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J Knee Surg 2014; 27(03): 185-192
DOI: 10.1055/s-0034-1374810
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Emerging Technologies in Arthroplasty: Additive Manufacturing

Samik Banerjee
1   Department of Orthopaedic Surgery, Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Gene Kulesha
2   Stryker Orthopaedics, Mahwah, New Jersey
,
Mark Kester
2   Stryker Orthopaedics, Mahwah, New Jersey
,
Michael A. Mont
1   Department of Orthopaedic Surgery, Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
› Author Affiliations
Further Information

Publication History

21 February 2014

26 February 2014

Publication Date:
24 April 2014 (online)

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Abstract

Additive manufacturing is an industrial technology whereby three-dimensional visual computer models are fabricated into physical components by selectively curing, depositing, or consolidating various materials in consecutive layers. Although initially developed for production of simulated models, the technology has undergone vast improvements and is currently increasingly being used for the production of end-use components in various aerospace, automotive, and biomedical specialties. The ability of this technology to be used for the manufacture of solid-mesh-foam monolithic and coated components of complex geometries previously considered unmanufacturable has attracted the attention of implant manufacturers, bioengineers, and orthopedic surgeons. Currently, there is a paucity of reports describing this fabrication method in the orthopedic literature. Therefore, we aimed to briefly describe this technology, some of the applications in other orthopedic subspecialties, its present use in hip and knee arthroplasty, and concerns with the present form of the technology. As there are few reports of clinical trials presently available, the true benefits of this technology can only be realized when studies evaluating the clinical and radiographic outcomes of cementless implants manufactured with additive manufacturing report durable fixation, less stress shielding, and better implant survivorship. Nevertheless, the authors believe that this technology holds great promise and may potentially change the conventional methods of casting, machining, and tooling for implant manufacturing in the future.

