical implants, surgical predictive models, and bone tissue engineering. Moreover, various postprocessing methods for additive manufacturing for orthopedics are described.
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Affiliation(s)
- Yingchao Zhao
- Xiangya School of Medicine, Central South University, No.172 Yinpenling Street, Tongzipo Road, Changsha 410013, China
| | - Zhen Wang
- Xiangya School of Medicine, Central South University, No.172 Yinpenling Street, Tongzipo Road, Changsha 410013, China
| | - Jingzhou Zhao
- Department of Chemical & Biomolecular Engineering, National University of Singapore, 4 Engineering Drive 4, Singapore 117585, Singapore
| | - Mubashir Hussain
- Postdoctoral Innovation Practice, Shenzhen Polytechnic, No.4089 Shahe West Road, Xinwei Nanshan District, Shenzhen 518055, China
| | - Maonan Wang
- Department of Chemical & Biomolecular Engineering, National University of Singapore, 4 Engineering Drive 4, Singapore 117585, Singapore
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Hung CC, Shen PH, Wu JL, Cheng YW, Chen WL, Lee SH, Yeh TT. Association between 3D Printing-Assisted Pelvic or Acetabular Fracture Surgery and the Length of Hospital Stay in Nongeriatric Male Adults. J Pers Med 2022; 12:jpm12040573. [PMID: 35455689 PMCID: PMC9026420 DOI: 10.3390/jpm12040573] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/24/2022] [Accepted: 03/30/2022] [Indexed: 02/07/2023] Open
Abstract
Pelvic and acetabular fractures are challenging for orthopedic surgeons, but 3D printing has many benefits in treating these fractures and has been applied worldwide. This study aimed to determine whether 3D printing can shorten the length of hospital stay (LHS) in nongeriatric male adult patients with these fractures. This is a single-center retrospective study of 167 nongeriatric male adult participants from August 2009 to December 2021. Participants were divided into two groups based on whether they received 3D printing assistance. Subgroup analyses were performed. Pearson’s correlation and multivariable linear regression models were used to analyze the LHS and the parameters. Results showed that 3D printing-assisted surgery did not affect LHS in the analyzed patients. The LHS was positively correlated with the Injury Severity Score (ISS). Initial hemoglobin levels were negatively associated with LHS in patients aged 18−40 and non-major trauma (ISS < 16) patients. In 40−60-year-old and non-major trauma patients, the duration from fracture to admission was significantly associated with LHS. This study indicates that 3D-assisted technology for pelvic or acetabular fracture surgery for nongeriatric male adults does not influence the LHS. More importantly, the initial evaluation of patients in the hospital was the main predictor of the LHS.
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Affiliation(s)
- Chun-Chi Hung
- Department of Orthopaedic Surgery, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd. Neihu Dist., Taipei City 11490, Taiwan; (C.-C.H.); (P.-H.S.)
- Division of Traumatology, Department of Surgery, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd. Neihu Dist., Taipei City 11490, Taiwan
| | - Pei-Hung Shen
- Department of Orthopaedic Surgery, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd. Neihu Dist., Taipei City 11490, Taiwan; (C.-C.H.); (P.-H.S.)
| | - Jia-Lin Wu
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; (J.-L.W.); (S.-H.L.)
- Department of Orthopedics, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Orthopedics Research Center, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Centers for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 11600, Taiwan
| | - Yung-Wen Cheng
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd. Neihu Dist., Taipei City 11490, Taiwan; (Y.-W.C.); (W.-L.C.)
| | - Wei-Liang Chen
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd. Neihu Dist., Taipei City 11490, Taiwan; (Y.-W.C.); (W.-L.C.)
- Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd. Neihu Dist., Taipei City 11490, Taiwan
- Department of Biochemistry, National Defense Medical Center, No. 161, Sec. 6, Minquan E. Rd. Neihu Dist., Taipei City 11490, Taiwan
| | - Shih-Han Lee
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; (J.-L.W.); (S.-H.L.)
- Department of Orthopedics, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Orthopedics Research Center, Taipei Medical University Hospital, Taipei 11031, Taiwan
| | - Tsu-Te Yeh
- Department of Orthopaedic Surgery, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd. Neihu Dist., Taipei City 11490, Taiwan; (C.-C.H.); (P.-H.S.)
- Medical 3D Printing Center, Tri-Service General Hospital and National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd. Neihu Dist., Taipei City 11490, Taiwan
- Correspondence: ; Tel.: +886-2-87923311
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Use of 3D printing and pre-contouring plate in the surgical planning of acetabular fractures: A systematic review. Orthop Traumatol Surg Res 2022; 108:103111. [PMID: 34648997 DOI: 10.1016/j.otsr.2021.103111] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 06/15/2021] [Accepted: 07/16/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Acetabular fractures are caused by high energy injuries. The treatment aims to reconstruct the articular surface, restoring the anatomical structure. The surgical management of these fractures is difficult because it requires familiarity with the 3D anatomy of the pelvis. With the use of 3D printing technique for planning surgery, this limitation could be overcome. HYPOTHESIS Studies examining the use of 3D printing in pre-operative planning of acetabular fractures tend to agree on its usefulness. METHODS A systematic review of two electronic medical databases was performed by three independent authors, using the following inclusion criteria: any type of acetabular fracture and pre-operative use of 3D printing to plan the surgery. RESULTS Among 93 screened articles, following selection criteria, six randomised controlled human trials (hRCT) were eligible for the study; articles compare a group in which a pre-contouring plate was performed through 3D printing with a control group in which the plate was intraoperatively modelled. CONCLUSION This review demonstrates the advantage of 3D printing in terms of surgical time, reduction of blood losses, quality of fracture reduction, and fixation, and reporting best clinical outcomes. LEVEL OF EVIDENCE II.
