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Taiwan: Researchers Rely on 3D Printed Models & Surgical Guides for Pediatric Orthopedic Surgery

Medical researchers and orthopedic surgeons in Taiwan at Kaohsiung Veterans General Hospital continue to explore better ways to heal bones and manage defects, with their findings outlined in the recently published ‘Anatomic three-dimensional model-assisted surgical planning for treatment of pediatric hip dislocation due to osteomyelitis.’

While bone defects are already a challenge to manage, obviously the problem is compounded in children, with smaller bones being even more difficult to repair in surgery. Currently, there are few options for a good device meant for small bone repair during pediatric osteotomies—making it difficult for surgeons around the world to correct both subluxated hip joints and deformed femurs in children.

The authors (and surgeons) performed corrective surgery on a four-year-old boy with a post-osteomyelitis deformity. In preparing for the surgery, they relied on a 3D printed model of the bone for studying the condition, surgery and preparing the site for the appropriate implant. Because this type of surgery requires ‘meticulous planning,’ the doctors required both 2D and 3D assistance, in the respective forms of axial images and 3D virtual models of patient anatomies.

Radiographs taken before corrective surgery. (a) Triple film showing the proximal femur deformity with osseous recovery. Three-dimensional computed tomography image: (b) anteroposterior and (c) lateral views

As the surgeons examined the patient and reviewed the CT, they noticed a genu valgus deformity (more commonly known as a ‘knock-knee’ condition). Another corrective surgery was scheduled, with 3D CT imaging examined for bone tissue analysis. The surgeons realized, however, that the procedure would be more successful overall with a life-size 3D model. They were able to outline a patient-specific plan, also bringing in additional assistance from an orthopedic consulting firm focused around 3D orthopedics and ‘patient-specific instrumentation.’

Customized-to-patient three-dimensionally–printed guide. (a) The patient-specific guide for our patient. (b) Two resecting osteotomies can achieve optimal joint congruency and varus angle correction. (c) Correcting the femoral rotation would result in joint translation in both the coronal and axial planes

What was also very valuable to the surgery—and the outcome for the little boy involved—was that the surgeons could use the model to practice on, exercising ‘simulations of possible osteotomy options.’

“After a few osteotomy options had been analyzed, one osteotomy cut was made vertically to the femoral shaft on the subtrochanteric area, and another was made on the middle third of the femur to correct the bowing deformity of the midshaft,” stated the researchers. “Correction of femoral rotation can result in either joint translation in the coronal and axial planes or difficulty with fixation, both of which could be prevented with the help of the 3D model in the present case.”

The results of the surgeries were successful, with the patient able to stretch and begin other mobilization activity after four months.

Postoperative (a) anteroposterior and (b) lateral views. Fifteen-month postoperative (c) anteroposterior and (d) lateral views

“The result of our case suggests that the use of 3D printing models improves the postoperative performance as shown by both physical function and radiological evidence,” stated the authors in the concluding discussion.

“The use of a 3D-printed patient-specific guide is a safe, modern, affordable, and promising method that offers advantages including a shorter surgical time, optimally positioned implant placement, acceptable alignment, and a probable lower rate of complications. The utilization of 3D-printed models for skeletal deformity surgery, especially complex and difficult pediatric surgery, provides superior precision and foreseeably better outcomes. We strongly believe that with the promotion of 3D printing methodology, models for preoperative planning may soon become the gold standard for pediatric deformity correction surgery.”

3D printing continues to make impacts in the area of healing bones, regeneration and planning for complex surgeries with a range of medical devices and models. What do you think of this news? Let us know your thoughts! Join the discussion of this and other 3D printing topics at 3DPrintBoard.com.

