Additive manufacturing methods enable the rapid fabrication of fully functional customized objects with complex geometry and lift the limitations of traditional manufacturing techniques, such as machining. Therefore, the structural optimization of parts has concentrated increased scientific interest and more especially for topology optimization (TO) processes. In this paper, the working principles and the two approaches of the TO procedures were analyzed along with an investigation and a comparative study of a novel case study for the TO processes of a tibial implant designed for additive manufacturing (DfAM). In detail, the case study focused on the TO of a tibial implant for knee replacement surgery in order to improve the overall design and enhance its efficiency and the rehabilitation process. An initial design of a customized tibial implant was developed utilizing reserve engineering procedures with DICOM files from a CT scan machine. The mechanical performance of the designed implant was examined via finite element analyses (FEA) under realistic static loads. The TO was conducted with two distinct approaches, namely density-based and discrete-based, to compare them and lead to the best approach for biomechanical applications. The overall performance of each approach was evaluated through FEA, and its contribution to the final mass reduction was measured. Through this study, the maximum reduction in the implant’s mass was achieved by maintaining the mechanical performance at the desired levels and the best approach was pointed out. To conclude, with the discrete-based approach, a mass reduction of around 45% was achieved, almost double of the density-based approach, offering on the part physical properties which provide comprehensive advantages for biomechanical application.
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