Application of customized augments fabricated by rapid prototyping for severe bone defects of the knee

With the population aging and an increasing desire for a high quality of life,millions of patients who suffered knee arthropathy have undergone total knee arthroplasty （TKA）.Although the success rate for primary TKA has been quite high,the number of revision surgeries can not be ignored.Bone loss is one of the challenges confronting surgeons who perform revision TKAs as it can impair alignment accuracy and the long-term stability of the implant.Although several options are available for bone loss after TKA--cement,bone grafting,standard augments,and hinged implants--there is no single ideal option available for all patients with a severe bone defect because of the variety and severity of the defects.1 The burgeoning rapid prototyping （RP） technique,which has been used to fabricate components with complex and unique structures,may offer a novel option in these cases.Keywords：rapid prototyping; severe bone defects; knee

Customized reconstructive prosthesis design based on topological optimization to treat severe proximal tibia defect

A novel reconstructive prosthesis was designed with topological optimization(TO)and a lattice structure to enhance biomechanical and biological properties in the proximal tibia.The biomechanical performance was validated through finite element analysis(FEA)and biomechanical tests.The tibia with inhomogeneous material properties was reconstructed according to computed tomography images,and different components were designed to simulate the operation.Minimum compliance TO subject to a volume fraction constraint combined with a graded lattice structure was utilized to redesign the prosthesis.FEA was performed to evaluate the mechanical performances of the tibia and implants after optimization,including stress,micromotion,and strain energy.The results were analyzed by paired-samples t tests,and p<0.05 was considered significant.Biomechanical testing was used to verify the tibial stresses.Compared to the original group(OG),the TO group(TOG)exhibited lower stress on the stem,and the maximum von Mises stresses were 87.2 and 53.1 MPa,respectively,a 39.1%reduction(p<0.05).Conversely,the stress and strain energy on the tibia increased in the TOG.The maximum von Mises stress values were 16.4 MPa in the OG and 22.9 MPa in the TOG with a 39.6%increase(p<0.05),and the maximum SED value was 0.026 MPa in the OG and 0.042 MPa in the TOG,corresponding to an increase of 61.5%(p<0.05).The maximum micromotions in the distal end of the stem were 135μm in the OG and 68μm in the TOG,almost a 50%reduction.The stress curves of the biomechanical test coincided well with the FEA results.The TO approach can effectively reduce the whole weight of the prosthesis and improve the biomechanical environment of the tibia.It could also pave the way for next-generation applications in orthopedics surgery.

3D printing of conch-like scaffolds for guiding cell migration and directional bone growth

Regeneration of severe bone defects remains an enormous challenge in clinic.Developing regenerative scaffolds to directionally guide bone growth is a potential strategy to overcome this hurdle.Conch,an interesting creature widely spreading in ocean,has tough spiral shell that can continuously grow along the spiral direction.Herein,inspired by the physiological features of conches,a conch-like(CL)scaffold based onβ-TCP bioceramic material was successfully prepared for guiding directional bone growth via digital light processing(DLP)-based 3D printing.Benefiting from the spiral structure,the CL scaffolds significantly improved cell adhesion,proliferation and osteogenic differentiation in vitro compared to the conventional 3D scaffolds.Particularly,the spiral structure in the scaffolds could efficiently induce cells to migrate from the bottom to the top of the scaffolds,which was like“cells climbing stairs”.Furthermore,the capability of guiding directional bone growth for the CL scaffolds was demonstrated by a special half-embedded femoral defects model in rabbits.The new bone tissue could consecutively grow into the protruded part of the scaffolds along the spiral cavities.This work provides a promising strategy to construct biomimetic biomaterials for guiding directional bone tissue growth,which offers a new treatment concept for severe bone defects,and even limb regeneration.