J Shanghai Jiaotong Univ Sci ›› 2021, Vol. 26 ›› Issue (3): 334-338.doi: 10.1007/s12204-021-2301-9

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3D-Printed Porous Titanium Augments for Reconstruction of Massive Bone Defect in Complex Revision Total Knee Arthroplasty: Implant Design and Surgical Technique

KAN Tianyoua‡ (阚天佑), XIE Kaia‡ (谢凯), QU Yangb (曲扬), AI Songtaob (艾松涛), JIANG Wenboc (姜闻博), WU Haishana (吴海山), WANG Liaoa(王燎), YAN Mengninga(严孟宁)   

  1. (a. Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery; b. Department of Radiology;
    c. Clinical and Translational Research Center for 3D Printing Technology, Shanghai Ninth People’s Hospital,
    Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China)
  • 出版日期:2021-06-28 发布日期:2021-06-02
  • 通讯作者: WANG Liao(王燎), YAN Mengning(严孟宁) E-mail:wang821127@163.com, yanmengning@163.com
  • 基金资助:
    the 3D Snowball Project of Shanghai
    Jiao Tong University School of Medicine
    (No. GXQ202007), the Natural Science Foundation
    of Shanghai (No. 20ZR1432000), the Project of
    Shanghai Collaborative Innovation Center for Translational
    Medicine (No. TM201814), the Clinical Research
    Program of the 9th People’s Hospital affiliated to
    Shanghai Jiao Tong University School of Medicine
    (No. JYLJ025), and the National Natural Science
    Foundation of China (No. 81772425)

3D-Printed Porous Titanium Augments for Reconstruction of Massive Bone Defect in Complex Revision Total Knee Arthroplasty: Implant Design and Surgical Technique

KAN Tianyoua‡ (阚天佑), XIE Kaia‡ (谢凯), QU Yangb (曲扬), AI Songtaob (艾松涛), JIANG Wenboc (姜闻博), WU Haishana (吴海山), WANG Liaoa(王燎), YAN Mengninga(严孟宁)   

  1. (a. Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery; b. Department of Radiology;
    c. Clinical and Translational Research Center for 3D Printing Technology, Shanghai Ninth People’s Hospital,
    Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China)
  • Online:2021-06-28 Published:2021-06-02
  • Contact: WANG Liao(王燎), YAN Mengning(严孟宁) E-mail:wang821127@163.com, yanmengning@163.com
  • Supported by:
    the 3D Snowball Project of Shanghai
    Jiao Tong University School of Medicine
    (No. GXQ202007), the Natural Science Foundation
    of Shanghai (No. 20ZR1432000), the Project of
    Shanghai Collaborative Innovation Center for Translational
    Medicine (No. TM201814), the Clinical Research
    Program of the 9th People’s Hospital affiliated to
    Shanghai Jiao Tong University School of Medicine
    (No. JYLJ025), and the National Natural Science
    Foundation of China (No. 81772425)

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摘要： Reconstruction of severe bone defects in revision total knee arthroplasty (TKA) remains a challenge  for orthopaedists. The progression of medical imaging and additive manufacturing technology has enabled the  rapid manufacture of custom-made implants, and 3D-printed augments with interconnected pore structures have  become an alternative approach for the reconstruction of bone defects in revision TKA, especially in patients  with complex bone defects. The size and location of the bone defect were determined by thin-layer computed  tomography (CT; layer thickness is 1mm) after reduction of artifacts. The 3D reconstruction models of the host  bone were obtained based on thin-layer CT imaging. The custom-made augmentation was designed according to  the 3D reconstruction bone model. The augmentation had an interconnected porous structure on the bone-implant  interface to achieve biological fixation. After the design was complete, the 3D model of augment was exported in  STL format, and augments were fabricated with Ti6Al4V powder using electron beam melting. Thin-layer CT  and 3D reconstruction bone models are accurate methods for evaluating periprosthetic bone loss after artifact  reduction. The 3D-printed augments perfectly match the bone defects during surgery. 3D-printed augmentation  is an effective approach for the reconstruction of bone defects in revision TKA. Thus, surgeons and engineers  should carefully evaluate the bone defect during augment design to avoid a mismatch between the augment and  host bone. 

Abstract: Reconstruction of severe bone defects in revision total knee arthroplasty (TKA) remains a challenge  for orthopaedists. The progression of medical imaging and additive manufacturing technology has enabled the  rapid manufacture of custom-made implants, and 3D-printed augments with interconnected pore structures have  become an alternative approach for the reconstruction of bone defects in revision TKA, especially in patients  with complex bone defects. The size and location of the bone defect were determined by thin-layer computed  tomography (CT; layer thickness is 1mm) after reduction of artifacts. The 3D reconstruction models of the host  bone were obtained based on thin-layer CT imaging. The custom-made augmentation was designed according to  the 3D reconstruction bone model. The augmentation had an interconnected porous structure on the bone-implant  interface to achieve biological fixation. After the design was complete, the 3D model of augment was exported in  STL format, and augments were fabricated with Ti6Al4V powder using electron beam melting. Thin-layer CT  and 3D reconstruction bone models are accurate methods for evaluating periprosthetic bone loss after artifact  reduction. The 3D-printed augments perfectly match the bone defects during surgery. 3D-printed augmentation  is an effective approach for the reconstruction of bone defects in revision TKA. Thus, surgeons and engineers  should carefully evaluate the bone defect during augment design to avoid a mismatch between the augment and  host bone. 

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