Is Preoperative Planning for Hip Surgery Using Three-Dimensional Printed Models Associated with Improved Intra- and Postoperative Outcomes? A Systematic Review

2019 ◽  
Vol 03 (03) ◽  
pp. 151-160
Author(s):  
Michael J. Mosca ◽  
Pablo Castañeda
Keyword(s):  
3D Printing ◽  
Clinical Outcomes ◽  
Preoperative Planning ◽  
Three Dimensional ◽  
Postoperative Outcomes ◽  
Hip Surgery ◽  
Patient Specific ◽  
Original Research ◽  
Surgical Guides ◽  
3D Printed

AbstractUse of three-dimensional (3D) printed models for preoperative planning, patient-specific surgical guides, and implants in orthopaedic surgery is a burgeoning technology. It has not been established if 3D-printed models for preoperative planning are associated with improved clinical outcomes or if they are cost-effective for hip surgeries including total hip arthroplasty (THA), periacetabular osteotomy (PAO), proximal femoral osteotomy (PFO), and/or hip fractures. The purpose of this study was to conduct a systematic search and literature review to determine if preoperative planning for hip surgery using 3D-printed models was associated with improved intra- and postoperative outcomes. Specific aims were to determine the (1) types of applications and studies conducted, (2) types of 3D printing/materials used, (3) specific outcomes evaluated, (4) efficacy of 3D printing in planning for hip surgery, and (5) limitations of current research. The authors searched Medline, Embase, Cochrane Database of Systematic Reviews, CINAHL, and PubMed from inception through July 2017. Original research publications were included if the primary purpose was to evaluate 3D-printed models' ability to assist with the planning of hip surgeries. Papers were excluded if they were reviews, abstracts, and not available in English, their models were not patient-specific, or their research did not evaluate surgery of the acetabulofemoral joint or pelvis. Of the 3,369 unique papers identified, 21 met inclusion criteria after full-text review. Among the included studies, six evaluated 3D printing in THA, seven in PAO/PFO, and eight in fracture repairs/reconstruction. The research included nine case reports, three case series, one retrospective uncontrolled study, six prospective uncontrolled studies, and two prospective controlled studies. 3D printed models resulted in: reduced intraoperative improvisation, operating room time, blood loss/transfusions, improved positioning of plates/screws/implants, clinical scores, measures of realignment, and functional status. Recent innovations in 3D printing are promising but unproven to improve clinical outcomes in hip surgeries due to limitations of published research. This may impact utilization and reimbursement of 3D-printed models in hip surgery. Studies of resource utilization, cost-effectiveness, and controlled trials with standardized methods and clinical outcomes of relevance are needed.

scholarly journals In-Hospital 3D Printed Scaphoid Prosthesis Using Medical-Grade Polyetheretherketone (PEEK) Biomaterial

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Philipp Honigmann ◽  
Neha Sharma ◽  
Ralf Schumacher ◽  
Jasmine Rueegg ◽  
Mathias Haefeli ◽  
...  
Keyword(s):  
3D Printing ◽  
Point Of Care ◽  
Low Cost ◽  
Three Dimensional ◽  
Patient Specific ◽  
Fused Filament Fabrication ◽  
Patient Specific Implants ◽  
Surgical Guides ◽  
3D Printed ◽  
Medical Grade

Recently, three-dimensional (3D) printing has become increasingly popular in the medical sector for the production of anatomical biomodels, surgical guides, and prosthetics. With the availability of low-cost desktop 3D printers and affordable materials, the in-house or point-of-care manufacturing of biomodels and Class II medical devices has gained considerable attention in personalized medicine. Another projected development in medical 3D printing for personalized treatment is the in-house production of patient-specific implants (PSIs) for partial and total bone replacements made of medical-grade material such as polyetheretherketone (PEEK). We present the first in-hospital 3D printed scaphoid prosthesis using medical-grade PEEK with fused filament fabrication (FFF) 3D printing technology.

