Porous Titanium Implants Research Articles

Long-term enophthalmos after complex orbital bone loss successfully treated with patient-specific porous titanium implants: A case series

IntroductionLong-term enophthalmos and diplopia resulting from orbital bone loss pose significant challenges in reconstructive surgery. This study evaluated the effectiveness of patient-specific porous titanium implants (PSIs) for addressing these conditions. Materials and methodsThis retrospective study involved 12 patients treated at Croix-Rousse Hospital, Lyon, from April 2015 to April 2022 who underwent late reconstruction via PSI for unilateral complex orbital bone loss. These implants were customized via 3D mirroring techniques on the basis of high-resolution computed tomography (CT) scans of the patients' unaffected orbits. ResultsAll 12 patients presented with significant preoperative enophthalmos, with an average displacement of 3.24 mm, which was effectively corrected postoperatively to an average of 0.17 mm (p < 0.001). Orbital volume notably improved from a preoperative average of 3.38 mL to 0.37 mL postsurgery (p < 0.001). Functional improvements were evident as both enophthalmos and diplopia resolved completely. The Lancaster test revealed an improvement in the visual field, with 83.3 % of patients achieving normal results postoperatively. DiscussionBy ensuring anatomical accuracy, patient-specific porous titanium implants, tailored from patient-specific imaging and fabricated via advanced 3D printing technology, provide a precise, effective, and reliable solution for reconstructing complex orbital defects and performing complicated revision surgeries.

Cleaning and coating procedures determine biological properties of gyroid porous titanium implants

Cleaning and coating procedures determine biological properties of gyroid porous titanium implants

Efficacy of Commercially Available Irrigation Solutions on Removal of Staphylococcus Aureus and Biofilm From Porous Titanium Implants: An In Vitro Study

BackgroundPeriprosthetic joint infection remains a major problem. The bactericidal efficacy of commercial irrigation solutions for the treatment of infection is not well established in the presence of porous titanium (Ti) implants. This study compared the in vitro efficacy of five irrigation solutions on infected three-dimensional–printed porous Ti discs. MethodsTitanium discs (2 × 4 mm, 400, 700, and 1,000 μm) were infected with S. aureus (1 × 106 colony-forming unit/mL) and incubated for 3 hours or 3 days to create acute or chronic infection with biofilm. Discs were irrigated with saline, antibiotic, or antiseptic solutions, then repeatedly sonicated. Sonicates were cultured for bacterial quantification. Statistical analyses were performed using one-way analysis of variance (ANOVA), followed by Tukey-Kramer post hoc testing (P < .05 significance). Biofilms were visualized by scanning electron microscopy. ResultsSaline irrigation was ineffective in both groups. In acute infections with 400 μm pores, differences were found with saline versus solution #3 (P = .015) and #4 (P = .015). Solution #4 had the lowest bacterial counts for all pore sizes. For biofilm, irrigation with saline, solutions #1, #2, and #3 inadequately cleared bacteria in all pore sizes. Lower remaining concentrations were observed in #4 with 400μm pores compared to saline (P = .06) and #2 (P = .039). The scanning electron microscopy showed a reduction of biofilm in samples washed with #4. ConclusionsIrrigation of infected porous Ti discs with saline, solutions #1 and #2 failed to reduce the bacterial load. The 400 μm discs consistently had more bacteria despite irrigation, highlighting the difficulty of removing bacteria from small pores. Solutions #3 and #4 reduced bacteria acutely, but only #4 demonstrated efficacy in clearing biofilm compared to saline. These results should be considered when treating periprosthetic joint infection in the presence of porous components and the potential presence of biofilm.