Keywords

arthroplasty - technology - manufacturing
 

  • References

  • 1 Hazlehurst KB, Wang CJ, Stanford M. The potential application of a Cobalt Chrome Molybdenum femoral stem with functionally graded orthotropic structures manufactured using Laser Melting technologies. Med Hypotheses 2013; 81 (6) 1096-1099
    CrossrefPubMedGoogle Scholar
  • 2 Horn TJ, Harrysson OL. Overview of current additive manufacturing technologies and selected applications. Sci Prog 2012; 95 (Pt 3) 255-282
    CrossrefPubMedGoogle Scholar
  • 3 Bourell DL, Beaman Jr JJ, Leu MC , et al. A Brief History of Additive Manufacturing and the 2009 Roadmap for Additive Manufacturing: Looking Back and Looking Ahead. RapidTech 2009: US-Turkey Workshop on Rapid Technologies; 2009
    Google Scholar
  • 4 Krishna BV, Bose S, Bandyopadhyay A. Low stiffness porous Ti structures for load-bearing implants. Acta Biomater 2007; 3 (6) 997-1006
    CrossrefPubMedGoogle Scholar
  • 5 Parthasarathy J, Starly B, Raman S, Christensen A. Mechanical evaluation of porous titanium (Ti6Al4V) structures with electron beam melting (EBM). J Mech Behav Biomed Mater 2010; 3 (3) 249-259
    CrossrefPubMedGoogle Scholar
  • 6 Murr LE, Gaytan SM, Martinez E, Medina F, Wicker RB. Next generation orthopaedic implants by additive manufacturing using electron beam melting. Int J Biomater 2012; 2012: 245727
    PubMedGoogle Scholar
  • 7 Palmquist A, Snis A, Emanuelsson L, Browne M, Thomsen P. Long-term biocompatibility and osseointegration of electron beam melted, free-form-fabricated solid and porous titanium alloy: experimental studies in sheep. J Biomater Appl 2013; 27 (8) 1003-1016
    CrossrefPubMedGoogle Scholar
  • 8 Murr LE, Amato KN, Li SJ , et al. Microstructure and mechanical properties of open-cellular biomaterials prototypes for total knee replacement implants fabricated by electron beam melting. J Mech Behav Biomed Mater 2011; 4 (7) 1396-1411
    CrossrefPubMedGoogle Scholar
  • 9 Bertollo N, Da Assuncao R, Hancock NJ, Lau A, Walsh WR. Influence of electron beam melting manufactured implants on ingrowth and shear strength in an ovine model. J Arthroplasty 2012; 27 (8) 1429-1436
    CrossrefPubMedGoogle Scholar
  • 10 Kern R. 3-D Printed implants hit the market, pave the way for more personalized devices. The Gray Sheet . Vol. 39, No. 44; November 4, 2013
    PubMedGoogle Scholar
  • 11 Gan Y, Xu D, Lu S, Ding J. Novel patient-specific navigational template for total knee arthroplasty. Comput Aided Surg 2011; 16 (6) 288-297
    CrossrefPubMedGoogle Scholar
  • 12 Yaffe MA, Patel A, Mc Coy BW , et al. Component sizing in total knee arthroplasty: patient-specific guides vs. computer-assisted navigation. Biomed Tech (Berl) 2012; 57 (4) 277-282
    PubMedGoogle Scholar
  • 13 Issa K, Rifai A, McGrath MS , et al. Reliability of templating with patient-specific instrumentation in total knee arthroplasty. J Knee Surg 2013; 26 (6) 429-433
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Small T, Krebs V, Molloy R, Bryan J, Klika AK, Barsoum WK. Comparison of acetabular shell position using patient specific instruments vs. standard surgical instruments: a randomized clinical trial. J Arthroplasty 2013; ; October 16 (Epub ahead of print)
    PubMedGoogle Scholar
  • 15 Russell R, Brown T, Huo M, Jones R. Patient-specific instrumentation does not improve alignment in total knee arthroplasty. J Knee Surg 2014; ; February 6 (Epub ahead of print)
    PubMedGoogle Scholar
  • 16 Marimuthu K, Chen DB, Harris IA, Wheatley E, Bryant CJ, Macdessi SJ. A multi-planar CT-based comparative analysis of patient-specific cutting guides with conventional instrumentation in total knee arthroplasty. J Arthroplasty 2013; ; December 19 (Epub ahead of print)
    PubMedGoogle Scholar
  • 17 Macdessi SJ, Jang B, Harris IA, Wheatley E, Bryant C, Chen DB. A comparison of alignment using patient specific guides, computer navigation and conventional instrumentation in total knee arthroplasty. Knee 2013;
    PubMedGoogle Scholar
  • 18 Hamilton WG, Parks NL, Saxena A. Patient-specific instrumentation does not shorten surgical time: a prospective, randomized trial. J Arthroplasty 2013; 28 (8, Suppl): 96-100
    CrossrefPubMedGoogle Scholar
  • 19 Watters TS, Mather III RC, Browne JA, Berend KR, Lombardi Jr AV, Bolognesi MP. Analysis of procedure-related costs and proposed benefits of using patient-specific approach in total knee arthroplasty. J Surg Orthop Adv 2011; 20 (2) 112-116
    PubMedGoogle Scholar
  • 20 Nunley RM, Ellison BS, Ruh EL , et al. Are patient-specific cutting blocks cost-effective for total knee arthroplasty?. Clin Orthop Relat Res 2012; 470 (3) 889-894
