Radial head replacement with the 3D-printed patient-specific titanium prosthesis: Preliminary results of a multi-centric prospective study.

PURPOSE: To report preliminary clinical results and safety of 3D-printed patient-specific titanium radial head (RH) prosthesis in treatment of the irreparable RH fractures. MATERIAL AND METHODS: This multi-centric prospective study included 10 patients (6 men and four women, mean age 41 years (range, 25-64 years)). Three cases were classified as Mason type III and 7 cases as type IV. Patients were assessed preoperatively, intraoperatively, and at 1, 6, 12, 24, 36, and 48 weeks postoperatively. Range of motion (ROM), visual analog scale (VAS) score, Disabilities of the Arm, Shoulder and Hand (DASH) score, Mayo Elbow Performance Score (MEPS), radiology imaging, and laboratory blood and urine testing were evaluated. RESULTS: The prostheses were implanted utilizing cemented stems in 5 patients and cementless stems in 5 patients. Intraoperatively, well congruency of a prosthesis with capitellum and radial notch of ulna was observed in all cases. All patients had improvement of ROM, VAS score, DASH score, and MEPS during the postoperative follow-ups. At the final follow-up, mean elbow extension was 6.5° (range, 0°-30°), flexion 145° (range, 125°-150°), supination 79° (range, 70°-80°), and pronation 73.5° (range, 45°-80°). Mean VAS score was 0.3 (range, 0-3), DASH score was 12.35 (range, 1.7-23.3), and MEPS was 99.5 (range, 95-100). Postoperative radiographs demonstrated heterotopic ossification in 2 cases, periprosthetic radiolucency in 2 cases, and proximal radial neck resorption in 2 cases. No one had the evidence of capitellar erosion, implant failure, malpositioning, overstuffing, or symptomatic stem loosening. There was no significant alteration of laboratory results or adverse events related to the 3D-printed prosthesis implantation. CONCLUSION: The preliminary results demonstrated that implantation of the 3D-printed patient-specific titanium RH prosthesis is safe and may be a potential treatment option for irreparable RH fracture.

Enhancing PEEK surface bioactivity: Investigating the effects of combining sulfonation with sub-millimeter laser machining.

Due to its superior mechanical properties and chemical stability, Polyetheretherketone (PEEK) has emerged as an alternative to conventional metal implants. However, the bio-inertness of PEEK's surface has limited its applications. Ambient sulfonation has been adopted to enhance bioactivity, but its nanoscale topographic changes are insufficient for implant-bone interlock. To further improve bone-implant interlock, this study employs CO2 laser machining to create sub-millimeter (0.5 mm) grooves on PEEK's surface, aiming to encourage bone ingrowth and strengthen the implant-bone interface. This research investigated the physical and chemical properties and bio-interaction of PEEK surface modified by sulfonation (SPEEK), laser machining (L-PEEK), and combination of both technique (L-SPEEK). X-ray photoelectron spectroscopy (XPS) spectra revealed that sulfonation compensates for the surface chemical shift instigated by laser ablation, aligning the surface chemistry of L-SPEEK with that of SPEEK. Furthermore, L-PEEK surfaces presented pores with sizes ranging from 1 to 600 µm, while SPEEK surfaces exhibited pores between 5 and 700 nm. All tested samples demonstrated non-cytotoxicity, with L-SPEEK exhibiting the highest mineralization and ALP activity as 2 and 2.1 times that of intrinsic PEEK, after 21 days of incubation. Microscopic imaging reveals a notably higher extracellular content on L-SPEEK compared to the other groups. This study underscores the potential of combining sub-millimeter laser machining with sulfonation in enhancing early osteogenic markers, providing a promising pathway for future PEEK-based orthopedic applications.

Understanding the Stress Distribution on Anatomic Customized Root-Analog Dental Implant at Bone-Implant Interface for Different Bone Densities.

The aim of this study is to assess the stress distribution on the bone tissue and bone-implant interface of a customized anatomic root-analog dental implant (RAI) by means of finite element analysis (FEA) for different types of bone density. A mandibular right second premolar was selected from the CBCT database. A DICOM file was converted to an STL file to create a CAD model in FEA software. The bone boundary model was created, while bone density types I-IV were determined. Von Mises stress was measured at bone tissues and bone-implant interfaces. To validate the models, the RAI was 3D printed through a laser powder-bed fusion (L-PBF) approach. The results revealed that all RAI designs could not cause plastic deformation or fracture resulting in lower stress than the ultimate tensile stress of natural bone and implant. Compared to a conventional screw-type implant, RAIs possess a more favorable stress distribution pattern around the bone tissue and the bone-implant interface. The presence of a porous structure was found to reduce the stress at cancellous bone in type IV bone density.