From clinic to lab: Advances in porous titanium-based orthopedic implant research

Solid titanium alloys are extensively employed in orthopedic applications due to their reliable mechanical strength, but the stress shielding phenomenon caused by its high elastic modulus and the disadvantage of lack of bone integration may lead to clinical complications. The design of porous structure is a feasible approach to reduce the elastic modulus and promote bone and vascular ingrowth. This paper reviewed the application and current challenges of solid titanium implants in orthopedics. To address the drawbacks and explore porous titanium implants that can effectively integrate with bone tissue while possessing sufficient mechanical strength, this review discussed the latest preclinical research from the perspectives of structural design, surface modification, and material composition. The porous structure parameters that affect bone ingrowth and mechanical strength in implants, including porosity, pore size, cellular structure, and gradient structure, were presented. Based on the current research progress, various surface modification techniques aimed at enhancing the performance of porous titanium implants were overviewed. Moreover, a range of titanium alloys including nickel-titanium alloy, β-titanium alloy, high-entropy alloy, and composite alloys are investigated for their prospective applications in orthopedics. Overall, this review provided valuable insights into the current state of research and highlighted the potential of porous titanium alloys in improving clinical outcomes in orthopedics.

Stress distribution pattern in all-on-four maxillary restorations supported by porous tantalum and solid titanium implants using three-dimensional finite element analysis.

Success/failure of dental implants depends on stress transfer and distribution at the bone-implant interface. This study aimed to assess the stress distribution pattern in all-on-four maxillary restorations supported by porous tantalum and solid titanium implants using three-dimensional (3D) finite element analysis (FEA). In this FEA, a geometric model of an edentulous maxilla, Zimmer screw-vent tantalum and solid titanium implants were modelled. Four models with the all-on-four concept were designed. The fifth model had 6 vertical implants (all-on-six). Two different implant types (porous tantalum and solid titanium) were modelled to yield a total of 10 models, and subjected to 200 N bilateral vertical load. Pattern of stress distribution and maximum von Mises stress values in cancellous and cortical bones around implants were analysed. In tantalum models, the effect of increasing the distal tilting of posterior implants was comparable to the effect of increasing the number of implants to 6 on von Mises stress values in cortical bone. However, in cancellous bone, the effect of increasing the tilting of posterior implants on stress was slightly greater than the effect of increasing the number of implants to 6. In solid titanium models, the effect of both of the abovementioned parameters was comparable on stress in cancellous bone; but in cortical bone, the effect of increasing the implant number was slightly greater on stress reduction. Despite similar pattern of stress distribution in bone around implants, higher maximum von Mises stress values around tantalum implants indicate higher stress transfer capacity of this type of implant to the adjacent bone, compared with solid titanium implants.

Drug-Releasing Tannic Acid-Mediated Adhesive PEG Hydrogel for Porous Titanium Implants.

Porous titanium implants are commonly utilized for orthopedic surgery because they can mimic the mechanical properties and porous structure of human bone. However, the bioinertness of titanium (Ti) has been reported to obstruct biointegration processes, resulting in slower bone repair. Here, we propose a localized drug delivery system on Ti surfaces using adhesive hydrogel to enhance biological-Ti interactions. The hydrogel was fabricated from polyethylene glycol (PEG), which was cross-linked by the complex of tannic acid (TA) and 1,4-phenylenediboronic acid (PDBA) and stabilized by bovine serum albumin (BSA). The hydrogel was formed and attached to a Ti plate to investigate stability, biodegradability, controlled drug release, and biocompatibility. The stability and biodegradability of the hydrogel could be tuned by adjusting the concentrations of BSA and TA. The hydrogel lasted and remained adhered to the Ti surface after being submerged in PBS for at least 15 days. The controlled release of strontium ranelate (SrRan) and the release mechanism depended on the amount of TA since it was found to govern the hydrogel integrity and pore size. Additionally, in vitro biocompatibility was validated using L929 fibroblast and MC3T3-E1 osteoblast cells that showed greater than 70% viability. The adhesive hydrogel was further studied by injecting it into a 3D-printed Ti-scaffold that contained a porous structure mimicking natural human bone. The hydrogel completely filled and adhered to the inner porous structure of the scaffold. The biodegradation and drug release of the hydrogel in the scaffold occurred at a slower rate, suggesting sustainable drug release that is suitable for bone cell regeneration. The overall results in biodegradability, controlled drug release, and biocompatibility demonstrate the great potential of the drug-releasing TA-mediated adhesive PEG hydrogel as a Ti-enhancing biomaterial that supports osseointegration.