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31
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Papotto G, Testa G, Mobilia G, Perez S, Dimartino S, Giardina SMC, Sessa G, Pavone V. Use of 3D printing and pre-contouring plate in the surgical planning of acetabular fractures: A systematic review. ORTHOPAEDICS & TRAUMATOLOGY: SURGERY & RESEARCH 2022; 108:103111. [DOI: https:/doi.org/10.1016/j.otsr.2021.103111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
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Abstract
The importance of 3D printing applications in the surgery of musculoskeletal tumors has increased in recent years. Even prior to the era of 3D printing, computer-assisted techniques, such as navigation, have proved their utility. Due to the variable appearance of bone tumors, there is a need for individual solutions. The 3D printing can be used for the development of anatomical demonstration models, the construction of patient-specific instruments and custom-made implants. For these three applications, different regulatory hurdles exist. Especially for the resection of pelvic tumors, 3D printing technologies seem to provide advantages due to the complicated anatomy and the proximity to relevant neurovascular structures. With the introduction of titanium printing, construction of individualized implants that fit exactly into the defect became feasible.
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Willemsen K, Magré J, Mol J, Noordmans HJ, Weinans H, Hekman EEG, Kruyt MC. Vital Role of In-House 3D Lab to Create Unprecedented Solutions for Challenges in Spinal Surgery, Practical Guidelines and Clinical Case Series. J Pers Med 2022; 12:395. [PMID: 35330395 PMCID: PMC8951204 DOI: 10.3390/jpm12030395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/17/2022] Open
Abstract
For decades, the advantages of rapid prototyping for clinical use have been recognized. However, demonstrations of potential solutions to treat spinal problems that cannot be solved otherwise are scarce. In this paper, we describe the development, regulatory process, and clinical application of two types of patient specific 3D-printed devices that were developed at an in-house 3D point-of-care facility. This 3D lab made it possible to elegantly treat patients with spinal problems that could not have been treated in a conventional manner. The first device, applied in three patients, is a printed nylon drill guide, with such accuracy that it can be used for insertion of cervical pedicle screws in very young children, which has been applied even in semi-acute settings. The other is a 3D-printed titanium spinal column prosthesis that was used to treat progressive and severe deformities due to lysis of the anterior column in three patients. The unique opportunity to control size, shape, and material characteristics allowed a relatively easy solution for these patients, who were developing paraplegia. In this paper, we discuss the pathway toward the design and final application, including technical file creation for dossier building and challenges within a point-of-care lab.
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Affiliation(s)
- Koen Willemsen
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (J.M.); (J.M.); (H.W.); (M.C.K.)
- 3D Lab, Division of Surgical Specialties, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Joëll Magré
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (J.M.); (J.M.); (H.W.); (M.C.K.)
- 3D Lab, Division of Surgical Specialties, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Jeroen Mol
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (J.M.); (J.M.); (H.W.); (M.C.K.)
| | - Herke Jan Noordmans
- Department of Medical Technology and Clinical Physics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Harrie Weinans
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (J.M.); (J.M.); (H.W.); (M.C.K.)
- Department Biomechanical Engineering, Delft University of Technology, 2628 CD Delft, The Netherlands
| | - Edsko E. G. Hekman
- Department of Biomechanical Engineering, Twente University, 7522 NB Enschede, The Netherlands;
| | - Moyo C. Kruyt
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (J.M.); (J.M.); (H.W.); (M.C.K.)
- Department of Biomechanical Engineering, Twente University, 7522 NB Enschede, The Netherlands;
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Bouabdellah M, Bensalah M, Kamoun C, Bellil M, Kooli M, Hadhri K. Advantages of three-dimensional printing in the management of acetabular fracture fixed by the Kocher-Langenbeck approach: randomised controlled trial. INTERNATIONAL ORTHOPAEDICS 2022; 46:1155-1163. [PMID: 35103815 DOI: 10.1007/s00264-022-05319-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/26/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the outcomes of the Kocher-Langenbeck reduction and fixation of the posterior structures of the acetabulum between 3D printing technique and conventional technique. METHODS Forty-three patients who sustained fractures of the posterior part of the acetabulum were randomly assigned to two groups: 3D printing (G1; n = 20) and conventional technique (G2; n = 23). The surgical time, intra-operative blood loss, differences between pre-and post-operative haemoglobin, universal functional and radiographic scores, and complications were compared between the groups. The minimum follow-up was 18 months. RESULTS The average operating time (120.75 min) and intra-operative blood loss (244 ml) were lower in G1 than in G2 (125.87 min and 268.7 ml, respectively; p = 0.42, p = 0.1, respectively). The difference between the pre- and post-operative haemoglobin was 1.71 g/dl in G1 and 1.93 g/dl in G2 (p = 0.113). Post-operative complications occurred more frequently in patients in G2 (34.7%) than in patients in G1 (15%), though these differences were also not significant (p = 0.6). The radiographic result was satisfactory in 16 patients (80%) in G1 and 18 patients (78.26%) in G2 (p = 0.5). The clinical result was satisfactory in 15 patients (75%) in G1 and in 17 patients (73.9%) in G2 (p = 0.6). CONCLUSIONS No significant differences were found in terms of surgical time, overall complications, and radiographic or functional outcomes between 3D printing and the conventional technique.