Triple film at 2-year postoperative follow-up showing no significant leg length discrepancy (<0.5 cm)

[Source / Images: ‘Anatomic three-dimensional model-assisted surgical planning for treatment of pediatric hip dislocation due to osteomyelitis’]

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Indian Surgeons Use 3D Printing to Make Custom Pelvic Implant and Surgical Guidance Jigs

Pre-operative CT scan depicting the massive tumor in the left pelvis

Chondromyxoid fibroma, or CMF, is a rare, benign bone tumor that’s typically found in the bones of legs, arms, feet, hands, fingers, and toes and occurs most often between the ages of 10 and 30. A few years ago, 18-year-old Noor Fadil was experiencing severe pain in her left hip, which was caused by CMF of the pelvis, and was unable to bear weight on the hip or walk normally, which was obviously causing some issues in her daily life. After one medical facility advised a hindquarter amputation due to the severity of the tumor, she sought a second opinion from the Yellow Ribbon team in Bangalore, India.

“We are a group of orthopaedic oncosurgeons involved in managing Sarcomas,” Dr. Pramod Chinder told 3DPrint.com about the team. “We use 3D Prints regularly Mainly for planning and making guided Jigs.”

The team of self-described “super specialists” began managing bone and soft tissue sarcoma in 2008 and started the Yellow Ribbon movement, which, according to the website, “ensure the best outcomes to put a child back to normal.”

Once Fadil’s CMF diagnosis was confirmed, Dr. Chinder, along with fellow Yellow Ribbon team members Dr. Chandramouli, Dr Suraj, and Dr Srinath, collaborated with Bangalore-based Osteo3D and implantcast GmbH in Germany to make a custom 3D printed pelvic implant for Fadil…the first ever in the country, in fact. It’s no easy feat to reconstruct or resect a pelvis, which is why the team turned to 3D printing to get the job done.

“In this era of evolving relationship between technology and medicine, revolutionizing health care; our prior experience with 3D printed models and its application for surgical practice helped us to move a step ahead in utilizing this technology,” the team wrote in about the case.

“Collaboration of medicine and technology is becoming the antidote for issues that formerly caused despair, for both the patient and the surgeon. We feel the need for a generation of physicians and surgeons, who are technologically skilled and adapted toward innovation.”

During a multidisciplinary tumor board meeting, the team planned their approach, starting with using a minimally invasive approach to debulk the lesion in the patient’s pelvis, then using an ultrasonic probe to find “a well-defined cavity.”

Custom 3D printed hip implant and jig

The surgeons completed removed the tumor, and completed an excision of the head of the femur for good measure, to ensure that no tumor tissue was left. Then Fadil went home and began therapy both to maintain her limb function and to begin forming a strong, healthy bone bed – an essential foundation for a reconstructed hip joint.

Then the waiting began. To make sure she was completely ready for her hip reconstruction, the Yellow Ribbon team followed up with Fadil for two years to make sure that there no signs of the tumor coming back; luckily, there weren’t any. However, the patient’s remaining pelvis was distorted after her surgery, so the team took CT and MRI scans of the area in order to create a realistic digital model for planning purposes and to help design a biocompatible, patient-specific, 3D printed implant.

It was not an easy procedure, because the 3D printed implant needed to be placed at a very specific location, with specific angles, for it to fit properly. The screws to anchor the implant were also well-designed, as they too needed to end up in a certain place since Fadil only had a limited amount of native pelvic bone left. The team designed and used 3D printed plastic guidance jigs to make sure everything ended up where it was supposed to be.

“We operated the child for 8 hrs plus in 3 sittings,” Dr. Chinder told us, noting that Fadil and the team spent a grand total of 24 hours in the operating room. “We are very happy with overall outcome.”

Post-operative CT scan of the pelvis

Post-op, Fadil needed to take things slow, and with plenty of assistance, began non-weight bearing hip range of motion therapy and strengthening exercises during the first week after her surgery. Two months later, she began working on partial weight bearing, and eight months out, she was able to walk normally, bearing full weight, on her left side without relying on any supports like crutches and with no limp.

Just think – if the Yellow Ribbon team hadn’t been there, Fadil may have had to deal with an amputation. This is yet another example of 3D printing being used to change someone’s life for the better.

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[Images provided by Dr. Pramod Chinder]

SmarTech Dental and Medical 3D Printing Trend and Forecast Presentations at AMS 2019

Last week, our second annual Additive Manufacturing Strategies summit, “The Future of 3D Printing in Medicine and Dentistry,” was held in Boston. Co-hosted by SmarTech Markets Publishing, the summit was broken into separate tracks – one for medical and one for dental – and included a wide variety of speakers, a startup competition, and an exhibition floor.