    CrossrefPubMedGoogle Scholar
  • 21 Erbano BO, Opolski AC, Olandoski M , et al. Rapid prototyping of three-dimensional biomodels as an adjuvant in the surgical planning for intracranial aneurysms. Acta Cir Bras 2013; 28 (11) 756-761
    CrossrefPubMedGoogle Scholar
  • 22 Brown GA, Firoozbakhsh K, DeCoster TA, Reyna Jr JR, Moneim M. Rapid prototyping: the future of trauma surgery?. J Bone Joint Surg Am 2003; 85-A (Suppl. 04) 49-55
    PubMedGoogle Scholar
  • 23 Dérand P, Rännar LE, Hirsch JM. Imaging, virtual planning, design, and production of patient-specific implants and clinical validation in craniomaxillofacial surgery. Craniomaxillofac Trauma Reconstr 2012; 5 (3) 137-144
    CrossrefPubMedGoogle Scholar
  • 24 Akiba T, Nakada T, Inagaki T. Three-dimensional pulmonary model using rapid-prototyping in patient with lung cancer requiring segmentectomy. Ann Thorac Cardiovasc Surg 2013; ; November 8 (Epub ahead of print)
    PubMedGoogle Scholar
  • 25 Won SH, Lee YK, Ha YC, Suh YS, Koo KH. Improving pre-operative planning for complex total hip replacement with a rapid prototype model enabling surgical simulation. Bone Joint J 2013; 95-B (11) 1458-1463
    CrossrefPubMedGoogle Scholar
  • 26 Mashiko T, Otani K, Kawano R , et al. Development of 3-dimensional hollow elastic-model for cerebral aneurysm clipping simulation enabling rapid and low-cost prototyping. World Neurosurg 2013; ; October 16 (Epub ahead of print)
    PubMedGoogle Scholar
  • 27 Merc M, Drstvensek I, Vogrin M, Brajlih T, Recnik G. A multi-level rapid prototyping drill guide template reduces the perforation risk of pedicle screw placement in the lumbar and sacral spine. Arch Orthop Trauma Surg 2013; 133 (7) 893-899
    CrossrefPubMedGoogle Scholar
  • 28 Hazeveld A, Huddleston Slater JJ, Ren Y. Accuracy and reproducibility of dental replica models reconstructed by different rapid prototyping techniques. Am J Orthod Dentofacial Orthop 2014; 145 (1) 108-115
    CrossrefPubMedGoogle Scholar
  • 29 Bullock P, Dunaway D, McGurk L, Richards R. Integration of image guidance and rapid prototyping technology in craniofacial surgery. Int J Oral Maxillofac Surg 2013; 42 (8) 970-973
    CrossrefPubMedGoogle Scholar
  • 30 Arora A, Datarkar AN, Borle RM, Rai A, Adwani DG. Custom-made implant for maxillofacial defects using rapid prototype models. J Oral Maxillofac Surg 2013; 71 (2) e104-e110
    CrossrefPubMedGoogle Scholar
  • 31 Li X, Feng YF, Wang CT , et al. Evaluation of biological properties of electron beam melted Ti6Al4V implant with biomimetic coating in vitro and in vivo. PLoS ONE 2012; 7 (12) e52049
    CrossrefPubMedGoogle Scholar
  • 32 Huang SL, Wen B, Bian WG, Yan HW. Reconstruction of comminuted long-bone fracture using CF/CPC scaffolds manufactured by rapid prototyping. Med Sci Monit 2012; 18 (11) BR435-BR440
    PubMedGoogle Scholar
  • 33 Yang J, Cai H, Liu Z , et al. In vivo study of a self-stabilizing artificial vertebral body fabricated by electron beam melting. Spine 2014; ; January 21 (Epub ahead of print)
    PubMedGoogle Scholar
  • 34 Bustamante S, Bose S, Bishop P, Klatte R, Norris F. Novel application of rapid prototyping for simulation of bronchoscopic anatomy. J Cardiothorac Vasc Anesth 2013; ; December 12 (Epub ahead of print)
    PubMedGoogle Scholar
  • 35 Challoner A, Erolin C. Creating pathology models from MRI data: a comparison of virtual 3D modelling and rapid prototyping techniques. J Vis Commun Med 2013; 36 (1–2) 11-19
    PubMedGoogle Scholar
  • 36 Waran V, Pancharatnam D, Thambinayagam HC , et al. The utilization of cranial models created using rapid prototyping techniques in the development of models for navigation training. J Neurol Surg A Cent Eur Neurosurg 2014; 75 (1) 12-15
    PubMedGoogle Scholar
  • 37 Huotilainen E, Jaanimets R, Valášek J , et al. Inaccuracies in additive manufactured medical skull models caused by the DICOM to STL conversion process. J Craniomaxillofac Surg 2013; ; November 1 (Epub ahead of print)
    PubMedGoogle Scholar
  • 38 Chrzan R, Miechowicz S, Urbanik A, Markowska O, Kudasik T. Individually fitted hearing aid device manufactured using rapid prototyping based on ear CT. A case report. Neuroradiol J 2009; 22 (2) 209-214
    PubMedGoogle Scholar
  • 39 Tognola G, Parazzini M, Svelto C, Galli M, Ravazzani P, Grandori F. Design of hearing aid shells by three dimensional laser scanning and mesh reconstruction. J Biomed Opt 2004; 9 (4) 835-843
    CrossrefPubMedGoogle Scholar
  • 40 Massari L, Bagni B, Biscione R, Traina GC. Periprosthetic bone density in uncemented femoral hip implants with proximal hydroxylapatite coating. Bull Hosp Jt Dis 1996; 54 (4) 206-210
    PubMedGoogle Scholar