scholarly journals A Case Report: Custom Made Porous Titanium Implants in Revision: A New Option for Complex Issues

2018 ◽  
Vol 12 (1) ◽  
pp. 525-535
Author(s):  
Giorgio Burastero ◽  
Luca Cavagnaro ◽  
Francesco Chiarlone ◽  
Bernardo Innocenti ◽  
Lamberto Felli
Keyword(s):  
Bone Loss ◽  
Optimal Solution ◽  
Bone Defects ◽  
Porous Titanium ◽  
Titanium Implants ◽  
New Device ◽  
Custom Made ◽  
Knee Revision Surgery ◽  
Surgical Options ◽  
Clinical And Radiological Results

Background: Bone loss management is considered one of the most difficult challenges for orthopaedic surgeon. In massive bone defects, few surgical options are available and they do not offer a reliable or optimal solution for knee reconstruction. Objective: The aim of this paper is to present and justify a new custom-made approach for complex metadiaphyseal bone defects management in knee revision surgery. Methods: We report a case of a 66-year-old woman who underwent a staged left total knee arthroplasty revision for infection with Anderson Orthopaedic Research Institute classification III uncontained femoral and tibial metadiaphyseal bone defects following five prior surgeries. Along with a case discussion, we describe clinical and radiological outcomes of 3 similar patients treated with this new custom-made device. Results: To manage these problems, we developed new, custom porous titanium devices for both femoral and tibial reconstruction tailored to a patient’s specific bone loss. Since, 2014, we treated four cases using custom-made porous titanium cones and we had optimal clinical and radiological results, with no instances of loosening, component migration, or mismatches between preoperative planning and intraoperative findings. Conclusion: In extremely selected cases, this new device can be considered a possible and viable surgical step between “off the shelf” reconstruction implants and knee substitution with a tumor megaprosthesis.

scholarly journals Full regeneration of segmental bone defects using porous titanium implants loaded with BMP-2 containing fibrin gels

2015 ◽  
Vol 29 ◽  
pp. 141-154 ◽  
Author(s):  
J van der Stok ◽  
◽  
MKE Koolen ◽  
MPM de Maat ◽  
S Amin Yavari ◽  
...  
Keyword(s):  
Bone Defects ◽  
Porous Titanium ◽  
Titanium Implants ◽  
Fibrin Gels ◽  
Segmental Bone ◽  
Segmental Bone Defects

scholarly journals 3D Biomimetic Porous Titanium (Ti6Al4V ELI) Scaffolds for Large Bone Critical Defect Reconstruction: An Experimental Study in Sheep

Animals ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. 1389 ◽  
Author(s):  
Alberto Maria Crovace ◽  
Luca Lacitignola ◽  
Donato Monopoli Forleo ◽  
Francesco Staffieri ◽  
Edda Francioso ◽  
...  
Keyword(s):  
Bone Defects ◽  
Porous Titanium ◽  
Control Group ◽  
Large Animal ◽  
Sintered Titanium ◽  
Porous Hydroxyapatite ◽  
X Ray ◽  
Custom Made ◽  
Critical Defect ◽  
Large Bone

The main goal in the treatment of large bone defects is to guarantee a rapid loading of the affected limb. In this paper, the authors proposed a new reconstructive technique that proved to be suitable to reach this purpose through the use of a custom-made biomimetic porous titanium scaffold. An in vivo study was undertaken where a complete critical defect was experimentally created in the diaphysis of the right tibia of twelve sheep and replaced with a five-centimeter porous scaffold of electron beam melting (EBM)-sintered titanium alloy (EBM group n = 6) or a porous hydroxyapatite scaffold (CONTROL group, n = 6). After surgery, the sheep were allowed to move freely in the barns. The outcome was monitored for up to 12 months by periodical X-ray and clinical examination. All animals in the CONTROL group were euthanized for humane reasons within the first month after surgery due to the onset of plate bending due to mechanical overload. Nine months after surgery, X-ray imaging showed the complete integration of the titanium implant in the tibia diaphysis and remodeling of the periosteal callus, with a well-defined cortical bone. At 12 months, sheep were euthanized, and the tibia were harvested and subjected to histological analysis. This showed bone tissue formations with bone trabeculae bridging titanium trabeculae, evidencing an optimal tissue-metal interaction. Our results show that EBM-sintered titanium devices, if used to repair critical bone defects in a large animal model, can guarantee immediate body weight-bearing, a rapid functional recovery, and a good osseointegration. The porous hydroxyapatite scaffolds proved to be not suitable in this model of large bone defect due to their known poor mechanical properties.

