J Shanghai Jiaotong Univ Sci

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

• Medical 3D Printing and Personalised Medicine •Previous ArticlesNext Articles

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

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)
  2. (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:2021-06-28Published: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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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.

Key words:3D printing, revision, total knee arthroplasty, bone defect

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.

关键词:3D printing, revision, total knee arthroplasty, bone defect

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