Q&A: Provider-based additive manufacturing 3D-printed implants used in complex cases
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In March, the first surgeries were completed with patient-specific 3D-printed orthopedic implants produced at the LimaCorporate ProMade Point of Care Center at Hospital for Special Surgery.
Healio spoke with Peter K. Sculco, MD, hip and knee surgeon at Hospital for Special Surgery (HSS), about the first surgeries performed as a result of this collaboration.
Healio: What are the advantages of additive manufacturing for total hip and knee arthroplasty components?
Sculco: The advantages of additive manufacturing are its ability to create customized 3D titanium implants optimized for initial fixation and secondary osseous ingrowth. Additive manufacturing works hand in hand with computational modelling, in which different titanium shapes and material properties can be modified and tested. The optimized design is then 3D printed to this exact specification. This combination of computational modelling to find the best implant design and additive manufacturing to create that specific design has accelerated the research and development process and the creation of next-generation implants.
Healio: Specifically, how did additive manufacturing aid in the surgical planning and execution in the first surgical case completed at HSS vs. an off-the-shelf component?
Sculco: For the first surgical case completed at HSS with a LimaCorporate ProMade custom implant used in complex acetabular revision surgery, additive manufacturing produced a patient-specific implant that was designed to manage massive bone loss that an off-the-shelf component would not be able to address. The additive manufacturing process allows optimized implant contact with the LimaCorporate 3D-printed Trabecular Titanium, which is a proprietary, highly porous 3-D titanium that has greater than 10 years of clinical success in both the hip and shoulder.
Healio: What does a 3D-manufactured implant offer that an off-the-shelf implant may not?
Sculco: A custom 3D-manufactured implant offers exactly that, customization that off-the-shelf implants do not permit. When addressing complex bone defects, hemispherical shells may not adequately gain durable fixation. Off-the-shelf porous metal augments are also beneficial in more complex cases. However, certain cases require a customized implant with its unique shape, carefully placed screw trajectories and Trabecular Titanium back surface, all specifically designed to optimize fixation and biologic ingrowth.
Healio: In what types of cases and for what patient needs may using an implant fabricated at the Point of Care (POC) Center be most beneficial? Why?
Sculco: Cases most amenable to implants from the POC Center would be those complex hip or shoulder revisions in which a patient-specific solution is required. These custom implants use proprietary highly porous titanium for bone ingrowth and gaining biologic fixation. This is important to ensure long-term durability in these complex cases, especially when we want our patients to return to higher-demand activities, even after revision surgery.
Healio: What value does additive manufacturing bring to the operating physician, the patient and the institution where the surgery is performed?
Sculco: For the surgeon, additive manufacturing provides a comprehensive solution to manage some of our most complex cases. Surgeons should feel confident that we can offer patients an implant customized and optimized for a patient’s specific situation. For the patient, knowing the time, effort, clinical expertise and technology behind the creation of a 3D custom implant should give them a certain peace of mind the care team is doing everything possible to achieve a great outcome. For the institution where the surgery is performed, the hospital should be commended for being able to manage these complex cases and deliver this type of care while minimizing medical or surgical complications.
Healio: To date, how has the collaboration with LimaCorporate and the POC Center gone? Please discuss any related developments from which other hospital systems and companies contemplating a similar collaboration regarding 3D-printed patient-specific implants can learn.
Sculco: The collaboration between LimaCorporate and HSS and the development of the POC Center was an achievement. Creating an additive manufacturing facility in the heart of New York City is no easy feat and is a testament to the commitment of HSS and LimaCorporate to make this concept a reality. The center is gradually being integrated into the clinical workflows of several surgeons who treat complex cases at HSS in shoulder, hip and knee. The connection between LimaCorporate engineers and HSS engineers in our biomechanics department is also unique. We have an incredible opportunity to make the center a hub for education, research and clinical care, where we can bring out the most challenging cases and look at different solutions through a team-based approach. This includes CT-3D reconstructions, printed 3D models and then the process of creating a custom implant, if necessary. This team-based approach has helped engineers and surgeons develop effective solutions to solve difficult clinical problems.
Healio: Are there plans to expand the number of institutions, in addition to HSS, that will use the patient-specific 3D-printed implants in question?
Sculco: I do not know the future plans for this collaboration or for additional institutions to use implants from the POC Center. I think that as the additive manufacturing continues to improve and computational modelling becomes more powerful, as automation with machine learning becomes more integrated, these implants will be designed more rapidly and at lower cost. This will likely allow for an expansion for the number of cases that can be addressed with a patient-specific solution. I think we are still at the beginning of this journey and that the process for additive manufacturing will continue to improve and will also improve patient outcomes.
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