Morphometric analysis of patient-specific 3D-printed acetabular cups: a comparative study of commercially available implants from 6 manufacturers
Tóm tắt
3D printed patient-specific titanium acetabular cups are used to treat patients with massive acetabular defects. These have highly porous surfaces, with the design intent of enhancing bony fixation. Our aim was to characterise these porous structures in commercially available designs. We obtained 12 final-production, patient-specific 3D printed acetabular cups that had been produced by 6 manufacturers. High resolution micro-CT imaging was used to characterise morphometric features of their porous structures: (1) strut thickness, 2) the depth of the porous layer, (3) pore size and (4) the level of porosity. Additionally, we computed the surface area of each component to quantify how much titanium may be in contact with patient tissue. Statistical comparisons were made between the designs. We found a variability between designs in relation to the thickness of the struts (0.28 to 0.65 mm), how deep the porous layers are (0.57 to 11.51 mm), the pore size (0.74 to 1.87 mm) and the level of porosity (34 to 85%). One manufacturer printed structures with different porosities between the body and flange; another manufacturer had two differing porous regions within the body of the cups. The cups had a median (range) surface area of 756.5 mm2 (348 – 1724). There is a wide variability between manufacturers in the porous titanium structures they 3D print. We do not currently know whether there is an optimal porosity and how this variability will impact clinically on the integrity of bony fixation; this will become clearer as post market surveillance data is generated.
Tài liệu tham khảo
Durand-Hill M, Henckel J, Di Laura A, Hart AJ. Can custom 3D printed implants successfully reconstruct massive acetabular defects? A 3D-CT assessment. J Orthop Res. 2020;38(12):2640–8.
Tack P, Victor J, Gemmel P, Annemans L. Do custom 3D-printed revision acetabular implants provide enough value to justify the additional costs? The health-economic comparison of a new porous 3D-printed hip implant for revision arthroplasty of Paprosky type 3B acetabular defects and its closest alternative. Orthop Traumatol Surg Res. 2021;107(1): 102600.
Dall’Ava L, Hothi H, Di Laura A, Henckel J, Hart A. 3D printed acetabular cups for total hip arthroplasty: a review article. Metals. 2019;9(7):729.
Dall’Ava L, Hothi H, Henckel J, Di Laura A, Shearing P, Hart A. Comparative analysis of current 3D printed acetabular titanium implants. 3D Print Med. 2019;5:15.
Dall’Ava L, Hothi H, Henckel J, Di Laura A, Bergiers S, Shearing P, Hart A. Dimensional analysis of 3D-printed acetabular cups for hip arthroplasty using X-ray microcomputed tomography. Rapid Prototyping J. 2020;26(3):567–76.
Dall’Ava L, Hothi H, Henckel J, Di Laura A, Shearing P, Hart A. Characterization of dimensional, morphological and morphometric features of retrieved 3D-printed acetabular cups for hip arthroplasty. J Orthop Surg Res. 2020;15:157.
Ghanem M, Zajonz D, Heyde CE, Roth A. Acetabular defect classification and management: revision arthroplasty of the acetabular cup based on 3-point fixation. Der Orthopade. 2020;49(5):432–42.
Sikavitsas VI, Temenoff JS, Mikos AG. Biomaterials and bone mechanotransduction. Biomaterials. 2001;22(19):2581–93.
Wang X, Zhu Z, Xiao H, Luo C, Luo X, Lv F, Liao J, Huang W. Three-dimensional, multiscale, and interconnected trabecular bone mimic porous tantalum scaffold for bone tissue engineering. ACS Omega. 2020;5(35):22520–8.
Karageorgiou V, Kaplan D. Porosity of 3D biomaterial scaffolds and osteogenesis. Biomaterials. 2005;26(27):5474–91.
Boyan BD, Hummert TW, Dean DD, Schwartz Z. Role of material surfaces in regulating bone and cartilage cell response. Biomaterials. 1996;17(2):137–46.
Freyman TM, Yannas IV, Gibson LJ. Cellular materials as porous scaffolds for tissue engineering. Prog Mater Sci. 2001;46:273e82.
Li G, Wang L, Pan W, et al. In vitro and in vivo study of additive manufactured porous Ti6Al4V scaffolds for repairing bone defects. Sci Rep. 2016;6:34072.
Kujala S, Ryhänen J, Danilov A, Tuukkanen J. Effect of porosity on the osteointegration and bone ingrowth of a weight-bearing nickel-titanium bone graft substitute. Biomaterials. 2003;24(25):4691–7.
Frosch KH, Barvencik F, Viereck V, Lohmann CH, Dresing K, Breme J, Brunner E, Stürmer KM. Growth behavior, matrix production, and gene expression of human osteoblasts in defined cylindrical titanium channels. J Biomed Mater Res A. 2004;68(2):325–34.
Zhao D, Huang Y, Ao Y, Han C, Wang Q, Li Y, Liu J, Wei Q, Zhang Z. Effect of pore geometry on the fatigue properties and cell affinity of porous titanium scaffolds fabricated by selective laser melting. J Mech Behav Biomed Mater. 2018;88:478–87.
Li JP, Habibovic P, van den Doel M, Wilson CE, de Wijn JR, van Blitterswijk CA, de Groot K. Bone ingrowth in porous titanium implants produced by 3D fiber deposition. Biomaterials. 2007;28(18):2810–20.
Ziebart J, Fan S, Schulze C, Kämmerer PW, Bader R, Jonitz-Heincke A. Effects of interfacial micromotions on vitality and differentiation of human osteoblasts. Bone Joint Res. 2018;7(2):187–95.
Sidambe AT. Biocompatibility of advanced manufactured titanium implants-a review. Materials (Basel, Switzerland). 2014;7(12):8168–88.
Hothi H, Dall’Ava L, Henckel J, Di Laura A, Iacoviello F, Shearing P, Hart A. Evidence of structural cavities in 3D printed acetabular cups for total hip arthroplasty. J Biomed Mater Res B Part Appl Biomater. 2020;108(5):1779.