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Affiliation(s)
- Mohamed Bouabdellah
- Department of Orthopaedic and Traumatology of Charles Nicolle Hospital of Tunis- Tunisia, University of Tunis El Manar, Farhat Hached University Campus n ° 94, ROMMANA , 1068, Tunis, Tunisia.
- GHG-SOTCOT (Tunisian Group of Hip and Knee surgery-Tunisian Society of Orthopaedic Surgery and Traumatology, ROMMANA, Tunisia.
| | - Mohamed Bensalah
- Department of Orthopaedic and Traumatology of Charles Nicolle Hospital of Tunis- Tunisia, University of Tunis El Manar, Farhat Hached University Campus n ° 94, ROMMANA , 1068, Tunis, Tunisia
- GHG-SOTCOT (Tunisian Group of Hip and Knee surgery-Tunisian Society of Orthopaedic Surgery and Traumatology, ROMMANA, Tunisia
| | - Chrif Kamoun
- Department of Orthopaedic and Traumatology of Charles Nicolle Hospital of Tunis- Tunisia, University of Tunis El Manar, Farhat Hached University Campus n ° 94, ROMMANA , 1068, Tunis, Tunisia
| | - Mehdi Bellil
- Department of Orthopaedic and Traumatology of Charles Nicolle Hospital of Tunis- Tunisia, University of Tunis El Manar, Farhat Hached University Campus n ° 94, ROMMANA , 1068, Tunis, Tunisia
- GHG-SOTCOT (Tunisian Group of Hip and Knee surgery-Tunisian Society of Orthopaedic Surgery and Traumatology, ROMMANA, Tunisia
| | - Mondher Kooli
- Department of Orthopaedic and Traumatology of Charles Nicolle Hospital of Tunis- Tunisia, University of Tunis El Manar, Farhat Hached University Campus n ° 94, ROMMANA , 1068, Tunis, Tunisia
| | - Khaled Hadhri
- Department of Orthopaedic and Traumatology of Charles Nicolle Hospital of Tunis- Tunisia, University of Tunis El Manar, Farhat Hached University Campus n ° 94, ROMMANA , 1068, Tunis, Tunisia
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Zhang HR. Application and Development of Megaprostheses in Limb Salvage for Bone Tumors Around the Knee Joint. Cancer Control 2022; 29:10732748221099219. [PMID: 35499495 PMCID: PMC9067034 DOI: 10.1177/10732748221099219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In recent decades, limb-salvage surgery has replaced amputation as the first choice for the treatment of bone tumors around knee. After tumor resection, there are a variety of reconstruction methods for us to choose, including autograft or allograft, inactivation and reimplantation, artificial prosthesis replacement, and allograft-prosthesis compound reconstruction. Compared with other reconstruction methods, artificial prosthesis reconstruction has some advantages: relatively simple, early weight bearing, fewer early complications, and good function in the early and mid-term follow-up. After decades of continuous improvements, the design of tumor prosthesis has reached a relatively mature stage, and the failure rate of prosthesis has also been declining year by year. However, artificial prostheses also have multiple complications such as infection, aseptic loosening, prosthetic breakage, and patients sometimes face the risk of revision or amputation. Therefore, clinicians need to deeply understand the characteristics of related complications and the principles of treatment.
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Kim J, Ko J, Kim J, Seo A, Eom K. Efficacy of a Customized Three-Dimensional Printing Surgical Guide for Tibial Plateau Leveling Osteotomy: A Comparison With Conventional Tibial Plateau Leveling Osteotomy. Front Vet Sci 2021; 8:751908. [PMID: 34901244 PMCID: PMC8656361 DOI: 10.3389/fvets.2021.751908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/05/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To prospectively evaluate the effect of a computed tomography (CT)-based three-dimensional (3D) printing surgical guide on surgical accuracy of tibial plateau leveling osteotomy (TPLO). Study Design: Cadaveric study. Animals: Canine cadaveric hindlimbs (n = 14). Methods: TPLO was performed on cadaver hindlimbs disarticulated at the coxofemoral joint to compare and evaluate the conventional TPLO method (n = 7) with one that used customized 3D printing surgical guides (n = 7). The operation time and postoperative tibial plateau angle (TPA) of the osteotomy were evaluated. Moreover, the osteotomy inclination, torsion, and distance and the direction of eccentricity were assessed using CT reconstruction. Results: Significant differences in the operation time (p < 0.001), postoperative TPA (p < 0.05), osteotomy inclination (p < 0.05), and osteotomy torsion (p < 0.05) were observed. Conclusion: The use of TPLO surgical guide reduced the operation time and inaccurate osteotomy. Clinical Significance: The surgical technique applied with a customized 3D printing surgical guide could be used to perform osteotomy and TPA adjustment more precisely than conventional TPLO.
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Affiliation(s)
- Jayon Kim
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Jaeeun Ko
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Jaehwan Kim
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Anna Seo
- Research Institute, SEEANN Solution Co., Ltd., Incheon, South Korea
| | - Kidong Eom
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
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Ranzzi A, Lucena RDLD, Schwartsmann CR, Galia CR, Girotto MC, Spinelli LDF. Estudo comparativo com e sem o uso de prototipagem em 3D de uma técnica não convencional no planejamento cirúrgico de revisão de artroplastia total de quadril. Rev Bras Ortop 2021; 57:884-890. [PMID: 36226209 PMCID: PMC9550379 DOI: 10.1055/s-0041-1731659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 02/11/2021] [Indexed: 11/30/2022] Open
Abstract
This article presents a comparison between two cases in which there was a need for revision of total hip arthroplasty due to aseptic acetabular failure. We used 3D prototyping in one of the cases to perform an unconventional technique of molding synthesis material before the procedure to evaluate the time saved in the transoperative period in complex cases.