Investigation of three-dimensional printing materials for printing aorta model replicating Type B aortic dissection

2021 ◽  
Vol 17 ◽  
Author(s):  
Chia-An Wu ◽  
Andrew Squelch ◽  
Zhonghua Sun
Keyword(s):  
3D Printing ◽  
Aortic Dissection ◽  
Three Dimensional ◽  
Ct Images ◽  
Patient Specific ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Ct Attenuation ◽  
Significant Difference ◽  
3D Printed

Aim: To determine a printing material that has both elastic property and radiology equivalence close to real aorta for simulation of endovascular stent graft repair of aortic dissection. Background: With the rapid development of three-dimensional (3D) printing technology, a patient-specific 3D printed model is able to help surgeons to make better treatment plan for Type B aortic dissection patients. However, the radiological properties of most 3D printing materials have not been well characterized. This study aims to investigate the appropriate materials for printing human aorta with mechanical and radiological properties similar to the real aortic computed tomography (CT) attenuation. Objective: Quantitative assessment of CT attenuation of different materials used in 3D printed models of aortic dissection for developing patient-specific 3D printed aorta models to simulate type B aortic dissection. Method: A 25-mm length of aorta model was segmented from a patient’s image dataset with diagnosis of type B aortic dissection. Four different elastic commercial 3D printing materials, namely Agilus A40 and A50, Visijet CE-NT A30 and A70 were selected and printed with different hardness. Totally four models were printed out and conducted CT scanned twice on a 192-slice CT scanner using the standard aortic CT angiography protocol, with and without contrast inside the lumen.Five reference points with region of interest (ROI) of 1.77 mm2 were selected at the aortic wall and intimal flap and their Hounsfield units (HU) were measured and compared with the CT attenuation of original CT images. The comparison between the patient’s aorta and models was performed through a paired-sample t-test to determine if there is any significant difference. Result: The mean CT attenuation of aortic wall of the original CT images was 80.7 HU. Analysis of images without using contrast medium showed that the material of Agilus A50 produced the mean CT attenuation of 82.6 HU, which is similar to that of original CT images. The CT attenuation measured at images acquired with other three materials was significantly lower than that of original images (p<0.05). After adding contrast medium, Visijet CE-NT A30 had an average CT attenuation of 90.6 HU, which is close to that of the original images with statistically significant difference (p>0.05). In contrast, the CT attenuation measured at images acquired with other three materials (Agilus A40, A50 and Visiject CE-NT A70) was 129 HU, 135 HU and 129.6 HU, respectively, which is significantly higher than that of original CT images (p<0.05). Conclusion: Both Visijet CE-NT and Agilus have tensile strength and elongation close to real patient’s tissue properties producing similar CT attenuation. Visijet CE-NT A30 is considered the appropriate material for printing aorta to simulate contrast-enhanced CT imaging of type B aortic dissection. Due to lack of body phantom in the experiments, further research with simulation of realistic anatomical body environment should be conducted.

scholarly journals 3D Printed Acetabular Cups for Total Hip Arthroplasty: A Review Article

Metals ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. 729 ◽  
Author(s):  
Dall’Ava ◽  
Hothi ◽  
Di Laura ◽  
Henckel ◽  
Hart
Keyword(s):  
3D Printing ◽  
Total Hip Arthroplasty ◽  
Clinical Outcomes ◽  
Hip Arthroplasty ◽  
Three Dimensional ◽  
Total Hip ◽  
3D Printed ◽  
Key Variables ◽  
End Use ◽  
Acetabular Components

Three-dimensional (3D) printed titanium orthopaedic implants have recently revolutionized the treatment of massive bone defects in the pelvis, and we are on the verge of a change from conventional to 3D printed manufacture for the mass production of millions of off-the-shelf (non-personalized) implants. The process of 3D printing has many adjustable variables, which taken together with the possible variation in designs that can be printed, has created even more possible variables in the final product that must be understood if we are to predict the performance and safety of 3D printed implants. We critically reviewed the clinical use of 3D printing in orthopaedics, focusing on cementless acetabular components used in total hip arthroplasty. We defined the clinical and engineering rationale of 3D printed acetabular cups, summarized the key variables involved in the manufacturing process that influence the properties of the final parts, together with the main limitations of this technology, and created a classification according to end-use application to help explain the controversial and topical issues. Whilst early clinical outcomes related to 3D printed cups have been promising, in-depth robust investigations are needed, partly because regulatory approval systems have not fully adapted to the change in technology. Analysis of both pristine and retrieved cups, together with long-term clinical outcomes, will help the transition to 3D printing to be managed safely.