A Novel Patient-specific Titanium Mesh Implant Design for Reconstruction of Complex Orbital Fracture.

Complex orbital fractures, including orbital rims and walls, require precise reconstruction. A titanium-based patient-specific implant (PSI) benefits over other implants when challenged with narrow surgical space and designable implant fixation point. METHODS: This is a prospective noncomparative case series to evaluate the effect of complex orbital reconstruction using the newly designed lateral fixation patient-specific implant. The PSI was individually fabricated by 3D reconstruction using the mirrored nonaffected orbit as a template. The fixation point was at maxillary or zygomatic bone, depending on the bony remnant. Outcomes were obtained from computed tomography scan to compare orbital tissue volume and exophthalmometry value by posterior clinoid method before and after the surgery and also between both orbits in each patient. RESULTS: Sixteen patients with complex orbital fracture with inferior orbital rim defect were enrolled. Seven were previously repaired with other implants. Compared with the preoperative measurement, the postoperative mean difference of orbital volume and exophthalmometry value between both eyes was significantly decreased (reduction of the mean difference of 2904.40 mm3; P < 0.001 and 2.89 mm; P < 0.001, respectively). The mean orbital volume and exophthalmometry value between affected and unaffected eyes were not different after surgical correction (P = 0.57 and P = 0.28, respectively). There was one infected wound from retained foreign body and one unresolved vertical diplopia after the reconstruction. CONCLUSIONS: Reconstruction of complex orbital fractures using the novel designed-PSI had excellent outcomes. Appropriate implant design with caution of orbital anatomy and placement techniques are keys for successful results.

Titania Nanotube Architectures Synthesized on 3D-Printed Ti-6Al-4V Implant and Assessing Vancomycin Release Protocols.

The aim of this study is to synthesize Titania nanotubes (TNTs) on the 3D-printed Ti-6Al-4V surface and investigate the loading of antibacterial vancomycin drug dose of 200 ppm for local drug treatment application for 24 h. The antibacterial drug release from synthesized nanotubes evaluated via the chemical surface measurement and the linear fitting of Korsmeyer-Peppas model was also assessed. The TNTs were synthesized on the Ti-6Al-4V surface through the anodization process at different anodization time. The TNTs morphology was characterized using field emission scanning electron microscope (FESEM). The wettability and the chemical composition of the Ti-6Al-4V surface and the TNTs were assessed using the contact angle meter, Fourier transform infrared spectrophotometer (FTIR) and the X-ray photoelectron spectroscopy (XPS). The vancomycin of 200 ppm release behavior under controlled atmosphere was measured by the high-performance liquid chromatography (HPLC) and hence, the position for retention time at 2.5 min was ascertained. The FESEM analysis confirmed the formation of nanostructured TNTs with vertically oriented, closely packed, smooth and unperforated walls. The maximum cumulative vancomycin release of 34.7% (69.5 ppm) was recorded at 24 h. The wetting angle of both Ti-6Al-4V implant and the TNTs were found below 90 degrees. This confirmed their excellent wettability.

Three-dimensional printing technology for patient-matched instrument in treatment of cubitus varus deformity: A case report.

BACKGROUND: Recently, medical three-dimensional printing technology (3DPT) has demonstrated potential benefits for the treatment of cubitus varus deformity (CVD) by improving accuracy of the osteotomy through the use of an osteotomy guide, with or without a patient-mated plate. Here, we present an interesting CVD case, involving a patient who was treated with corrective biplanar chevron osteotomy using an innovative customized osteotomy guide and a newly designed patient-matched monoblock crosslink plate created with 3DPT. CASE SUMMARY: A 32-year-old female presented with a significant CVD from childhood injury. A computer simulation was processed using images from computerized tomography scans of both upper extremities. The biplanar chevron osteotomy was designed to create identical anatomy between the mirror image of the contralateral distal humerus and the osteotomized distal humerus. Next, the customized osteotomy guide and patient-matched monoblock crosslink plate were designed and printed. A simulation osteotomy was created for the real-sized bone model, and the operation was performed using the posterior paratricipital approach with k-wire positioning from the customized osteotomy guide as a predrilled hole for screw fixation to achieve immediate control of the reduction after osteotomy. Our method allowed for successful treatment of the CVD case, significantly improving the patient's radiographic and clinical outcomes, with satisfactory result. CONCLUSION: 3DPT-created patient-matched osteotomy guide and instrumentation provides accurate control during CVD correction.