Development and Preclinical Trials of Castomized Porous Titanium Implants with Bioactive Coatings in Model Systems

This paper presents a technology for creating customized porous titanium implants with bioactive coatings, manufactured using additive technologies. The stages of creating an implant include obtaining primary data from the bone defect area using computed tomography; 3D modeling of the defect area and the corresponding implant; production of a customized implant from titanium alloys using selective laser fusion technology; application of bioactive coatings. The as-created customized implant can have several functional structures. Samples of titanium implants with bioactive coatings were subjected to extensive testing. Mathematical modeling and experiments were used to verify the correspondence of the mechanical properties of the developed structures to natural bone tissue. In vitro tests of the studied samples showed the absence of acute toxicity along with high levels of biocompatibility. In vivo tests of the studied samples on Soviet chinchilla rabbits and Anubis baboon monkeys approved by local ethical committees showed their adequate biomechanical and high osteoinductive properties. The successful results of preclinical studies, as well as toxicological and technical tests in certified laboratories, made it possible to create a registration dossier for state registration of customized porous titanium implants with bioactive coatings, manufactured using additive technologies.

In Vivo Prevention of Implant-Associated Infections Caused by Antibiotic-Resistant Bacteria through Biofunctionalization of Additively Manufactured Porous Titanium.

Additively manufactured (AM) porous titanium implants may have an increased risk of implant-associated infection (IAI) due to their huge internal surfaces. However, the same surface, when biofunctionalized, can be used to prevent IAI. Here, we used a rat implant infection model to evaluate the biocompatibility and infection prevention performance of AM porous titanium against bioluminescent methicillin-resistant Staphylococcus aureus (MRSA). The specimens were biofunctionalized with Ag nanoparticles (NPs) using plasma electrolytic oxidation (PEO). Infection was initiated using either intramedullary injection in vivo or with in vitro inoculation of the implant prior to implantation. Nontreated (NT) implants were compared with PEO-treated implants with Ag NPs (PT-Ag), without Ag NPs (PT) and infection without an implant. After 7 days, the bacterial load and bone morphological changes were evaluated. When infection was initiated through in vivo injection, the presence of the implant did not enhance the infection, indicating that this technique may not assess the prevention but rather the treatment of IAIs. Following in vitro inoculation, the bacterial load on the implant and in the peri-implant bony tissue was reduced by over 90% for the PT-Ag implants compared to the PT and NT implants. All infected groups had enhanced osteomyelitis scores compared to the noninfected controls.

3D Printed Titanium Wedges for Distraction Arthrodesis of the Subtalar Joint

Category: Hindfoot Introduction/Purpose: Distraction arthrodesis of the subtalar joint is performed to restore height and correct deformity in the case of subtalar joint arthrosis, malalignment of the rear foot, calcaneal fracture, or other pathologies. Historically, autograft or allograft bone blocks were used to restore natural alignment and improve hindfoot function. Although successful use has been reported, complications associated with donor site morbidity and size limitation for autograft, as well as additional complications including nonunion, graft collapse, and loss of alignment are common. Recently, innovative advancements have enabled the use of 3D printed porous titanium implants for use, improving the union rates and reduced risk of subsidence and graft collapse. Methods: 6 patients with subtalar collapse and anterior ankle impingement were indicated for distraction subtalar arthrodesis. Surgery was performed with a lateral approach for the distraction arthrodesis using an off the shelf 3D printed subtalar wedge and a nitinol pseudoelastic fusion rod for stabilization and fixation. Patients were followed 6 months post op for fusion and alignment. Fusion was confirmed at 3 months with CT scans and alignment was monitored with weightbearing ankle X-rays. Results: 3D wedge incorporation and sustained correction of height and alignment was maintained over time at the subtalar joint. There were no nonunions, 2 patients reports skin healing issues due to tension on the skin with wound closure. These healed with local wound care. Improvement in preoperative to postoperative tibiotalar sagittal plane alignment was observed in all patients. Conclusion: The use of a 3D printed titanium wedge for distraction Arthrodesis of the subtalar joint is a safe procedure and useful procedure in short-term follow-up. This procedure does provide improvement in the patients alignment and fusion occurs with in 3 months of surgery.