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Affiliation(s)
- Alonso Ranzzi
- Departamento de Ortopedia e Traumatologia, Santa Casa de Misericórdia de Porto Alegre, Rio Grande do Sul, Brasil
- Departamento de Ortopedia e Traumatologia, Universidade Federal de Ciências da Saúde de Porto Alegre, Rio Grande do Sul, Brasil
| | - Rafael de Luca de Lucena
- Serviço de Ortopedia e Traumatologia, Santa Casa de Misericórdia de Porto Alegre, Rio Grande do Sul, Brasil
- Serviço de Ortopedia e Traumatologia, Universidade Federal de Ciências da Saúde de Porto Alegre, Rio Grande do Sul, Brasil
| | - Carlos Roberto Schwartsmann
- Serviço de Ortopedia e Traumatologia, Santa Casa de Misericórdia de Porto Alegre, Rio Grande do Sul, Brasil
- Departamento de Clínica Cirúrgica, Ortopedia e Traumatologia, Universidade Federal de Ciências da Saúde de Porto Alegre, Rio Grande do Sul, Brasil
| | - Carlos Roberto Galia
- Departamento de Cirurgia, Ortopedia e Traumatologia, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brasil
| | - Marina Cornelli Girotto
- Serviço de Ortopedia e Traumatologia, Santa Casa de Misericórdia de Porto Alegre, Rio Grande do Sul, Brasil
- Serviço de Ortopedia e Traumatologia, Universidade Federal de Ciências da Saúde de Porto Alegre, Rio Grande do Sul, Brasil
| | - Leandro de Freitas Spinelli
- Departamento de Clínica Cirúrgica, Ortopedia e Traumatologia, Universidade Federal de Ciências da Saúde de Porto Alegre, Rio Grande do Sul, Brasil
- Programa de Pós-Graduação em Projeto e Processos de Fabricação, Laboratório de Bioengenharia, Biomecânica e Biomateriais, Universidade de Passo Fundo, Rio Grande do Sul, Brasil
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Yang S, Lin H, Luo C. Meta-Analysis of 3D Printing Applications in Traumatic Fractures. Front Surg 2021; 8:696391. [PMID: 34532337 PMCID: PMC8439573 DOI: 10.3389/fsurg.2021.696391] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/27/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Traumatic fracture is a common orthopaedic disease, and application of 3D printing technology in fracture treatment, which entails utilisation of pre-operative printed anatomic fracture model, is increasingly gaining popularity. However, effectiveness of 3D printing-assisted surgery lacks evidence-based findings to support its application. Materials and Methods: Embase, PubMed and Cochrane Library databases were systematically searched until October, 2020 to identify relevant studies. All randomised controlled trials (RCTs) comparing efficacy of 3D printing-assisted surgery vs. conventional surgery for traumatic fractures were reviewed. RevMan V.5.3 software was used to conduct meta-analysis. Results: A total of 12 RCTs involving 641 patients were included. Pooled findings showed that 3D printing-assisted surgery had shorter operation duration [standardised mean difference (SMD) = −1.52, 95% confidence interval (CI) – 1.70 ~ −1.34, P < 0.00001], less intraoperative blood loss (SMD = 1.34, 95% CI 1.74 ~ 0.94, P < 0.00001), fewer intraoperative fluoroscopies (SMD = 1.25, 95% CI 1.64 ~ 0.87, P < 0.00001), shorter fracture union time (SMD = −0.15, 95% CI −0.25 ~ −0.05, P = 0.003), and higher rate of excellent outcomes (OR = 2.40, 95% CI 1.07 ~ 5.37, P = 0.03) compared with conventional surgery. No significant differences in complication rates were observed between the two types of surgery (OR = 0.69, 95% CI 0.69 ~ 1.42, P = 0.32). Conclusions: Indicators including operation duration, intraoperative blood loss, number of intraoperative fluoroscopies, fracture union time, and rates of excellent outcomes showed that 3D printing-assisted surgery is a superior alternative in treatment of traumatic fractures compared with conventional surgery. Moreover, the current study did not report significant differences in incidence of complications between the two approaches. Systematic Review Registration: CRD42021239507.
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Affiliation(s)
- Sha Yang
- Department of Orthopaedics, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Huapeng Lin
- Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Cong Luo
- Department of Orthopaedics, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
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A Systematic Review and Meta-Analysis of 3D Printing Technology for the Treatment of Acetabular Fractures. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5018791. [PMID: 34458367 PMCID: PMC8387177 DOI: 10.1155/2021/5018791] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/01/2021] [Accepted: 08/06/2021] [Indexed: 01/20/2023]
Abstract
Purpose Three-dimensional (3D) printing technology has been widely used in orthopedics surgery. However, its efficacy in acetabular fractures remains unclear. The aim of this systematic review and meta-analysis was to examine the effect of using 3D printing technology in the surgery for acetabular fractures. Methods The systematic review was performed following the PRISMA guidelines. Four major electronic databases were searched (inception to February 2021). Studies were screened using a priori criteria. Data from each study were extracted by two independent reviewers and organized using a standardized table. Data were pooled and presented in forest plots. Results Thirteen studies were included in the final analysis. Four were prospective randomized trials, and nine used a retrospective comparative design. The patients aged between 32.1 (SD 14.6) years and 51.9 (SD 18.9) years. Based on the pooled analyses, overall, 3D printing-assisted surgery decreased operation time by 38.8 minutes (95% CI: -54.9, -22.8), intraoperative blood loss by 259.7 ml (95% CI: -394.6, -124.9), instrumentation time by 34.1 minutes (95% CI: -49.0, -19.1). Traditional surgery was less likely to achieve good/excellent function of hip (RR, 0.53; 95% CI: 0.34, 0.82) and more likely to have complications than 3D printing-assisted surgery (RR, 1.19; 95% CI: 1.07, 1.33). Conclusions 3D printing technology demonstrated efficacy in the treatment of acetabular fractures. It may improve surgery-related and clinical outcomes. More prospective studies using a rigorous design (e.g., randomized trial with blinding) are warranted to confirm the long-term effects of 3D printing technology in orthopedics surgeries.