A custom-made distal humerus plate fabricated by selective laser melting.

This study aims to evaluate the mechanical performance of custom 3D-printed titanium plates in the treatment of distal humerus fractures. Rigidity of four plating configurations were investigated by finite element analysis. The results reveal that implementation of custom designs with minimal screw holes, lateral-medial linking screw and lateral brim could significantly improve stiffness and consequently leads to better biomechanical stability as compared to standard osteosynthesis design. Biomechanical testing was also performed to validate practical usability. The results confirm that newly designed custom plates fabricated by selective laser melting is a possible alternative for the treatment of distal humerus fracture.

Orbitocranial Fibrous Dysplasia: Immediate Reconstruction with Titanium 3-dimensional Printing.

We present the case of an 18-year-old man who was referred to our department with a suspected tumor in the right orbital region, which caused exophthalmos due to its pressure effect. Preoperative CT imaging revealed an expansile ground-glass appearance of bone mass, with sclerotic bone on the right frontal bone (right superior orbital wall). There was no orbital mass and no enlargement of the extraocular muscles and tendons; the retrobulbar fat and optic nerve appeared unremarkable. A preoperative tissue biopsy confirmed the FD. Complete tumor removal was performed via the right hemicoronal approach. The orbital roof and temporal bone defect were immediately reconstructed using the 3-dimensional titanium printing plate.

Three-dimensional printed, proximal phalangeal prosthesis with metatarsophalangeal joint arthroplasty for the treatment of a giant cell tumor of the fifth toe: The first case report.

INTRODUCTION: The majority of patients with bone sarcoma or an aggressive benign tumor of the toe can be successfully treated by amputation. However, limb-salvage surgery for toe tumors remains challenging. PRESENTATION OF CASE: A 26-year-old female presented with an enlarging mass on her right 5th toe. Imaging studies revealed an expansile osteolytic, destructive lesion of the proximal phalanx of the 5th toe with metatarsophalangeal (MTP) joint invasion. A biopsy specimen confirmed a grade 1, giant cell tumor of the bone. An en bloc resection of the proximal phalanx was performed, and the defect was reconstructed with a patient-matched, three-dimensional, printed titanium proximal phalanx endoprosthesis with an MTP joint extension. The postoperative course was uneventful. The patient has walked with full weight-bearing since early postoperatively. No local recurrence or metastases were evident. However, scar formation occurred after two years, causing an overriding toe deformity. DISCUSSION: This case represents the first use of a toe prosthesis with MTP joint reconstruction. The complex MTP structure with a preserved metatarsal head facilitates the effort to mimic normal weight-bearing. CONCLUSION: A three-dimensional printed prosthesis of the 5th toe is a viable alternative to a bone graft or amputation. However, to avoid stiffness and complications, further study is needed to improve the prosthesis design.

Finite element analysis comparison between superior clavicle locking plate with and without screw holes above fracture zone in midshaft clavicular fracture.

BACKGROUND: Midshaft clavicular fractures are common fractures and generally treated conservatively. Among the surgical options, plate fixation is the most popular and has been biomechanically and clinically proven in numerous studies. However, implant failures caused by plate deformations or breakage still occur in up to 16.7% of cases, and recent studies showed that screw holes above fracture zone (SHFZ) might be the at-risk location. Using finite element analysis, this study aimed to test the biomechanical property of the superior clavicle locking plate (SCLP) with and without SHFZ in comminuted midshaft clavicular fracture. METHODS: Finite element models of comminuted midshaft clavicular fracture fixed with standard 8-hole titanium SCLP with screw holes (SHFZ plate) and without screw holes above fracture zone (No-SHFZ plate) were built. Both groups were tested under three different loading models (100-N cantilever bending, 100-N axial compression, and 1-Nm torsion). The average peak stress on medial clavicle, fracture zone, and lateral clavicle, and the peak stress on each screw hole (or the same position in the No-SHFZ plate) were measured and compared. RESULTS: The highest average peak stress on the fracture zone was higher than those on medial and lateral clavicles under all loading conditions in both plates. However, the No-SHFZ plate significantly reduced the average peak stress value on the fracture zone, compared to the SHFZ plate (45.0% reduction in cantilever bending, 52.2% reduction in axial compression, and 54.9% reduction in axial torsion). The peak stress value on the maximal stress point in the SHFZ and No-SHFZ plates with cantilever bending, axial compression, and torsion loads were 1257.10 MPa vs. 647.21 MPa, 186.42 MPa vs. 131.63 MPa, and 111.86 MPa vs. 82.41 MPa, respectively. CONCLUSION: The weakest link of the SCLP construct in comminuted midshaft clavicular fracture fixation is the SHFZ, especially in the cantilever bending load. Additionally, the biomechanical property of the SCLP without SHFZ model (No-SHFZ plate) is superior to the standard SCLP model (SHFZ plate), with a significantly lower peak stress on the SHFZ location in all loading conditions. We recommend a new SCLP design with SHFZ to prevent implant failure and improve surgical outcomes.