Surface Modification of Porous Titanium and Titanium Alloy Implants Manufactured by Selective Laser Melting: A Review

Titanium (Ti) and its alloy implants with porous structures manufactured by selective laser melting (SLM) can match the elastic modulus of human bone to reduce the stress‐shielding effect and satisfy the personalized requirement in orthopedic surgery. Compared with conventional casting and forging Ti and its alloy implants, SLM implants possess unique microstructural features and excellent comprehensive mechanical properties. However, the unmelted powder particles inevitably adhere to the surfaces of SLM implants, which may result in excessive surface roughness and potential health risks. Moreover, there are significant issues encountered, such as bioactivity, toxicity, antibacterial activity, corrosion, and wear resistance. Consequently, surface modification methods are essential to remove the unmelted powder particles and improve biological and mechanical properties of SLM implants. Herein, the research efforts focus exclusively on chemical (acid treatment, alkali treatment, sol–gel, chemical vapor deposition, and atomic layer deposition) and electrochemical methods (anodization and microarc oxidation) for SLM Ti and its alloy implants, especially for porous structures. Particularly, the characteristics of these methods are summarized, and their commonly used pre‐ and post‐treatment methods are introduced. In addition, the development trends and challenges in surface modification of SLM Ti and its alloy implants are discussed.

Osseointegrability of 3D-printed porous titanium alloy implant on tibial shaft bone defect in rabbit model.

Previous studies have demonstrated the ability of osseointegration of porous titanium implants in cancellous bone. Our study was designed to (i) investigate the ability of bone ingrowth into 3D-printed porous titanium alloy implant on the cortical bone of rabbits using CT-scan and histology, and (ii) to identify the consistency of the radiology information between clinical Cone Beam Computed Tomography (CBCT) and Micro Computed Tomography (μCT) in the evaluation of bone ingrowth. The porous titanium alloy implants were 3D-printed employing the Electron Beam Melting (EBM) technology with an intended pore size of 600 μm and porosity of approximately 50 percent. Each implant was inserted into tibial diaphysis in one rabbit and its pores were classified as contacting bone or non-contacting bone. Depending on the time of explantation, the rabbits were divided into two groups: group 1 consisting of 6 rabbits between 13 and 20 weeks and group 2 consisting of 6 rabbits between 26 and 32 weeks. Tissue ingrowth into the non-bone contacting pores were evaluated by CBCT and histology. μCT was used to further investigate the bone ingrowth into four implants (two from each group were randomly chosen). The CBCT detected the present of tissue with bone-like density in both bone-contacting pores and non-bone-contacting pores of all implants. The μCT analysis also supported this result. All the bone-like tissues were then histologically confirmed to be mature bone. The analysis of CBCT data to assess bone ingrowth in porous implants had the sensitivity, specificity, positive and negative predictive values of 85, 84, 93 and 70 percent, respectively, when considering μCT assessment as the gold standard. Fully porous titanium alloy implant has great potential to reconstruct diaphyseal bone defect due to its good ability of osseointegration. CBCT is a promising method for evaluation of bone ingrowth into porous implants.