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Meesters AML, Assink N, ten Duis K, Fennema EM, Kraeima J, Witjes MJH, de Vries JPPM, Stirler VMA, IJpma FFA. Accuracy of Patient-Specific Drilling Guides in Acetabular Fracture Surgery: A Human Cadaver Study. J Pers Med 2021; 11:jpm11080763. [PMID: 34442407 PMCID: PMC8400721 DOI: 10.3390/jpm11080763] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 07/26/2021] [Accepted: 07/31/2021] [Indexed: 12/14/2022] Open
Abstract
Due to the complex anatomical shape of the pelvis, screw placement can be challenging in acetabular fracture surgery. This study aims to assess the accuracy of screw placement using patient-specific surgical drilling guides applied to pre-contoured conventional implants in acetabular fracture surgery. CT scans were made of four human cadavers to create 3D models of each (unfractured) pelvis. Implants were pre-contoured on 3D printed pelvic models and optically scanned. Following virtual preoperative planning, surgical drilling guides were designed to fit on top of the implant and were 3D printed. The differences between the pre-planned and actual screw directions (degrees) and screw entry points (mm) were assessed from the pre- and postoperative CT-scans. The median difference between the planned and actual screw direction was 5.9° (IQR: 4–8°) for the in-plate screws and 7.6° (IQR: 6–10°) for the infra-acetabular and column screws. The median entry point differences were 3.6 (IQR: 2–5) mm for the in-plate screws and 2.6 (IQR: 2–3) mm for the infra-acetabular and column screws. No screws penetrated into the hip joint or caused soft tissue injuries. Three-dimensional preoperative planning in combination with surgical guides that envelope pre-contoured conventional implants result in accurate screw placement during acetabular fracture surgery.
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Affiliation(s)
- Anne M. L. Meesters
- Department of Surgery, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.M.L.M.); (N.A.); (K.t.D.); (E.M.F.); (J.-P.P.M.d.V.); (V.M.A.S.)
- 3D Lab, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (J.K.); (M.J.H.W.)
| | - Nick Assink
- Department of Surgery, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.M.L.M.); (N.A.); (K.t.D.); (E.M.F.); (J.-P.P.M.d.V.); (V.M.A.S.)
- 3D Lab, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (J.K.); (M.J.H.W.)
| | - Kaj ten Duis
- Department of Surgery, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.M.L.M.); (N.A.); (K.t.D.); (E.M.F.); (J.-P.P.M.d.V.); (V.M.A.S.)
| | - Eelco M. Fennema
- Department of Surgery, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.M.L.M.); (N.A.); (K.t.D.); (E.M.F.); (J.-P.P.M.d.V.); (V.M.A.S.)
| | - Joep Kraeima
- 3D Lab, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (J.K.); (M.J.H.W.)
- Department of Oral and Maxillofacial Surgery, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Max J. H. Witjes
- 3D Lab, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (J.K.); (M.J.H.W.)
- Department of Oral and Maxillofacial Surgery, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Jean-Paul P. M. de Vries
- Department of Surgery, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.M.L.M.); (N.A.); (K.t.D.); (E.M.F.); (J.-P.P.M.d.V.); (V.M.A.S.)
| | - Vincent M. A. Stirler
- Department of Surgery, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.M.L.M.); (N.A.); (K.t.D.); (E.M.F.); (J.-P.P.M.d.V.); (V.M.A.S.)
| | - Frank F. A. IJpma
- Department of Surgery, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.M.L.M.); (N.A.); (K.t.D.); (E.M.F.); (J.-P.P.M.d.V.); (V.M.A.S.)
- Correspondence: ; Tel.: +31-50-361-6161
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Yam MGJ, Chao JYY, Leong C, Tan CH. 3D printed patient specific customised surgical jig for reverse shoulder arthroplasty, a cost effective and accurate solution. J Clin Orthop Trauma 2021; 21:101503. [PMID: 34414069 PMCID: PMC8361309 DOI: 10.1016/j.jcot.2021.101503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The reverse shoulder arthroplasty is a common orthopaedic procedure, where placement of the initial guiding wire is paramount to the implant instrumentation and position. To improve the position of the guiding wire, navigation and patient specific instrumentation have been used. These are however expensive and lengthy with many logistical issues. MATERIAL AND METHODS We utilised in house 3D printing to create a surgical guide to help with positioning of the central guiding wire. Pre and post op CT scans were utilised to determine positioning of the central screw. RESULTS Position of the screw tip was a mean of 3.3 mm away from the central point of the thickest portion of bone in the scapula with good bony purchase. There were no complications reported. DISCUSSION We report our experience in creation of the 3D printed surgical jig and the pearls of its creation, detailing from CT scan image acquisition to creation of surgical guide to intraoperative usage. 3D printing is a cost effective and accurate solution for the positioning of orthopaedic instrumentation. This can be easily applied to other operations in our institution, even with a low start up cost.