Matching precision of the reverse contralateral radial head in generating of the individualized prosthesis from the surface registration in tuberosity-neck and in tuberosity-diaphysis.

PURPOSE: Following the radial head replacement, the surface mismatches between the implants and the morphological characteristics of the original proximal radius decreased contact areas and increased contact forces which is potential for the long-term articulating cartilage wear. Several studies demonstrated that the individualized prosthesis, created from computed tomographic (CT) images of the contralateral side with the reverse engineering technology, may reduce the mismatch. The aim of this study is to demonstrate the matching precision of the reverse contralateral head between the surface registration in tuberosity-neck (TN) area and in tuberosity-diaphysis (TD) area. MATERIALS AND METHODS: High-resolution CT scan of 11 pairs of the cadaveric arms was performed. Utilizing advanced image processing techniques, three-dimensional (3-D) models of each specimen was generated. The model of the left side was reversed and matched with the model of the right side in the same cadaver by registering in the area of radial neck along with tuberosity (TN) and in the area of radial tuberosity combined with 2 cm of proximal diaphysis (TD). The alteration of the head diameter, dish diameter, articular depth, head thickness, end-plane angle, offset, and head volume were evaluated and analyzed by paired t-test. RESULTS: No statistically significant difference was found in all parameters from both TN and TD registrations ( p < 0.05). CONCLUSION: The surface registration in either TN or TD area can generate the statistically symmetrical 3-D model with the original head. The registration in these areas may possibly be used in creating the individualized radial head prosthesis.

The Patient-Specific Implant Created with 3D Printing Technology in Treatment of the Irreparable Radial Head in Chronic Persistent Elbow Instability.

Successful treatment of the chronic persistent elbow instability is a challenge for orthopedic surgeons. In this form, it is important to recognize and restore the osseous stabilizer in order to obtain the concentric reduction. In the present report, we describe a case of such injury with irreparable radial head treated with patient-specific radial head prosthesis which was created with 3D printing technology. To our knowledge, this is the first report in clinical use of this kind of prosthesis for the radial head fracture. At a 24-month follow-up visit, the patient was satisfied with the functional outcomes. The Mayo Elbow Performance Index (MEPI) increased from 20 points at the preoperative day to 85 points, and the patient-based Disabilities of the Arm, Shoulder, and Hand (DASH) was reduced from 88.33 points to 28.33 points. Due to the favorable result, replacement of the radial head with the patient-specific implant could be a useful treatment for the irreparable radial head in chronic persistent elbow instability.

A Patient-Matched Entire First Metacarpal Prosthesis in Treatment of Giant Cell Tumor of Bone.

Giant cell tumor of the bones occurring in the first metacarpals frequently requires entire metacarpal resection due to the aggressive nature and high rate of recurrence. Bone reconstruction can be performed with autogenous bone grafts. Here we describe a new technique of reconstruction using a patient-matched three-dimensional printed titanium first metacarpal prosthesis. This prosthesis has a special design for ligament reconstruction in the proximal and distal portions. Good hand function and aesthetic appearance were maintained at a 24-month follow-up visit. This reconstructive technique can avoid donor-site complications and spare the autogenous bone grafts for revision options.

Strain rate induced crystallization in bulk metallic glass-forming liquid.

We report on the solidification of Au49, Ag5.5, Pd2.3, Cu26.9, Si16.3 bulk metallic glass under various strain rates. Using a copper mold casting technique with a low strain rate during solidification, this alloy is capable of forming glassy rods of at least 5 mm in diameter. Surprisingly, when the liquid alloy is splat cooled at much higher cooling rates and large strain rates, the solidified alloy is no longer fully amorphous. Our finding suggests that the large strain rate during splat cooling induces crystallization. The pronounced difference in crystallization behavior cannot be explained by the previously observed strain rate effect on viscosity alone. A strain rate induced phase separation process is suggested as one of the explanations for this crystallization behavior. The strain-rate-dependent critical cooling rate must be considered in order to assess the intrinsic glass forming ability of metallic liquid.