scholarly journals Three-dimensional Printing Versus Conventional Machining in the Creation of a Meatal Urethral Dilator: a Cost and Mechanical Strength Analysis

2020 ◽  
Author(s):  
Michael Yue-Cheng Chen ◽  
Jacob Skewes ◽  
Ryan Daley ◽  
Maria Ann Woodruff ◽  
Nicholas John Rukin
Keyword(s):  
3D Printing ◽  
Three Dimensional ◽  
Patient Specific ◽  
Strength Analysis ◽  
Fused Deposition Modelling ◽  
3D Printer ◽  
Current Time ◽  
Fused Deposition ◽  
3D Printed ◽  
Conventional Machining

Abstract BackgroundThree-dimensional (3D) printing is a promising technology but the limitations are often poorly understood. We compare different 3D printingmethods with conventional machining techniques in manufacturing meatal urethral dilators which were recently removed from the Australian market. MethodsA prototype dilator was 3D printed vertically orientated on a low cost fused deposition modelling (FDM) 3D printer in polylactic acid (PLA) and acrylonitrile butadiene styrene (ABS). It was also 3D printed horizontally orientated in ABS on a high-end FDM 3D printer with soluble support material, as well as on a SLS 3D printer in medical nylon. The dilator was also machined in stainless steel using a lathe. All dilators were tested mechanically in a custom rig by hanging calibrated weights from the handle until the dilator snapped. ResultsThe horizontally printed ABS dilator experienced failure at a greater load than the vertically printed PLA and ABS dilators respectively (503g vs 283g vs 163g, p < 0.001). The SLS nylon dilator and machined steel dilator did not fail. The steel dilator is most expensive with a quantity of five at 98 USD each, but this decreases to 30 USD each for a quantity of 1000. In contrast, the cost for the SLS dilator is 33 USD each for five and 27 USD each for 1000. ConclusionsAt the current time 3D printing is not a replacement for conventional manufacturing. 3D printing is best used for patient-specific parts, prototyping or manufacturing complex parts that have additional functionality that cannot otherwise beachieved.

Living the heart in three dimensions: applications of 3D printing in CHD

2019 ◽  
Vol 29 (06) ◽  
pp. 733-743 ◽  
Author(s):  
Mari Nieves Velasco Forte ◽  
Tarique Hussain ◽  
Arno Roest ◽  
Gorka Gomez ◽  
Monique Jongbloed ◽  
...  
Keyword(s):  
3D Printing ◽  
Heart Surgery ◽  
Wide Spectrum ◽  
Three Dimensional ◽  
Structural Heart Disease ◽  
Medical Personnel ◽  
Three Dimensions ◽  
Patient Specific ◽  
3D Printed

AbstractAdvances in biomedical engineering have led to three-dimensional (3D)-printed models being used for a broad range of different applications. Teaching medical personnel, communicating with patients and relatives, planning complex heart surgery, or designing new techniques for repair of CHD via cardiac catheterisation are now options available using patient-specific 3D-printed models. The management of CHD can be challenging owing to the wide spectrum of morphological conditions and the differences between patients. Direct visualisation and manipulation of the patients’ individual anatomy has opened new horizons in personalised treatment, providing the possibility of performing the whole procedure in vitro beforehand, thus anticipating complications and possible outcomes. In this review, we discuss the workflow to implement 3D printing in clinical practice, the imaging modalities used for anatomical segmentation, the applications of this emerging technique in patients with structural heart disease, and its limitations and future directions.

scholarly journals The Role of 3D Printing in Medical Applications: A State of the Art

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Anna Aimar ◽  
Augusto Palermo ◽  
Bernardo Innocenti
Keyword(s):  
3D Printing ◽  
Three Dimensional ◽  
Patient Specific ◽  
Digital Information ◽  
Medical Implants ◽  
Medical Field ◽  
3D Printed ◽  
Pipe Dream ◽  
Manufacturing Technologies