Clinical study of outcomes after revision surgery using porous titanium custom-made implants for severe acetabular septic bone defects

2020 ◽  
Vol 44 (10) ◽  
pp. 1957-1964
Author(s):  
Giorgio Burastero ◽  
Luca Cavagnaro ◽  
Francesco Chiarlone ◽  
Andrea Zanirato ◽  
Lorenzo Mosconi ◽  
...  
Keyword(s):  
Clinical Study ◽  
Revision Surgery ◽  
Bone Defects ◽  
Porous Titanium ◽  
Custom Made

scholarly journals Reconstruction options and outcomes for acetabular bone loss in revision hip arthroplasty

2020 ◽  
Author(s):  
Fabio Mancino ◽  
Giorgio Cacciola ◽  
Davide De Marco ◽  
Alexander Greenberg ◽  
Carlo Perisano ◽  
...  
Keyword(s):  
Bone Loss ◽  
Hip Arthroplasty ◽  
Bone Defects ◽  
Acetabular Reconstruction ◽  
Metal Mesh ◽  
Acetabular Bone ◽  
Acetabular Bone Loss ◽  
Custom Made ◽  
Long Term Studies

Revision total hip arthroplasty in the setting of acetabular bone loss is a challenging procedure and requires a solid understanding of current acetabular reconstruction options. Despite major developments in the field of revision hip surgery in recent decades, reconstruction of acetabular defects remains a major problem in order to achieve primary stability and durable fixation without sacrificing additional bone stock. Although there are several ways to classify acetabular bone defects, the Paprosky classification system is the most commonly used to describe the defects and guide treatment strategy. An understanding of the bone defects associated with detailed pre-operative assessment and planning are essential elements in order to achieve satisfactory outcomes. Multiple acetabular reconstructive options are currently available including impaction bone grafting with metal mesh, reinforcement rings and antiprotrusio cage, structural allografts, cementless hemispherical cups, extra-large “jumbo cups”, oblong cups, modular porous metal augments, cup-cage constructs, custom- made triflange cups, and acetabular distraction. To date, debate continues as to which technique is most effective due to the lack of long-term studies of modern reconstruction systems. Further long-term studies are necessary to assess the longevity of the different implants. The purpose of this study was to review the current literature and provide a comprehensive understanding of the available reconstruction options with their clinical outcomes.

Use of porous custom-made cones for meta-diaphyseal bone defects reconstruction in knee revision surgery: a clinical and biomechanical analysis

2020 ◽  
Vol 140 (12) ◽  
pp. 2041-2055
Author(s):  
Giorgio Burastero ◽  
Silvia Pianigiani ◽  
Cristiana Zanvettor ◽  
Luca Cavagnaro ◽  
Francesco Chiarlone ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Bone Defects ◽  
Biomechanical Analysis ◽  
Diaphyseal Bone ◽  
Custom Made ◽  
Knee Revision Surgery ◽  
Knee Revision

scholarly journals Custom-made reverse shoulder arthroplasty for severe glenoid bone loss: review of the literature and our preliminary results

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
G. Porcellini ◽  
G. M. Micheloni ◽  
L. Tarallo ◽  
P. Paladini ◽  
G. Merolla ◽  
...  
Keyword(s):  
Bone Loss ◽  
Shoulder Arthroplasty ◽  
Reverse Shoulder Arthroplasty ◽  
Glenoid Bone Loss ◽  
Navigation Systems ◽  
Preliminary Results ◽  
The Past ◽  
Custom Made ◽  
Literature Evidence ◽  
Surgical Options

