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Additive manufactured metallic implants for orthopaedic applications

用于矫形外科的增材制造金属植入物

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Abstract

Metallic implants are commonly used in various orthopaedic surgeries, like fracture fixation, spinal instrumentation, joint replacement and bone tumour surgery. Patients may need to adapt to the fixed dimensions of the standard implants. It may result in suboptimal fit to the host bones and possible adverse clinical results. The standard traditional implants may not address the reconstructive challenges such as severe bone deformity or bone loss after implant loosening and bone tumour resection. With the advent of digital technologies in medical imaging, computer programming in three-dimensional (3D) modelling and computer-assisted tools in precise placement of implants, patient-specific implants (PSI) have gained more attention in complex orthopaedic reconstruction. Additive manufacturing technology, in contrast to the conventional subtractive manufacturing, is a flexible process that can fabricate anatomically conforming implants that match the patients’ anatomy and surgical requirements. Complex internal structures with porous scaffold can also be built to enhance osseointegration for better implant longevity. Although basic studies have suggested that additive manufactured (AM) metal structures are good engineered biomaterials for bone replacement, not much peer-reviewed literature is available on the clinical results of the new types of implants. The article gives an overview of the metallic materials commonly used for fabricating orthopaedic implants, describes the metal-based additive manufacturing technology and the processing chain in metallic implants; discusses the features of AM implants; reports the current status in orthopaedic surgical applications and comments on the challenges of AM implants in orthopaedic practice.

摘要

金属植入物通常用于各种矫形外科手术, 如骨折固定、 脊柱内置物、 关节置换和骨肿瘤手术等. 患者需要适应标准植入物的固定尺寸, 这可能会导致对宿主骨的不匹配和其他临床副作用. 标准的传统植入物可能无法解决骨骼重建的挑战, 如种植体松动和骨肿瘤切除后严重的骨骼畸形或骨质流失. 随着数字技术应用于医学成像, 如三维(3D)建模中的计算机编程和精确植入种植体的计算机辅助工具, 患者特异性植入物在复杂的骨科重建中获得了更多关注. 与传统的减材制造相比, 增材制造技术是一种灵活的工艺, 它可以制备符合解剖学标准的植入物以匹配患者解剖结构和手术要求, 还可以建立复杂的内部结构与多孔支架, 以促进骨整合和延长植入寿命. 尽管基础研究表明增材制造(AM)金属结构是良好的骨替代生物材料, 但关于此类新型植入物临床结果的同行评议文献还不是很多. 本文概述了通常用于制造矫形外科植入物的金属材料, 描述了基于金属的增材制造技术和金属植入物的加工链, 介绍了AM植入物的特征及其在矫形手术中的应用现状, 最后讨论了AM植入物在矫形外科应用中存在的挑战.

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, 852, China

    Kwok-Chuen Wong

  2. Implantcast GmbH, D-21614, Buxtehude, Germany

    Peter Scheinemann

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  1. Kwok-Chuen Wong
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  2. Peter Scheinemann
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Correspondence to Kwok-Chuen Wong.

Additional information

Kwok-Chuen Wong, MBChB, MD (CUHK) and FRCSEd (Ortho), has specialised in orthopaedic oncology since 2004 with a research interest in applying advanced technology in orthopaedics. He was one of the pioneers in developing computer navigation application and 3D-printed patient-specific instruments in orthopaedic oncology surgery and has extensively published in the field. Currently, he is Clinical Associate Professor (Honorary) and the chief of Orthopaedic Oncology, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong.

Peter Scheinemann is an engineer with more than 20 years’ industrial experience in design and development of orthopaedic implants. Currently, he is the head of research and development in Implantcast GmbH company. He has been in charge of producing MUTARS tumour and revision prostheses, noninvasive growing prostheses in orthopaedics. Since 2013, he has introduced additive manufacturing for custom made implants and instruments and is one of the key opinion leaders in the field.

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Wong, KC., Scheinemann, P. Additive manufactured metallic implants for orthopaedic applications. Sci. China Mater. 61, 440–454 (2018). https://doi.org/10.1007/s40843-017-9243-9

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