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Complex Bone Tumors of the Trunk-The Role of 3D Printing and Navigation in Tumor Orthopedics: A Case Series and Review of the Literature. J Pers Med 2021; 11:jpm11060517. [PMID: 34200075 PMCID: PMC8228871 DOI: 10.3390/jpm11060517] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 02/07/2023] Open
Abstract
The combination of 3D printing and navigation promises improvements in surgical procedures and outcomes for complex bone tumor resection of the trunk, but its features have rarely been described in the literature. Five patients with trunk tumors were surgically treated in our institution using a combination of 3D printing and navigation. The main process includes segmentation, virtual modeling and build preparation, as well as quality assessment. Tumor resection was performed with navigated instruments. Preoperative planning supported clear margin multiplanar resections with intraoperatively adaptable real-time visualization of navigated instruments. The follow-up ranged from 2–15 months with a good functional result. The present results and the review of the current literature reflect the trend and the diverse applications of 3D printing in the medical field. 3D printing at hospital sites is often not standardized, but regulatory aspects may serve as disincentives. However, 3D printing has an increasing impact on precision medicine, and we are convinced that our process represents a valuable contribution in the context of patient-centered individual care.
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Aguado-Maestro I, De Frutos-Serna M, González-Nava A, Merino-De Santos AB, García-Alonso M. Are the common sterilization methods completely effective for our in-house 3D printed biomodels and surgical guides? Injury 2021; 52:1341-1345. [PMID: 32962830 DOI: 10.1016/j.injury.2020.09.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/06/2020] [Accepted: 09/15/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION In-hospital 3D printing is being implemented in orthopaedic departments worldwide, being used for additive manufacturing of fracture models (or even surgical guides) which are sterilized and used in the operating room. However, to save time and material, prints are nearly hollow, while 3D printers are placed in non-sterile rooms. The aim of our study is to evaluate whether common sterilization methods can sterilize the inside of the pieces, which would be of utmost importance in case a model breaks during a surgical intervention. MATERIAL AND METHOD A total of 24 cylinders were designed and printed with a 3D printer in Polylactic Acid (PLA) with an infill density of 12%. Manufacturing was paused when 60% of the print was reached and 20 of the cylinders were inoculated with 0.4 mL of a suspension of S epidermidis ATTCC 1228 in saline solution at turbidity 1 McFarland. Printing was resumed, being all the pieces completely sealed with the inoculum inside. Posteriorly, 4 groups were made according to the chosen sterilization method: Ethylene Oxide (EtO), Gas Plasma, Steam Heat or non-sterilized (positive control). Each group included 5 contaminated cylinders and 1 non-contaminated cylinder as a negative control. After sterilization, the inside of the cylinders was cultured during 7 days. RESULTS We observed bacterial growth of just a few Forming Colony Units (FCU) in 4 out of 5 positive controls and in 2 out of 5 contaminated cylinders sterilized with Gas Plasma. We could not assess any bacterial growth in any of the EtO or Steam Heat samples or in any of the negative controls. Pieces sterilized under Steam Heat resulted completely deformed. CONCLUSIONS High temperatures reached during the procedure of additive manufacturing can decrease the bacterial load of the biomodels. However, there is a potential risk of contamination during the procedure. We recommend sterilization with EtO for in-hospital 3D-printed PLA hollow biomodels or guides. Otherwise, in case of using Gas Plasma, an infill of 100% should be applied.
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Affiliation(s)
- I Aguado-Maestro
- Department of Traumatology and Orthopaedic Surgery. Hospital Universitario del Río Hortega, Calle Dulzaina 2, 47012 Valladolid, Spain.
| | - M De Frutos-Serna
- Department of Microbiology, Hospital Universitario del Río Hortega, Calle Dulzaina 2, 47012, Valladolid, Spain
| | - A González-Nava
- Department of Microbiology, Hospital Universitario del Río Hortega, Calle Dulzaina 2, 47012, Valladolid, Spain
| | - A B Merino-De Santos
- Department of Sterilization. Hospital Universitario del Río Hortega, Calle Dulzaina 2. 47012, Valladolid, Spain
| | - M García-Alonso
- Department of Traumatology and Orthopaedic Surgery. Hospital Universitario del Río Hortega, Calle Dulzaina 2, 47012 Valladolid, Spain
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Highly Cancellous Titanium Alloy (TiAl 6V 4) Surfaces on Three-Dimensionally Printed, Custom-Made Intercalary Tibia Prostheses: Promising Short- to Intermediate-Term Results. J Pers Med 2021; 11:jpm11050351. [PMID: 33924789 PMCID: PMC8145557 DOI: 10.3390/jpm11050351] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/13/2021] [Accepted: 04/26/2021] [Indexed: 11/22/2022] Open
Abstract
Custom-made, three-dimensionally-printed (3D) bone prostheses gain increasing importance in the reconstruction of bone defects after musculoskeletal tumor resections. They may allow preservation of little remaining bone stock and ensure joint or limb salvage. However, we believe that by constructing anatomy-imitating implants with highly cancellous titanium alloy (TiAl6V4) surfaces using 3D printing technology, further benefits such as functional enhancement and reduction of complications may be achieved. We present a case series of four patients reconstructed using custom-made, 3D-printed intercalary monobloc tibia prostheses treated between 2016 and 2020. The mean patient age at operation was 30 years. Tumor resections were performed for Ewing sarcoma (n = 2), high-grade undifferentiated pleomorphic bone sarcoma (n = 1) and adamantinoma (n = 1). Mean resection length was 17.5 cm and mean operation time 147 min. All patients achieved full weight-bearing and limb salvage at a mean follow-up of 21.25 months. One patient developed a non-union at the proximal bone-implant interface. Alteration of implant design prevented non-union in later patients. Mean MSTS and TESS scores were 23.5 and 88. 3D-printed, custom-made intercalary tibia prostheses achieved joint and limb salvage in this case series despite high, published complication rates for biological and endoprosthetic reconstructions of the diaphyseal and distal tibia. Ingrowth of soft tissues into the highly cancellous implant surface structure reduces dead space, enhances function, and appears promising in reducing complication rates.