Attendees were able to learn about a range of important and useful 3D printing topics, such as surgical planning and modeling, regulatory issues, implants, dental materials like ceramics, bioprinting, the use of AM in veterinary medicine, and international 3D printing developments in the medical and dental fields.

After Tuesday’s keynote and a quick break for some coffee, I started off on the dental track with a presentation on SmarTech’s dental 3D printing forecast. The talk was given by the company’s VP of Research Scott Dunham, whom Lawrence Gasman, the President of SmarTech, called “one of the top analysts in the country in our area.”

Dunham explained that during the “strategy maturation period” for many 3D printing companies, dentistry has now become a very important “focal area,” as it’s managed to “infiltrate the clinical segment in an increasingly meaningful way.” Mainly due to a significant leveraging of dental labs, one of the largest opportunities in the 3D printing industry today is in the dental field.

According to Dunham, there will be three main drivers for dental 3D printing applications over the next five years:

clear dental aligners
full dentures
temporary and permanent restorations in dental ceramics and composites

Dunham noted that SmarTech had correctly predicted the timing when it came to aligners, which will likely see its major challenges in terms of materials development. However, some companies, such as EnvisionTEC, have already created materials for making clear dental aligners, with the assistance of 3D printing.

FDA-approved 3D printable denture base materials, which have proper aesthetic properties, have actually been around for several years, but there was a major uptick in interest from the industry over the last year or so to bring denture-related applications to the AM market through material partnerships. In terms of permanent restorations in dental ceramics and composites, the use of micro-filled hybrid materials to make temporary dentures has been a sort of “jumping-off point” for making permanent restorations, like bridges, crowns, and implants.

According to Dunham, we’re likely to see much more “diversity in what’s driving dental hardware & materials in the future,” and the ratio of materials to hardware in dental 3D printing is an indicator that the industry is transforming. Dental 3D printing materials are mostly high value, especially the ones that can retain margins and cost on average per kilogram more than many other segments, and the value of the materials exceeds the value of hardware in the dental field more so than in other applications, which makes it unique.

Once his presentation ended, I followed Dunham over to the next room, which was on the medical track, to hear his next presentation; this time he would be discussing SmarTech’s medical 3D printing forecast. One of the main reasons SmarTech co-hosts the AMS summit with us is because innovation in healthcare is part of the DNA of the 3D printing industry, and Dunham stated that the three main pillars of adopting 3D printing in the industry are prototyping, healthcare, and industrial manufacturing.

Dunham said that SmarTech believes there are “a number of reasons that healthcare applications will shift to become the backbone of the industry,” such as:

low barrier to entry, though he did note the existing FDA regulatory hurdles
high volume applications – device types, procedures, and treatments currently being commercially explored with 3D printing
industry disruption through design – treatments tend to be more successful with with individualized, patient-specific devices
the major societal impact it could have, moving beyond just 3D printing devices and models but expanding the universe of treating patients

Dunham provided a brief history of healthcare innovation in 3D printing, starting with SLA first being used for medical modeling in 1988, noting the first patented process for 3D printing hearing aid shells in 1999, the first recorded Ti-64 patient-specific 3D printed implant in 2007, the mainstreaming of patient-specific 3D printed knee instrumentation in 2010, and the launching of Materialise HeartPrint in 2013.

The outlook for medical 3D printing opportunities, including materials, services, software, and hardware, is currently estimated to be $1.25 billion, but the total is estimated to be $6.08 billion by the year 2027. If these totals are split into segments, Dunham said that the global revenue will likely be tied to three main areas: orthopedics, personalized surgery, and medical devices. Then he moved onto the recent strategic updates that influenced these estimates.

Spinal cage production build [Image: Betatype]

Dunham explained that there are many opportunities in the additive orthopedics sector, due to the fact that many of the large market players are stepping up their adoption of metal 3D printing in order to enhance traditional implant design for improved performance. He referenced a case study by Betatype centered around developing software solutions for orthopedic companies already involved in 3D printing, noting that “they achieved some really amazing results” in the study. When working to determine if 3D printing would become the main process in the future for making orthopedic implant devices, Dunham said that SmarTech figured the technology would most likely “at least tip the 50% penetration point.”

