Custom made implants using Additive Technology Future of personalized joint replacement solutions and orthopaedic products

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Augusta Williamson
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1 Custom made implants using Additive Technology Future of personalized joint replacement solutions and orthopaedic products SESVETE (ZAGREB), Rimski put 31, Sesvete P.P. 10 / Tel (0) , ; / TELEFAX +385 (0) , , instrumentaria@instrumentaria.hr 1

2 Custom Made Case - 15 Year Old Male Pelvic Tumor Medical Team: prof. dr. Robert Kolundžić, dr.sc. Srećko Sabalić, dr. Tadija Petrović, dr. Tomislav Čengić Instrumentaria R&D team: Krešimir Šoštarko, Atif Cakor FEA testing: Dr. sc. Janoš Kodvanj, Faculty of Mechanical Engineering Project Startup : Surgery Date :

Tomislav Čengić Instrumentaria R&D team: Krešimir Šoštarko, Atif Cakor FEA testing:

3 15 Year old Male diagnosed with a tumor in the left pelvis Tumor infected whole Acetabulum and Ilium area and Femoral head Surgeons indicated treatment with THA with Custom Made Pelvis implant Patient Condition required quick respond Comprehensive portfolio of standard traumatology and orthopedic products in some cases is not sufficient enough for a successful operation. Due to the spread of the tumor at the pelvis, it was necessary to make greater resection which required development of custom made pelvis implant in accordance with the estimated position of the resection. The solution proposed in this project is a synergy of three aspects of expertise: strategic planning and medical design expertise, medical industry and 3D printing expertise. 3

Due to the spread of the tumor at the pelvis, it was necessary to make greater resection which required development of custom made pelvis implant in accordance with the estimated position

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The basis for this specially designed implant is patient CT data based on which experts constructed threedimensional models, which is a prerequisite for the design of

5 The basis for this specially designed implant is patient CT data based on which experts constructed threedimensional models, which is a prerequisite for the design of implants that will comply with the requirements for each specific case. Segmentation Process on 300 axial slices with 1 mm slice thickness followed by noise reduction 5

of implants that will comply with the requirements for each specific case.

6 Creating 3D Model of Right Pelvis, Sacrum and Left Pelvis DETERMINATION OF RESECTION POSITION Workshop with surgeons Creating 3D CAD Model 6

7 2.1 Implant Cavity Construction 2.2 Liner Slot Construction 2.3 Holes Construction Construction of Supporting Columns 2.5 Implant cutting on the top of the pelvis 2.6 Docking Construction toward upper part of the pelvis 2.6 Implant cutting on the bottom side of the pelvis 2.7 Support Construction for fixation with bone 7

5 Implant cutting on the top of the pelvis 2.

8 3D Validation of the Final Model 8

9 FEA Testing Strain and Micromotion Testing 9

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11 Implant Verification 11

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13 Final Product : Custom Made Titanium alloy Pelvis Implant 13

14 Other THA Components : 1. Custom Made UHMWPE Acetabular Liner 2. Instrumentaria Zweymuller stem 3. Co-Cr Femoral Head 12/14 14

15 Surgical Procedure and Implantation 15

16 Pre-OP 3D model Post-Op X-Ray 16

17 Similar Custom Made implants projects using 3D print technology: 17

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19 Pre-Op Model Post-OP X-Ray 19

20 References : 1. Dominkus M, Darwish E, Funovics P. Reconstruction of the pelvis after resection of malignant bone tumours in children and adolescents. Recent Results Cancer Res. 2009;179: Iftikhar Ahmad, Azhar Quddus, Heikki-Jussi Laine, Olli Yli-Harja : Image segmentation of the ct-scans of hip endoprostheses 3. Leondes CT. Biomechanical Systems Technology - 4 Volume set, World Scientific Publishing Co. Pte. Ltd. ISBN , ISBN Heissler E, Fischer FS, Bolouri S, Lehmann T, Mathar W, Gebhardt A, Lanksch W,Bier J. Custom-made cast titanium implants produced with CAD/CAM for the reconstruction of cranium defects. Int J Oral Maxillofac Surg Oct;27(5): Grbic S, Mansi T, Ionasec R, Voigt I, Houle H, John M, Schoebinger M, Navab N, Comaniciu D. Image-based computational models for TAVI planning: from CT images to implantdeployment. Med Image Comput Comput Assist Interv. 2013;16(Pt 2): Jirman R, Vavrík P, Horák Z. [Custom-designed 3D tibial augmentation for knee replacement]. Acta Chir Orthop Traumatol Cech Feb;76(1): Niels W.L. Schep. Computer Assisted Orthopaedic and Trauma Surgery 8. Druschel C, Pirvu T, Schaser KD, Schwabe P, Melcher I. [Manifestation of osteosarcoma of chronic osteomyelitis: 2 case reports]. Unfallchirurg Sep;116 (9): Ciocca L, Mazzoni S, Fantini M, Persiani F, Baldissara P, Marchetti C, Scotti R. A CAD/CAM-prototyped anatomical condylar prosthesis connected to a custommade bone plate to support a fibula free flap. Med Biol Eng Comput Jul;50(7): Dai KR, Yan MN, Zhu ZA, Sun YH. Computer-aided custom-made hemipelvic prosthesis used in extensive pelvic lesions. J Arthroplasty Oct;22(7): Sun W, Li J, Li Q, Li G, Cai Z. Clinical effectiveness of hemipelvic reconstruction using computer-aided custom-made prostheses after resection of malignant pelvic tumors. J Arthroplasty Dec;26(8): doi: /j.arth Epub 2011 Apr Guo W, Yang RL, Tang XD, Tang S, Li DS, Yang Y. [Resection and reconstruction for primary pelvic tumors around acetabular]. Zhonghua Wai Ke Za Zhi Dec 7;42(23): Jiang T, Liu J. [Design, production and clinical application of custom total hip prosthesis]. Sheng Wu Yi Xue Gong Cheng Xue Za Zhi Apr;22(2): Gong X, Kang L, Wang J. [Study on design method for the individual anatomical hip joint endoprosthesis]. Sheng Wu Yi Xue Gong Cheng Xue Za Zhi Feb;25(1): Brassey CA, Kitchener AC, Withers PJ, Manning PL, Sellers WI. The role of cross-sectional geometry, curvature, and limb posture in maintaining equal safety factors: a computed tomography study. Anat Rec (Hoboken) Mar;296(3): doi: /ar Fernandes R, DiPasquale J. Computer-aided surgery using 3D rendering of maxillofacial pathology and trauma. Int J Med Robot Sep;3(3): Bagaria V, Deshpande S, Rasalkar DD, Kuthe A, Paunipagar BK. Use of rapid prototyping and three-dimensional reconstruction modeling in the management of complex fractures. Eur J Radiol Dec;80(3):

Biomechanical Systems Technology - 4 Volume set, World Scientific Publishing Co. Pte. Ltd. ISBN-13 978-981-270-981-3, ISBN-13 978-981-270-984-4 4.

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