Versatile Biodegradable Poly(acrylic acid)-Based Hydrogels Infiltrated in Porous Titanium Implants to Improve the Biofunctional Performance.

This research work proposes a synergistic approach to improve implants' performance through the use of porous Ti substrates to reduce the mismatch between Young's modulus of Ti (around 110 GPa) and the cortical bone (20-25 GPa), and the application of a biodegradable, acrylic acid-based polymeric coating to reduce bacterial adhesion and proliferation, and to enhance osseointegration. First, porous commercially pure Ti substrates with different porosities and pore size distributions were fabricated by using space-holder techniques to obtain substrates with improved tribomechanical behavior. On the other hand, a new diacrylate cross-linker containing a reduction-sensitive disulfide bond was synthesized to prepare biodegradable poly(acrylic acid)-based hydrogels with 1, 2, and 4% cross-linker. Finally, after the required characterization, both strategies were implemented, and the combination of 4% cross-linked poly(acrylic acid)-based hydrogel infiltrated in 30 vol % porosity, 100-200 μm average pore size, was revealed as an outstanding choice for enhancing implant performance.

Characterizing Mineral Ellipsoids in New Bone Formation at the Interface of Ti6Al4V Porous Implants

AbstractThe hierarchy of newly formed bone contains elements of disorder within an ordered multiscale structure, spanning from the macroscale to below the nanoscale. With mineralized structures presenting in the shape of ellipsoids in mature and mineralizing tissue, this work characterizes the heterogeneity in the mineral ellipsoid packing at the interface of porous titanium implants. Using scanning transmission electron microscopy and plasma‐focused ion beam–scanning electron microscopy, mineral ellipsoids are characterized at the implant interface in both 2D and 3D. Heterogeneous in their size and shape within the newly formed bone tissue, ellipsoids are observed with alternating orientations corresponding to unique lamellar packets within 23 µm of the titanium implant interface—although this motif is not universal, and a mineral‐dense zone can also appear at the implant interface. Short‐order ellipsoid orientation shifts are also present in the 3D probe of the implant interface, where a ≈90° misorientation angle between neighboring packets of mineral ellipsoids (and an intervening organic layer) resolves with increasing distance from the titanium. Combined with local patches of woven‐to‐lamellar transition, the early heterogeneity and transformation of peri‐implant bone structure is a quintessential step in the development of a functional connection between implant and bone.

Dual-Action Effect of Gallium and Silver Providing Osseointegration and Antibacterial Properties to Calcium Titanate Coatings on Porous Titanium Implants.

Previously, functional coatings on 3D-printed titanium implants were developed to improve their biointegration by separately incorporating Ga and Ag on the biomaterial surface. Now, a thermochemical treatment modification is proposed to study the effect of their simultaneous incorporation. Different concentrations of AgNO3 and Ga(NO3)3 are evaluated, and the obtained surfaces are completely characterized. Ion release, cytotoxicity, and bioactivity studies complement the characterization. The provided antibacterial effect of the surfaces is analyzed, and cell response is assessed by the study of SaOS-2 cell adhesion, proliferation, and differentiation. The Ti surface doping is confirmed by the formation of Ga-containing Ca titanates and nanoparticles of metallic Ag within the titanate coating. The surfaces generated with all combinations of AgNO3 and Ga(NO3)3 concentrations show bioactivity. The bacterial assay confirms a strong bactericidal impact achieved by the effect of both Ga and Ag present on the surface, especially for Pseudomonas aeruginosa, one of the main pathogens involved in orthopedic implant failures. SaOS-2 cells adhere and proliferate on the Ga/Ag-doped Ti surfaces, and the presence of gallium favors cell differentiation. The dual effect of both metallic agents doping the titanium surface provides bioactivity while protecting the biomaterial from the most frequent pathogens in implantology.