In terms of medical device manufacturing, Dunham said SmarTech definitely believes there are production opportunities for 3D printing, especially since the estimated value of medical 3D printing services in 2027 is $1.5 billion. He noted that there are an increasing number of opportunities to use 3D printing when fabricating medical devices with customized elements that are matched to specific procedures or treatments; on the flip side, use is also increasing of a range of production-oriented 3D printing methods in order to produce parts for medical devices and equipment that already exist.

Some of the major takeaways Dunham noted at the end of his presentation were that societal impact, and improving patient outcomes, are both “perfectly valid” ways of measuring how 3D printing is disrupting the industry, rather than just relying on money alone.

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[Images: Sarah Saunders]

Anatomiz3D Partners with Incredible AM to Deliver 3D Printed Patient-Specific Healthcare Solutions

From implant molds, prosthetics, and surgical and educational models to surgical guides and patient-specific surgical models, Mumbai-based medical 3D printing company Anatomiz3D Medtech Private Limited has worked with many aspects of medical 3D printing. Anatomiz3D, which is the healthcare division of tech company Sahas Softech, uses 3D printing to enhance and personalize patient care, whether it’s providing them with peace of mind by showing them a model or making their surgery quicker and easier with guides and implants.

The healthcare solutions company uses patient data from 2D MRI and CT scans to provide 3D modeling and printing services to the medical community, so physicians can better help their patients. More than three years ago, it was the first company in India to provide doctors with a 3D printed, patient-specific pediatric cardiology model before surgery, and has since moved on, 3D printing models for spinal, oral and maxillofacial, orthopaedic, head and neck, and neurosurgery operations using a variety of methods, including SLS, stereolithography, DMLS, and color jet printing.

Anatomiz3D’s mission is two-fold: to aid surgical practices by simplifying and customizing operative planning and procedures in order to improve patient recovery quality, and to develop patient-specific tissue engineering solutions to help lower the need for organ donors in the future.

Now, the surgical 3D printing company has announced that it’s partnering up with another Indian company to develop various 3D printed specialty solutions for the personalized healthcare industry. Incredible AM Pvt Ltd, established in 1974 as part of Industrial Metal Powders Pvt Ltd in Pune, works with both the medical and engineering industries by providing metal 3D printing services.

Incredible AM Pvt Ltd has a great facility that’s based on FDA guidelines, and is also reportedly the only company in India that has received both ISO 9001 and ISO 13485 certifications for the manufacture of metal medical devices; this has helped it provide many customers across India with custom implants for neuro, orthopaedic, and maxillofacial surgeries.

With Incredible AM Pvt Ltd’s capabilities in metal 3D printing, paired with the design and plastic 3D printing skills provided by Anatomiz3D, this new partnership is essentially a one-stop-shop when it comes to personalized, patient-specific healthcare solutions.

Now, Incredible AM Pvt Ltd has invested an undisclosed amount of money into its new partner, Anatomiz3D, so that the two can work together to successfully even offer more 3D printed patient-specific surgical solutions to customers all around the world, focusing on affordable prices, excellent quality, and precise designs. The two companies have already helped create several orthopaedic, maxillofacial, and cranial implants together, and continue to work hard and help their respective R&D teams develop even more 3D printed medical products.

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Optomec Introduces New Hybrid 3D Printing System, Used By Researchers to Make Dissolvable Magnesium Medical Implants

New Mexico-based Optomec is well-known for both its aerosol jet technology, which is used to 33D print electronics, and its other patented AM process: LENS, which uses Directed Energy Deposition (DED) for high-value metal 3D printing. The company has been busy in the last few years, winning contracts and awards and providing resources on its technologies. In 2016, the company first showcased its hybrid LENS Machine Tool series, which consist of a CNC Vertical Milling platform integrated with Optomec’s proprietary LENS metal 3D printing technology.

