J Shanghai Jiaotong Univ Sci

Journal of Shanghai Jiaotong University(Science) >

2021 , Vol. 26 >Issue 3: 334 - 338

DOI: https://doi.org/10.1007/s12204-021-2301-9

Medical 3D Printing and Personalised Medicine

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

Expand
  • (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 published: 2021-06-02

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)

Fold

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. 

Cite this article

KAN Tianyou(阚天佑), XIE Kai(谢凯), QU Yang(曲扬), AI Songtao (艾松涛), JIANG Wenbo (姜闻博), WU Haishan (吴海山), WANG Liao(王燎), YAN Mengning(严孟宁) . 3D-Printed Porous Titanium Augments for Reconstruction of Massive Bone Defect in Complex Revision Total Knee Arthroplasty: Implant Design and Surgical Technique[J]. Journal of Shanghai Jiaotong University(Science), 2021 , 26(3) : 334 -338 . DOI: 10.1007/s12204-021-2301-9

References

[1] SULTAN A A, MAHMOOD B, SAMUEL L T, et al. Cementless 3D printed highly porous titanium-coated baseplate total knee arthroplasty: Survivorship and outcomes at 2-year minimum follow-up [J]. The Journal of Knee Surgery, 2020, 33(3): 279-283.

[2] MANCUSO F, BELTRAME A, COLOMBO E, et al. Management of metaphyseal bone loss in revision knee arthroplasty [J]. Acta Bio-Medica, 2017, 88(2S): 98- 111.

[3] LEI P F, HU R Y, HU Y H. Bone defects in revision total knee arthroplasty and management [J]. Orthopaedic Surgery, 2019, 11(1): 15-24.

[4] QIU Y Y, YAN C H, CHIU K Y, et al. Review article: Treatments for bone loss in revision total knee arthroplasty [J]. Journal of Orthopaedic Surgery, 2012, 20(1): 78-86.

[5] HUTEN D. Femorotibial bone loss during revision total knee arthroplasty [J]. Orthopaedics & Traumatology: Surgery & Research, 2013, 99S: S22-S33.

[6] LI G, WANG L, PAN W, et al. In vitro and in vivo study of additive manufactured porous Ti6Al4V scaffolds for repairing bone defects [J]. Scientific Reports, 2016, 6: 34072.

[7] ANGELINI A, TROVARELLI G, BERIZZI A, et al. Three-dimension-printed custom-made prosthetic reconstructions: From revision surgery to oncologic reconstructions [J]. International Orthopaedics, 2019, 43(1): 123-132.

[8] HUGHES A J, DEBUITLEIR C, SODEN P, et al. 3D printing aids acetabular reconstruction in complex revision hip arthroplasty [J]. Advances in Orthopedics, 2017, 2017: 8925050.

[9] WANG B C, HAO Y Q, PU F F, et al. Computeraided designed, three dimensional-printed hemipelvic prosthesis for peri-acetabular malignant bone tumour [J]. International Orthopaedics, 2018, 42(3): 687-694.

[10] LIUWJ, SHAO ZW, RAI S, et al. Three-dimensionalprinted intercalary prosthesis for the reconstruction of large bone defect after joint-preserving tumor resection [J]. Journal of Surgical Oncology, 2020, 121(3): 570- 577.

[11] HAO Y Q, WANG L, JIANG W B, et al. 3D printing hip prostheses offer accurate reconstruction, stable fixation, and functional recovery for revision total hip arthroplasty with complex acetabular bone defect [J]. Engineering, 2020, 6(11): 1285-1290. 
Options
Outlines

/

〈 〉