BONE TISSUE INTERACTION WITH 3D-PRINTED TITANIUM IMPLANTS IN A BIOREACTOR TESTING MACHINE: A PRECLINICAL ASSESSMENT METHODOLOGY FOR NEW IMPLANT DESIGNS

The success of cementless orthopaedic implants relies on bony ingrowth and active bone remodelling. Much research effort is invested to develop implants with controllable surface roughness and internal porous architectures that encourage these biological processes. Evaluation of these implants requires long-term and costly animal studies, which do not always yield the desired outcome requiring iteration. The aim of our study is to develop a cost-effective method to prescreen design parameters prior to animal trials to streamline implant development and reduce live animal testing burden.Ex vivo porcine cancellous bone cylinders (n=6, Ø20×12mm) were extracted from porcine knee joints with a computer-numerically-controlled milling machine under sterile conditions within 4 hours of animal sacrifice. The bone discs were implanted with Ø6×12mm additive manufactured porous titanium implants and were then cultured for 21days. Half underwent static culture in medium (DMEM, 10% FBS, 1% antibiotics) at 37°C and 5% CO2. The rest were cultured in novel high-throughput stacked configuration in a bioreactor that simulated physiological conditions after surgery: the fluid flow and cyclic compression force were set at 10ml/min and 10–150 N (1Hz,5000 cycles/day) respectively. Stains were administered at days 7 and 14. Samples were evaluated with widefield microscopy, scanning electron microscopy (SEM) and with histology.More bone remodelling was observed on the samples cultured within the bioreactor: widefield imaging showed more remodelling at the boundaries between the implant-bone interface, while SEM revealed immature bone tissue integration within the pores of the implant. Histological analysis confirmed these results, with many more trabecular struts with new osteoid formation on the samples cultured dynamically compared to static ones.Ex vivo bone can be used to analyse new implant technologies with lower cost and ethical impact than animal trial. Physiological conditions (load and fluid flow) promoted bone ingrowth and remodelling.

Improving osteogenic and antibacterial properties of porous titanium scaffolds by facile flow-casting of bioactive glass-Ag@MSN coatings

Modification of porous titanium (PT) implants with biological coatings is being challenged due to their inert surface and complex internal structure. A facile flow-casting technique has been utilized to prepare a bioceramic coating consisting of 45S5 bioactive glass (BG) and core-shelled Ag@MSN particles homogeneously on the entire surface of PT. The addition of Ag@MSN nanoparticles facilitated the sintering of BG and subsequently enhanced the adhesion of the coating. Slightly delayed hydroxyapatite formation was also detected probably due to minimized release and consumption of calcium ions. In-vitro assessments of the coating cultured with MC3T3-E1 osteoblasts and Staphylococcus aureus were carried out to assess their potential as multifunctional bone implants with excellent bioactivity and antibacterial properties. A template for producing robust and multi-component ceramic coatings on PT and other porous implants with tailorable biological properties for bone tissue engineering has been established.

Bioreactor analyses of tissue ingrowth, ongrowth and remodelling around implants: An alternative to live animal testing.

Introduction: Preclinical assessment of bone remodelling onto, into or around novel implant technologies is underpinned by a large live animal testing burden. The aim of this study was to explore whether a lab-based bioreactor model could provide similar insight. Method: Twelve ex vivo trabecular bone cylinders were extracted from porcine femora and were implanted with additively manufactured stochastic porous titanium implants. Half were cultured dynamically, in a bioreactor with continuous fluid flow and daily cyclic loading, and half in static well plates. Tissue ongrowth, ingrowth and remodelling around the implants were evaluated with imaging and mechanical testing. Results: For both culture conditions, scanning electron microscopy (SEM) revealed bone ongrowth; widefield, backscatter SEM, micro computed tomography scanning, and histology revealed mineralisation inside the implant pores; and histology revealed woven bone formation and bone resorption around the implant. The imaging evidence of this tissue ongrowth, ingrowth and remodelling around the implant was greater for the dynamically cultured samples, and the mechanical testing revealed that the dynamically cultured samples had approximately three times greater push-through fixation strength (p < 0.05). Discussion: Ex vivo bone models enable the analysis of tissue remodelling onto, into and around porous implants in the lab. While static culture conditions exhibited some characteristics of bony adaptation to implantation, simulating physiological conditions with a bioreactor led to an accelerated response.

