Dynamic topology optimization of 3D-Printed transtibial orthopedic implant using tunable isotropic porous metamaterials

In this paper, we introduce the design and manufacturing process of a transtibial orthopedic implant. We used medical-grade polyurethane polymer resin to fabricate a 3D porous architected implant with tunable isotropy, employing a high-speed printing method known as Continuous Liquid Interface Production (CLIP). Our objective is to enhance the weight-bearing capabilities of the bone structures in the residual limb, thereby circumventing the traditional reliance on a natural bridge. To achieve a custom-made design, we acquire the topology and morphology of the residual limb as well as the bone structure of the tibia and fibula, utilizing computed tomography (CT) and high-resolution 3D scanning. We employed a dynamic topological optimization method, informed by gait cycle data, to effectively reduce the mass of the implant. This approach, which differs from conventional static methods, enables the quantification of variations in applied forces over time. Using the Euler-Lagrange energy approach, we propose the equations of motion for a homologous multibody model with three degrees of freedom. The versatility of the Solid Isotropic Material with Penalization (SIMP) method facilitates the integration of homogenization methods for microscale porous architectures into the optimized domain. The design of these porous architectures is based on a bias-driven tuning symmetry isotropy of a Triply Periodic Minimal Surface (Schwarz Primitive surface). The internal porosity of the structure significantly reduces weight without compromising the isotropic behavior of the implant.

Accuracy of additively manufactured and steam sterilized surgical guides by means of continuous liquid interface production, stereolithography, digital light processing, and fused filament fabrication

Different printing technologies can be used for prosthetically oriented implant placement, however the influence of different printing orientations and steam sterilization remains unclear. In particular, no data is available for the novel technology Continuous Liquid Interface Production. The objective was to evaluate the dimensional accuracy of surgical guides manufactured with different printing techniques in vertical and horizontal printing orientation before and after steam sterilization. A total of 80 surgical guides were manufactured by means of continuous liquid interface production (CLIP; material: Keyguide, Keyprint), digital light processing (DLP; material: Luxaprint Ortho, DMG), stereolithography (SLA; Surgical guide, Formlabs), and fused filament fabrication (FFF; material: Clear Base Support, Arfona) in vertical and horizontal printing orientation (n = 10 per subgroup). Spheres were included in the design to determine the coordinates of 17 reference points. Each specimen was digitized with a laboratory scanner after additive manufacturing (AM) and after steam sterilization (134 °C). To determine the accuracy, root mean square values (RMS) were calculated and coordinates of the reference points were recorded. Based on the measured coordinates, deviations of the reference points and relevant distances were calculated. Paired t-tests and one-way ANOVA were applied for statistical analysis (significance p < 0.05). After AM, all printing technologies showed comparable high accuracy, with an increased deviation in z-axis when printed horizontally. After sterilization, FFF printed surgical guides showed distinct warpage. The other subgroups showed no significant differences regarding the RMS of the corpus after steam sterilization (p > 0.05). Regarding reference points and distances, CLIP showed larger deviations compared to SLA in both printing orientations after steam sterilization, while DLP manufactured guides were the most dimensionally stable. In conclusion, the different printing technologies and orientations had little effect on the manufacturing accuracy of the surgical guides before sterilization. However, after sterilization, FFF surgical guides exhibited significant deformation making their clinical use impossible. CLIP showed larger deformations due to steam sterilization than the other photopolymerizing techniques, however, discrepancies may be considered within the range of clinical acceptance. The influence on the implant position remains to be evaluated.

3D printed drug-loaded implantable devices for intraoperative treatment of cancer

Surgery is an important treatment for cancer; however, local recurrence following macroscopically-complete resection is common and a significant cause of morbidity and mortality. Systemic chemotherapy is often employed as an adjuvant therapy to prevent recurrence of residual disease, but has limited efficacy due to poor penetration and dose-limiting off-target toxicities. Selective delivery of chemotherapeutics to the surgical bed may eliminate residual tumor cells while avoiding systemic toxicity. While this is challenging for traditional drug delivery technologies, we utilized advances in 3D printing and drug delivery science to engineer a drug-loaded arrowhead array device (AAD) to overcome these challenges. We demonstrated that such a device can be designed, fabricated, and implanted intraoperatively and provide extended release of chemotherapeutics directly to the resection area. Using paclitaxel and cisplatin as model drugs and murine models of cancer, we showed AADs significantly decreased local recurrence post-surgery and improved survival. We further demonstrated the potential for fabricating personalized AADs for intraoperative application in the clinical setting.

Continuous liquid interface production of alginate/polyacrylamide hydrogels with supramolecular shape memory properties

A recently developed three-dimensional (3D) gel-printing technology, namely continuous liquid interface production (CLIP), was utilized to fabricate supramolecular shape memory hydrogels with high resolutions and complex 3D geometries. The UV-curable ink for CLIP was composed of hydrogel precursors (alginate and acrylamide) and a photo-initiator (ammonium persulfate). As expected, the double network formed from ionically crosslinked alginate and covalently crosslinked polyacrylamide endowed the printed hydrogels with excellent mechanical properties. Meanwhile, due to the reversible metal-ligand coordination interaction, the hydrogel could be temporarily immobilized into an optional shape after introducing calcium ions and return to its original shapes upon ion removal, exhibiting ion-triggered shape memory effect. Moreover, the presence of ions greatly improved the conductivity of the resultant hydrogels. Such 3D printed versatile hydrogels with complex geometries demonstrated the potential for selected applications, particularly in load-bearing materials and flexible electronic devices.

Synthesis of photocurable cellulose acetate butyrate resin for continuous liquid interface production of three-dimensional objects with excellent mechanical and chemical-resistant properties

Three-dimensional (3D) printing parts with excellent resolution and high performance are of great significance for scientific and engineering applications. In this study, a novel photocurable cellulose acetate butyrate (PC-CAB) resin was synthesized for continuous liquid interface production (CLIP) to construct 3D objects with high resolution, tailored mechanical properties, excellent chemical resistance and thermal stability. Particularly, the tensile and flexural strength of the CLIP 3D printed specimen could reach 44.67 and 64.53 MPa, respectively. Their solvent resistance against various organic solvents and strong acidic/basic solutions was evaluated. As expected, the 3D prints could well maintain their structural integrity and exhibited very low swelling ratios owing to the photo-induced chemical crosslinking structure. Notably, even after immersion in methylene chloride or 1.0 M acid/alkali for 3 h, the 3D prints still showed excellent mechanical and thermal properties. Further study demonstrated that when PC-CAB in the CLIP ink was optimized to 20 wt% while the photoinitiator (PI) was 0.5 wt%, complex-structured 3D printed objects with high surface quality could be obtained under specific printing parameters.