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Point-of-care manufacturing: a single university hospital's initial experience. 3D Print Med 2021; 7:11. [PMID: 33890198 PMCID: PMC8061881 DOI: 10.1186/s41205-021-00101-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 04/08/2021] [Indexed: 12/13/2022] Open
Abstract
Background The integration of 3D printing technology in hospitals is evolving toward production models such as point-of-care manufacturing. This study aims to present the results of the integration of 3D printing technology in a manufacturing university hospital. Methods Observational, descriptive, retrospective, and monocentric study of 907 instances of 3D printing from November 2015 to March 2020. Variables such as product type, utility, time, or manufacturing materials were analyzed. Results Orthopedic Surgery and Traumatology, Oral and Maxillofacial Surgery, and Gynecology and Obstetrics are the medical specialties that have manufactured the largest number of processes. Working and printing time, as well as the amount of printing material, is different for different types of products and input data. The most common printing material was polylactic acid, although biocompatible resin was introduced to produce surgical guides. In addition, the hospital has worked on the co-design of custom-made implants with manufacturing companies and has also participated in tissue bio-printing projects. Conclusions The integration of 3D printing in a university hospital allows identifying the conceptual evolution to “point-of-care manufacturing.”
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Calvo-Haro JA, Pascau J, Mediavilla-Santos L, Sanz-Ruiz P, Sánchez-Pérez C, Vaquero-Martín J, Perez-Mañanes R. Conceptual evolution of 3D printing in orthopedic surgery and traumatology: from "do it yourself" to "point of care manufacturing". BMC Musculoskelet Disord 2021; 22:360. [PMID: 33863319 PMCID: PMC8051827 DOI: 10.1186/s12891-021-04224-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 04/07/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND 3D printing technology in hospitals facilitates production models such as point-of-care manufacturing. Orthopedic Surgery and Traumatology is the specialty that can most benefit from the advantages of these tools. The purpose of this study is to present the results of the integration of 3D printing technology in a Department of Orthopedic Surgery and Traumatology and to identify the productive model of the point-of-care manufacturing as a paradigm of personalized medicine. METHODS Observational, descriptive, retrospective and monocentric study of a total of 623 additive manufacturing processes carried out in a Department of Orthopedic Surgery and Traumatology from November 2015 to March 2020. Variables such as product type, utility, time or materials for manufacture were analyzed. RESULTS The areas of expertise that have performed more processes are Traumatology, Reconstructive and Orthopedic Oncology. Pre-operative planning is their primary use. Working and 3D printing hours, as well as the amount of 3D printing material used, vary according to the type of product or material delivered to perform the process. The most commonly used 3D printing material for manufacturing is polylactic acid, although biocompatible resin has been used to produce surgical guides. In addition, the hospital has worked on the co-design of customized implants with manufacturing companies. CONCLUSIONS The integration of 3D printing in a Department of Orthopedic Surgery and Traumatology allows identifying the conceptual evolution from "Do-It-Yourself" to "POC manufacturing".
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Affiliation(s)
- Jose Antonio Calvo-Haro
- Orthopaedic Surgery and Traumatology Department, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo, 46, Postal code, 28007, Madrid, Spain.
- Advanced Planning and 3D 1Manufacturing Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
- Faculty of Medicine, Department of Surgery, Universidad Complutense, Madrid, Spain.