Numerical Simulation and Experimental Study of Porous Titanium Implants under Compressive Loading Conditions

Numerical Simulation and Experimental Study of Porous Titanium Implants under Compressive Loading Conditions

Total mandible and bilateral TMJ reconstruction combining a customized jaw implant with a free fibular flap: a case report and literature review

BackgroundThe need for whole mandibular bone reconstruction and bilateral joint replacement is fortunately rare, but it is an extremely challenging topic in maxillofacial surgery, due to its functional implications. CAD-CAM techniques development has opened new broad horizons in the surgical planning of complex maxillofacial reconstructions, in terms of accuracy, predictability, and functional cosmetic results. The review of the literature has revealed a small number of scientific reports on total mandibulectomy including the condyles, with only eleven cases from 1980. Most of the works describe reconstructions secondary to dysplastic or inflammatory diseases affecting the lower jaw. The aim of this work, reporting a rare case of massive fibrous dysplasia of the whole mandible, is to share our experience in the management of extended mandibular and bilateral joint reconstruction, using porous titanium patient-specific implants.Case presentationThe authors present a 20-year-old male patient suffering from massive bone fibrous dysplasia of the mandible. The mandibular body and both the rami and the condylar processes had been involved, causing severe functional impairment, tooth loss, and facial deformation. The young patient, after repeated ineffective conservative surgical treatments, has required a biarticular mandibular replacement. Using virtual surgical planning (VSP) software, the authors, in collaboration with medical engineers, have created a custom-made original titanium porous mandibular implant, suspended from a bilateral artificial temporomandibular joint. The mandibular titanium implant body has been specifically designed to support soft tissues and to fix, in the alveolar region, a free fibular bone graft, for delayed dental implant prosthetic rehabilitation.ConclusionThe surgical and technical details, as well as the new trends in mandibular reconstructions using porous titanium implants, are reported, and discussed, reviewing literature reports on this topic. Satisfactory functional and cosmetic restorative results have been obtained, and no major complications have occurred. The patient, currently in the 18th month clinical and radiological follow-up, has recently completed the functional restoration program by an implant-supported full-arch dental prosthesis.

Additive Titanium Manufacturing to Repair Critically Sized Antebrachial Bone Defects in Two Dogs

AbstractRecent developments in the medical field of additive manufacturing (AM) have allowed the creation of patient-specific porous titanium implants for use in the medical field. With correct pore size such scaffolds are able to be integrated into surrounding bone.Two dogs were presented with atrophic non-union of the proximal ulna involving the elbow joint due to previous orthopaedic procedures with severe complications that led to segmental bone defects that were not expected to heal without a secondary intervention. Computed tomography (CT) was performed and porous scaffolds and saw guides were designed in silico and printed by AM. Osteotomies in adjacent healthy bone were guided by patient-specific three-dimensional (3D)-printed nylon saw guides allowing a perfect fit for the 3D-printed implant. In one case the scaffold was filled with bone morphogenic protein and held in place by two plates. In the other case the scaffold was filled with cancellous bone graft and held in place by a titanium plate that was part of the scaffold design. Both cases regained function and weight-bearing without lameness. Osseointegration of the implant was shown in both cases on follow-up CT and radiographs and macroscopically evident in the pores of the 3D implant after plate removal. One dog was euthanatized for unrelated disease and micro-CT revealed solid bone bridging through the inner scaffold tunnel.This study showed the successful application of the design, fabrication and clinical use of a patient-specific 3D-printed titanium implant to repair segmental bone defects of the antebrachium in two dogs.