Three-dimensional (3D) printing refers to a number of manufacturing technologies that generate a physical model from digital information. Medical 3D printing was once an ambitious pipe dream. However, time and investment made it real. Nowadays, the 3D printing technology represents a big opportunity to help pharmaceutical and medical companies to create more specific drugs, enabling a rapid production of medical implants, and changing the way that doctors and surgeons plan procedures. Patient-specific 3D-printed anatomical models are becoming increasingly useful tools in today’s practice of precision medicine and for personalized treatments. In the future, 3D-printed implantable organs will probably be available, reducing the waiting lists and increasing the number of lives saved. Additive manufacturing for healthcare is still very much a work in progress, but it is already applied in many different ways in medical field that, already reeling under immense pressure with regards to optimal performance and reduced costs, will stand to gain unprecedented benefits from this good-as-gold technology. The goal of this analysis is to demonstrate by a deep research of the 3D-printing applications in medical field the usefulness and drawbacks and how powerful technology it is.

scholarly journals A review and guide to creating patient specific 3D printed anatomical models from MRI for benign gynecologic surgery

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Teresa E. Flaxman ◽  
Carly M. Cooke ◽  
Olivier X. Miguel ◽  
Adnan M. Sheikh ◽  
Sukhbir S. Singh
Keyword(s):  
3D Printing ◽  
Clinical Benefit ◽  
Three Dimensional ◽  
Uterine Fibroids ◽  
3D Models ◽  
Gynecologic Surgery ◽  
Patient Specific ◽  
Mr Images ◽  
Adjacent Structures ◽  
3D Printed

Abstract Background Patient specific three-dimensional (3D) models can be derived from two-dimensional medical images, such as magnetic resonance (MR) images. 3D models have been shown to improve anatomical comprehension by providing more accurate assessments of anatomical volumes and better perspectives of structural orientations relative to adjacent structures. The clinical benefit of using patient specific 3D printed models have been highlighted in the fields of orthopaedics, cardiothoracics, and neurosurgery for the purpose of pre-surgical planning. However, reports on the clinical use of 3D printed models in the field of gynecology are limited. Main text This article aims to provide a brief overview of the principles of 3D printing and the steps required to derive patient-specific, anatomically accurate 3D printed models of gynecologic anatomy from MR images. Examples of 3D printed models for uterine fibroids and endometriosis are presented as well as a discussion on the barriers to clinical uptake and the future directions for 3D printing in the field of gynecological surgery. Conclusion Successful gynecologic surgery requires a thorough understanding of the patient’s anatomy and burden of disease. Future use of patient specific 3D printed models is encouraged so the clinical benefit can be better understood and evidence to support their use in standard of care can be provided.

scholarly journals The use of three-dimensional anatomical patient-specific printed models in surgical clipping of intracranial aneurysm: A pilot study

2020 ◽  
Vol 11 ◽  
pp. 381
Author(s):  
Moneer K. Faraj ◽  
Samer S. Hoz ◽  
Amjad J. Mohammad
Keyword(s):  
3D Printing ◽  
Teaching Hospital ◽  
Three Dimensional ◽  
3D Models ◽  
Patient Specific ◽  
Anterior Communicating Artery ◽  
Parent Vessel ◽  
Microsurgical Clipping ◽  
Valuable Adjunct ◽  
3D Printed

Background: In the present study, we aim to develop simulation models based on computed tomography angiography images of intracranial aneurysms (IAs) and their parent vessels using three-dimensional (3D) printing technology. The study focuses on the value of these 3D models in presurgical planning and intraoperative navigation and ultimately their impact on patient outcomes. To the best of our knowledge, this is the first report of its kind from a war-torn country, like Iraq. Methods: This is a prospective study of a series of 11, consecutively enrolled, patients suffering from IAs for the period between February and September 2019. The study represents a collaboration between the two major neurosurgical centers in Baghdad/Iraq; Neurosciences Teaching Hospital and Neurosurgery Teaching Hospital. We analyzed the data of eleven patients with IAs treated by microsurgical clipping. These data include patient demographics, clinical, surgical, and outcomes along with the data of the 3D-printed replica used in these surgeries. All cases were operated on by one surgeon. Results: Our study included 11 patients, with a total of 11 aneurysms clipped. The mean age was 44 ± 8, with a median of 42.5 and a range of 35–61 years. About 60% of our patients were female with a female-to-male ratio of 1:5. About 60% of the aneurysms were located at the anterior communicating artery (Acom) while the remaining 40% were equally distributed between the posterior communicating and internal carotid arteries bifurcation. The standard pterional approach was followed in 50% of cases, whereas the other 50% of patients were treated through the lateral supraorbital approach. About 90% (n = 9) of the patients had a Glasgow Outcome Scale (GOS) of 5 and 10% had a GOS of 4. The 3D-printed models successfully replicated the aneurysm size, location, and relation to the parent vessel with 100% accuracy and were used for intraoperative guidance. The average production time was 24–48 h and the production cost was 10–20 US dollars. Conclusion: 3D printing is a promising technology that is rapidly penetrating the field of neurosurgery. In particular, the use of 3D-printed patient-matched, anatomically accurate replicas of the cerebral vascular tree is valuable adjunct to the microsurgical clipping of IAs, and our study conclusions support this concept. However, both the feasibility and clinical utility of 3D printing remain the subject of much, ongoing investigations.