Abstract The treatment of severe glenoid bone loss in shoulder arthroplasty represents a challenge, and the results of current prosthetic designs with only glenoid fixation still remain unsatisfactory. In the past decade, customized glenoid prostheses have been developed to address severe glenoid arthritis and in the revision setting. In this review, we analyzed the current surgical options, the classification limits, past literature evidence, and our preliminary results of 6 patients (3 male, 3 female) treated with a reverse implant and custom-made glenoid implant (ProMade; LimaCorporate, Italy). Computer analysis of the residual shape and the amount of glenoid bone stock in association with new classifications could help the surgeon to obtain good clinical and radiological outcomes. The development of navigation systems could improve the adequacy of the implant and, thus, the reliability and longevity of the implant itself.

scholarly journals Comparison of the different voxel sizes in the estimation of peri-implant fenestration defects using cone beam computed tomography: an ex vivo study

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Mehmet Hakan Kurt ◽  
Nilsun Bağış ◽  
Cengiz Evli ◽  
Cemal Atakan ◽  
Kaan Orhan
Keyword(s):  
Computed Tomography ◽  
Cone Beam Computed Tomography ◽  
Ex Vivo ◽  
Statistical Significance ◽  
Area Under The Curve ◽  
Titanium Implant ◽  
Bone Defects ◽  
Titanium Implants ◽  
Cone Beam ◽  
Voxel Size

Abstract Background To examine the influence of voxel sizes to detect of peri-implant fenestration defects on cone beam computed tomography (CBCT) images. Materials and methods This study performed with three sheep heads both maxilla and mandible and two types of dental implant type 1 zirconium implant (Zr40) (n = 6) and type 2 titanium implant (Ti22) (n = 10). A total of 14 peri-implant fenestrations (8 buccal surfaces, 6 palatal/lingual surface) were created while 18 surfaces (8 buccal, 10 palatal/lingual) were free of fenestrations. Three observers have evaluated the images of fenestration at each site. Images obtained with 0.75 mm3, 0.100 mm3, 0.150 mm3, 0.200 mm3, and 0.400 mm3 voxel sizes. For intra- and inter-observer agreements for each voxel size, Kappa coefficients were calculated. Results Intra- and inter-observer kappa values were the highest for 0.150 mm3, and the lowest in 0.75 mm3 and 0.400 mm3 voxel sizes for all types of implants. The highest area under the curve (AUC) values were found higher for the scan mode of 0.150 mm3, whereas lower AUC values were found for the voxel size for 0.400 mm3. Titanium implants had higher AUC values than zirconium with the statistical significance for all voxel sizes (p ≤ 0.05). Conclusion A voxel size of 0.150 mm3 can be used to detect peri-implant fenestration bone defects. CBCT is the most reliable diagnostic tool for peri-implant fenestration bone defects.

scholarly journals Understanding long-term silver release from surface modified porous titanium implants

2017 ◽  
Vol 58 ◽  
pp. 550-560 ◽  
Author(s):  
Anish Shivaram ◽  
Susmita Bose ◽  
Amit Bandyopadhyay
Keyword(s):  
Porous Titanium ◽  
Titanium Implants ◽  
Silver Release ◽  
Surface Modified

scholarly journals Case Report: Spinal Stabilization Surgery Using a Novel Custom-Made Titanium Fixation System for the Spinal Instability Caused by Vertebral Malformation in a Dog

2021 ◽  
Vol 8 ◽  
Author(s):  
Shintaro Kimura ◽  
Kohei Nakata ◽  
Yukiko Nakano ◽  
Yuta Nozue ◽  
Naoyuki Konno ◽  
...  
Keyword(s):  
Clinical Signs ◽  
Cord Compression ◽  
Titanium Implants ◽  
Radiographic Examination ◽  
Spinal Instability ◽  
Spinal Fixation ◽  
Spinal Stabilization ◽  
Custom Made ◽  
Dorsal Laminectomy ◽  
Fixation System

A 2-year-old Maltese was presented with wobbly gait of the pelvic limbs. Based on imaging examinations, a diagnosis of congenital malformation at T5–T8 and severe kyphosis causing spinal cord compression at T6–T7 was made. Dorsal laminectomy and stabilization of T6 and T7 vertebrae were performed. As the size of the vertebrae was small and they were severely deformed, novel custom-made titanium implants were used for spinal stabilization. Clinical signs were resolved 2 weeks after surgery. Although radiographic examination 373 days after surgery showed slight loosening of implants, post-operative course remained uneventful. This report describes the use of novel custom-made titanium implants for spinal fixation surgery in a dog.

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