This week at IMTS 2018 in Chicago, Optomec is introducing the latest addition to the series – the LENS 860 Hybrid Controlled Atmosphere (CA) System.

“The new LENS 860 suite of systems builds on the success of our Machine Tool Series, first launched at IMTS in 2016,” said Dave Ramahi, Optomec President and CEO. “These new larger machines continue to demonstrate our ability to transition Optomec production-proven 3D Metal Printing capability onto traditional CNC platforms that match the cost, performance and ease-of-use demands of the traditional machine tool market. These products are a key element of our strategy to bring Metal Additive Manufacturing into the industrial mainstream.”

The new large-format LENS 860 Hybrid CA System offers more capabilities for high-quality, affordable metal hybrid manufacturing, thanks to its higher laser power support and larger build volume of 860 x 600 x 610 mm. It features a hermetically-sealed build chamber that maintains moisture and oxygen levels below 10 ppm for processing reactive metals, like titanium, and can cost-effectively produce and repair parts.

The system offers versatility, as it can perform wide area cladding for wear coating applications and 3D print fine, detailed features for thin wall metal structures. It can also be configured with a high-power 3kW fiber laser and closed loop controls, which makes it the perfect choice for building, repairing, and coating mid- to large-size parts that offer superior metal quality. Optomec’s powerful software allows for 5-axis build strategies, which can combine both subtractive and additive operations in one tool path; the company also provides several material starter recipes to speed up adoption with the LENS 860 Hybrid CA System.

Performing finish machining on a 3D printed part with the LENS Hybrid configuration’s milling capability, without having to align it on another machine or re-fixture it, is one of the many advantages of the LENS Machine Tool Series, which start at under $250,000. There are three additional configurations to the LENS 860 Hybrid CA System model in the series: two Additive-Only models, both of which are Open and Controlled Atmosphere, and and the 860 Hybrid Open Atmosphere (OA) system, which is a good platform to use when processing non-reactive metals like Tool Steel Inconel and Stainless Steel.

You can see the new system for yourself this week at Optomec’s booth #432204 in the West Building at IMTS 2018. The first customer shipments of the LENS 860 Hybrid CA System will take place later this year.

Speaking of customers, Optomec also shared the details at IMTS of how the University of Nebraska-Lincoln (UNL) is using one of its new LENS Hybrid CA Systems to create dissolvable magnesium components for applications in the medical field.

Medical implants, like screws and plates, made of stainless steel or titanium, are permanent structures that can have high complications rates and need to be surgically removed and fixed. But the university’s work with the LENS Hybrid CA System will allow the creation of 3D printed, patient-specific implants with a controlled time to dissolve, which will lower the costs, risks, and suffering of patients who will no longer require a second surgery to remove implants.

Professor Mike Sealy of UNL and his team are using an Optomec LENS Hybrid CA System to advance the performance and functionality of medical implants.

“We are proud to be the first customer of an Optomec LENS Hybrid Controlled Atmosphere System, the only commercially-available machine to provide hybrid manufacturing capabilities for reactive metals. Our research is focused on advancing the performance and functionality of dissolvable devices. Using LENS, we are applying a hybrid additive manufacturing process to control the disintegration of medical fasteners and plates so they stay in-tact long enough to serve their purpose and then degrade away once the bone is healed,” said Dr. Michael Sealy, Assistant Professor of Mechanical and Materials Engineering at UNL, and a pioneer in advanced manufacturing research.

Optomec’s LENS 3D Hybrid CA System is the AM industry’s first atmosphere-controlled system for additive and subtractive processing of metals, and combines the company’s industry-proven LENS technology with a strong CNC automation platform. The system will make it more cost-effective to introduce metal 3D printing to industrial markets.

The UNL is a 3D printing and hybrid AM leader, and using the LENS Hybrid CA System allows Dr. Sealy and his team to combine layered surface treatments with LENS technology in order to 3D print magnesium components with controlled degradation – a coveted design capability in the medical field, in addition to areas like automotive structures and lightweight aerospace. Whereas dissasolvable and bioabsorbable 3D printed polymers have been shown dissovable metals is completely new.