scholarly journals Accuracy of Patient-Specific Drilling Guides in Acetabular Fracture Surgery: A Human Cadaver Study

2021 ◽  
Vol 11 (8) ◽  
pp. 763
Author(s):  
Anne M. L. Meesters ◽  
Nick Assink ◽  
Kaj ten Duis ◽  
Eelco M. Fennema ◽  
Joep Kraeima ◽  
...  
Keyword(s):  
Acetabular Fracture ◽  
Preoperative Planning ◽  
Soft Tissue Injuries ◽  
Ct Scans ◽  
Screw Placement ◽  
Patient Specific ◽  
Surgical Guides ◽  
Entry Points ◽  
3D Printed ◽  
Fracture Surgery

Due to the complex anatomical shape of the pelvis, screw placement can be challenging in acetabular fracture surgery. This study aims to assess the accuracy of screw placement using patient-specific surgical drilling guides applied to pre-contoured conventional implants in acetabular fracture surgery. CT scans were made of four human cadavers to create 3D models of each (unfractured) pelvis. Implants were pre-contoured on 3D printed pelvic models and optically scanned. Following virtual preoperative planning, surgical drilling guides were designed to fit on top of the implant and were 3D printed. The differences between the pre-planned and actual screw directions (degrees) and screw entry points (mm) were assessed from the pre- and postoperative CT-scans. The median difference between the planned and actual screw direction was 5.9° (IQR: 4–8°) for the in-plate screws and 7.6° (IQR: 6–10°) for the infra-acetabular and column screws. The median entry point differences were 3.6 (IQR: 2–5) mm for the in-plate screws and 2.6 (IQR: 2–3) mm for the infra-acetabular and column screws. No screws penetrated into the hip joint or caused soft tissue injuries. Three-dimensional preoperative planning in combination with surgical guides that envelope pre-contoured conventional implants result in accurate screw placement during acetabular fracture surgery.

scholarly journals 3D printed patient-specific bone models for anatomy education from medical imaging

2021 ◽  
Author(s):  
Arivazhagan Pugalendhi ◽  
◽  
SenthilMurugan Arumugam ◽  
Rajesh Ranganathan ◽  
Sivakumar Ganesan ◽  
...  
Keyword(s):  
3D Printing ◽  
Surgical Planning ◽  
Thin Layers ◽  
Physical Models ◽  
Patient Specific ◽  
Anatomy Education ◽  
Healthcare Applications ◽  
Surgical Guides ◽  
Solid Objects ◽  
3D Printed

Evolution of 3D printing from medical image datasets are escalating and has widespread in healthcare applications such as anatomical models, surgical guides, and customized implants. In 3D printing, solid objects are fabricated by the frequently added the thin layers of material as per the digital model. This paper demonstrates the fabrication of 3D printed patient-specific bone models of leg and ankle foot from Digital Imaging and Communications in Medicine (DICOM) files. Processing of DICOM file is prepared by D2P (DICOM to PRINT) software and physical models are produced by Stratasys uPrint 3D printer. This 3D printed anatomical model eliminates the requirement of actual human bones, significance of preservation and mistakes in assembly of bones. The results of the study not only encourage education, surgical planning and validating medical devices but stimulate exciting innovations.

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