Reducing subsidence risk by using rapid manufactured patient-specific intervertebral disc implants
BACKGROUND CONTEXT: Intervertebral disc implant size, shape, and position during total disc replacement have been shown to affect the risk of implant subsidence or vertebral fracture. Rapid manufacturing has been successfully applied to produce patient-specific implants for craniomaxillofacial, dental, hip, and knee requirements, but very little has been published on its application for spinal implants. PURPOSE: This research was undertaken to investigate the improved load distribution and stiffness that can be achieved when using implants with matching bone interface geometry as opposed to implants with flat end plate geometries. STUDY DESIGN: The study design comprises a biomechanical investigation and comparison of compressive loads applied to cadaveric vertebrae when using two different end plate designs. METHODS: Four spines from male cadavers (ages 45-65 years, average 52 years), which had a total of n=88 vertebrae (C3-L5), were considered during this study. Bone mineral density scans on each spine revealed only one to be eligible for this study. Twenty remaining vertebrae (C3-L3) were potted and subjected to nondestructive compression tests followed by destructive compression tests. Custom-made nonfunctional implants were designed for this experiment. Ten implants were designed with matching end plate-to-bone interface geometry, whereas the other 10 were designed with flat end plates. Testing did not incorporate the use of a keel in either design type. I-Scan pressure sensors (Tekscan, Inc., MA, USA) were used during the nondestructive tests to assess the load distribution and percentage surface contact. RESULTS: Average percent contact area measured during nondestructive tests was 45.27% and 10.49% for conformal and flat implants, respectively-a difference that is statistically significant (p<.001). A higher percent contact area was especially observed for cervical vertebrae because of their pronounced end plate concavity. During destructive compression tests, conformal implants achieved higher failure loads than flat implants. Conformal implants also performed significantly better when stiffness values were compared (p<.0001). CONCLUSIONS: One of the main expected benefits from customizing the end plate geometry of disc implants is the reduced risk and potential for subsidence into the vertebral bone end plate. Subsidence depends in part on the stiffness of the implant-bone construct, and with a 137% increase in stiffness, the results of this study show that there are indeed significant potential benefits that can be achieved through the use of customization during the design and manufacture of intervertebral disc implants.
Available from: CHi Hieu Le
[Show abstract] [Hide abstract]
ABSTRACT: Design methods for medical rapid prototyping (RP) of personalized cranioplasty implants are presented in this paper. These methods are applicable to model cranioplasty implants for all types of the skull defects including beyond-midline and multiple defects. The methods are based on two types of anatomical data, solid bone models (STereoLithography files – STL) and bone slice contours (Initial Graphics Exchange Specification – IGES and StrataSys Layer files – SSL). The bone solids and contours are constructed based on computed tomography scanning data, and these data are generated in medical image processing and STL slicing packages.
[Show abstract] [Hide abstract]
Distal humeral hemiarthroplasty results in altered cartilage contact mechanics, which may predispose to osteoarthritis. Current distal humeral hemiarthroplasty prostheses do not replicate the native anatomy, and therefore contribute to these changes. We hypothesized that prostheses reverse-engineered from the native bone shape would provide similar contact patterns as the native articulation.
Reverse-engineered distal humeral hemiarthroplasty prostheses were manufactured for five cadaveric elbow specimens based on computed tomographic images of the distal humerus. Passive flexion trials with constant muscle forces were performed with the native articulation intact while bone motions were recorded using a motion tracking system. Motion trials were then repeated after the distal humerus was replaced with a corresponding reverse-engineered prosthesis. Contact areas and patterns were reconstructed using computer models created from computed tomography scan images combined with the motion tracker data. The total contact areas, as well as the contact area within smaller sub-regions of the ulna and radius, were analyzed for changes resulting from distal humeral hemiarthroplasty using repeated-measures analyses of variance.
Contact area at the ulna and radius decreased on average 42% (SD 19%, p = .008) and 41% (SD 42%, p = .096), respectively. Contact area decreases were not uniform throughout the different sub-regions, suggesting that contact patterns were also altered.
Reverse-engineered prostheses did not reproduce the same contact pattern as the native joints, possibly because the thickness of the distal humerus cartilage layer was neglected when generating the prosthesis shapes or as a consequence of the increased stiffness of the metallic implants. Alternative design strategies and materials for distal humeral hemiarthroplasty should be considered in future work.
Available from: Eric T Ricchetti
[Show abstract] [Hide abstract]
Preoperative quantitative assessment of glenoid bone loss, selection of the glenoid component, and definition of its desired location can be challenging. Placement of the glenoid component in the desired location at the time of surgery is difficult, especially with severe glenoid pathological conditions.
Forty-six patients were randomly assigned to three-dimensional computed tomographic preoperative templating with either standard instrumentation or with patient-specific instrumentation and were compared with a nonrandomized group of seventeen patients with two-dimensional imaging and standard instrumentation used as historical controls. All patients had postoperative three-dimensional computed tomographic metal artifact reduction imaging to measure and to compare implant position with the preoperative plan.
Using three-dimensional imaging and templating with or without patient-specific instrumentation, there was a significant improvement achieving the desired implant position within 5° of inclination or 10° of version when compared with two-dimensional imaging and standard instrumentation.
Three-dimensional assessment of glenoid anatomy and implant templating and the use of these images at the time of surgery improve the surgeon's ability to place the glenoid implant in the desired location.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.