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - Javier Pascau
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain
| | - Lydia Mediavilla-Santos
- Orthopaedic Surgery and Traumatology Department, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo, 46, Postal code, 28007, Madrid, Spain
| | - Pablo Sanz-Ruiz
- Orthopaedic Surgery and Traumatology Department, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo, 46, Postal code, 28007, Madrid, Spain
- Faculty of Medicine, Department of Surgery, Universidad Complutense, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Coral Sánchez-Pérez
- Orthopaedic Surgery and Traumatology Department, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo, 46, Postal code, 28007, Madrid, Spain
| | - Javier Vaquero-Martín
- Orthopaedic Surgery and Traumatology Department, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo, 46, Postal code, 28007, Madrid, Spain
- Faculty of Medicine, Department of Surgery, Universidad Complutense, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Rubén Perez-Mañanes
- Orthopaedic Surgery and Traumatology Department, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo, 46, Postal code, 28007, Madrid, Spain
- Advanced Planning and 3D 1Manufacturing Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Faculty of Medicine, Department of Surgery, Universidad Complutense, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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Andrés-Cano P, Calvo-Haro J, Fillat-Gomà F, Andrés-Cano I, Perez-Mañanes R. Role of the orthopaedic surgeon in 3D printing: current applications and legal issues for a personalized medicine. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [DOI: 10.1016/j.recote.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Govaert GAM, Hietbrink F, Willemsen K. Three-Dimensional Manufacturing of Personalized Implants in Orthopedic Trauma Surgery-Feasible Future or Fake News? JAMA Netw Open 2021; 4:e210149. [PMID: 33599769 DOI: 10.1001/jamanetworkopen.2021.0149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Geertje A M Govaert
- Department of Trauma Surgery, Division for Surgical Specialties, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Falco Hietbrink
- Department of Trauma Surgery, Division for Surgical Specialties, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Koen Willemsen
- 3D Lab, Division for Surgical Specialties, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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IJpma FFA, Meesters AML, Merema BBJ, ten Duis K, de Vries JPPM, Banierink H, Wendt KW, Kraeima J, Witjes MJH. Feasibility of Imaging-Based 3-Dimensional Models to Design Patient-Specific Osteosynthesis Plates and Drilling Guides. JAMA Netw Open 2021; 4:e2037519. [PMID: 33599774 PMCID: PMC7893502 DOI: 10.1001/jamanetworkopen.2020.37519] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
IMPORTANCE In acetabular fracture surgery, achieving an optimal reconstruction of the articular surface decreases the risk of osteoarthritis and the subsequent need for total hip arthroplasty. However, no one-size-fits-all osteosynthesis plate is available owing to differences in fracture patterns and variations in pelvic anatomy. Currently, osteosynthesis plates need to be manually contoured intraoperatively, often resulting in inadequate reduction and fixation of the fractured segments. OBJECTIVE To determine the feasibility and accuracy of a novel concept of fast-track 3-dimensional (3-D) virtual surgical planning and patient-specific osteosynthesis for complex acetabular fracture surgery. DESIGN, SETTING, AND PARTICIPANTS This case series study examines the use of patient-specific osteosynthesis plates for patients needing operative treatment for displaced associated-type acetabular fractures at a tertiary university-affiliated referral center and level 1 trauma center between January 1, 2017, and December 31, 2018. Models were created in 3-D based on computed tomography (CT) data, fractures were virtually reduced, and implant positions were discussed in a multidisciplinary team of clinicians and engineers. Patient-specific osteosynthesis plates with drilling guides were designed, produced, sterilized and clinically applied within 4 days. Data were analyzed at the 1-year follow-up. EXPOSURES Development and clinical implementation of personalized fracture surgery. MAIN OUTCOMES AND MEASURES The primary outcome was the quality of the reduction as determined by the postoperative CT scan. The secondary outcomes were accuracy of the screw placement and clinical outcome using patient-reported outcome measures. RESULTS Ten patients with a median (range) age of 63 (46-79) years with an acetabular fracture were included. The median (interquartile range [IQR]) preoperative gap was 20 (15-22) mm, and the median (IQR) step-off was 5 (3-11) mm. Postoperatively, the median (IQR) gap was reduced to 3 (2-5) mm (P = .005), and the median (IQR) step-off was reduced to 0 (0-2) mm (P = .01), indicating good fracture reduction, indicating good fracture reduction. The mean difference between the preoperative and postoperative gap was 14.6 (95% CI, 10-19) mm, and the mean difference in step-off was 5.7 (95% CI, 2-9) mm. The median (IQR) difference in screw direction between the planning and actual surgery was only 7.1° (7°-8°). All patients retained their native hip and reported good physical functioning at follow-up. CONCLUSIONS AND RELEVANCE These findings suggest that 3-D virtual surgical planning, manufacturing, and clinical application of patient-specific osteosynthesis plates and drilling guides was feasible and yielded good clinical outcomes. Fast-track personalized surgical treatment could open a new era for the treatment of complex injuries.
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Affiliation(s)
- Frank F. A. IJpma
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Anne M. L. Meesters
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bram B. J. Merema
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Kaj ten Duis
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jean-Paul P. M. de Vries
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Hester Banierink
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Klaus W. Wendt
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Joep Kraeima
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Max J. H. Witjes
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Charbonnier B, Hadida M, Marchat D. Additive manufacturing pertaining to bone: Hopes, reality and future challenges for clinical applications. Acta Biomater 2021; 121:1-28. [PMID: 33271354 DOI: 10.1016/j.actbio.2020.11.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/06/2020] [Accepted: 11/24/2020] [Indexed: 12/12/2022]
Abstract
For the past 20 years, the democratization of additive manufacturing (AM) technologies has made many of us dream of: low cost, waste-free, and on-demand production of functional parts; fully customized tools; designs limited by imagination only, etc. As every patient is unique, the potential of AM for the medical field is thought to be considerable: AM would allow the division of dedicated patient-specific healthcare solutions entirely adapted to the patients' clinical needs. Pertinently, this review offers an extensive overview of bone-related clinical applications of AM and ongoing research trends, from 3D anatomical models for patient and student education to ephemeral structures supporting and promoting bone regeneration. Today, AM has undoubtably improved patient care and should facilitate many more improvements in the near future. However, despite extensive research, AM-based strategies for bone regeneration remain the only bone-related field without compelling clinical proof of concept to date. This may be due to a lack of understanding of the biological mechanisms guiding and promoting bone formation and due to the traditional top-down strategies devised to solve clinical issues. Indeed, the integrated holistic approach recommended for the design of regenerative systems (i.e., fixation systems and scaffolds) has remained at the conceptual state. Challenged by these issues, a slower but incremental research dynamic has occurred for the last few years, and recent progress suggests notable improvement in the years to come, with in view the development of safe, robust and standardized patient-specific clinical solutions for the regeneration of large bone defects.
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