“Two years ago, at IMTS in 2016, Dr. Sealy and his team at University of Nebraska became the first customer of our LENS Hybrid Controlled Atmosphere system. Today they are here at IMTS showcasing their groundbreaking accomplishments achieved with their LENS Hybrid system,” said Tom Cobbs, LENS Product Manager at Optomec. “Dr. Sealy’s pioneering work enables the design and manufacture of components with a combination of properties unobtainable using traditional metal working methods. We applaud his innovative use of hybrid additive manufacturing to create and qualify a new class of metal components with unique properties that will benefit mankind.”

Dr. Mike Sealy and UNL students have been using a LENS metal hybrid AM system from Optomec to advance research in key areas such as heavy machinery, medical devices, and aeronautics.

Reactive materials and powdered metals, such as titanium and magnesium, have to be processed in a controlled atmosphere, where oxygen and moisture impurities can be kept below 10 parts per million. Dr. Sealy used the Optomec LENS 3D Hybrid CA System to process these kinds of materials in a way that allowed a degradable implant to hang onto its integrity and strength long enough to complete its job. He is also working with Sentient Science to investigate hybrid processing techniques of 7000 series aluminum for the US Navy.

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[Images provided by Optomec]

The Real Wolverine: Anatomics Works with Surgeon to Design 3D Printed Titanium Metacarpal Implant

[Image: e-NABLE]

While I did not read the comic books, I was a big fan of the ’90s X-Men cartoon series growing up. In fact, the first short story I ever wrote was about a canine with superpowers named X-Dog…pretty original, right? My love for the mutant superheroes was reawakened when Bryan Singer’s blockbuster movie X-Men came out in 2000, and the world was treated to the first glimpse of Hugh Jackman as Wolverine, the moody mutant with a shadowy, unknown past.

Since then, 3D printing has given other Wolverine fans a way to embody him without having to turn to adamantium. But this has gone one step further now, with a story, as Paul D’Urso, MD, a neurosurgeon at Epworth Healthcare and the Executive Chairman of Australian medical device company Anatomics, tells us, about a “Real Life Wolverine.”

D’Urso said, “Anatomics pioneered the use of 3D printing in surgery in 1995 and has helped surgeons in 40 countries with the most difficult & complex reconstructive surgical problems that no other company could provide a solution for.”

Let’s back up a little first. The five metacarpal bones, which are located between the carpal bones of the wrist and the phalanges of the fingers, make up the intermediate portion of the human hand. Equivalent to the metatarsal bones in the foot, the tops of the metacarpals form our knuckles where they join to the wrist.

We’ve seen 3D printed haptic models representing carpal and metacarpal bones during various hand movements created and studied for potential use in preoperative planning for hand surgery, a 3D printed wrist brace for stabilizing a broken metacarpal while healing, 3D printed patient-specific models and surgical guides for metacarpal deformities, and even a 3D printed titanium bone to replace a metacarpal thumb bone.

Anatomics, a not-for-profit company, has plenty of experience using 3D printing in the medical field, such as 3D printing the first titanium sternum and set of ribs and vertebrae. The company recently had to call on this experience to help with an important case.

“This man had a severe workplace injury and lost the bones in the middle of his left hand,” D’Urso told 3DPrint.com. “As there was no ‘off the shelf ‘ solution his hand surgeon, Dr Dan Rowe, called upon Anatomics to reconstruct the patient’s hand with a 3D printed titanium implant.”

Anatomics stepped up to the plate and got to work. Together with Dr. Rowe, engineers from the medical device company designed a 3D printed, patient-specific metacarpal implant to replace the patient’s two missing metacarpals and missing capitate that had resulted from his injury.

The implant was designed with titanium mesh, which makes soft tissue ingrowth possible once it’s inserted into the patient’s body. Titanium is biocompatible, with a high resistance to corrosion, both of which combine to allow bone to grow. These qualities make it the perfect material for medical implants, once it’s combined with 3D printed lattice structures.

“The implant was designed to articulate with the other bones in the hand and had special channels in it that allowed the tendons to secure it in position,” D’Urso tells us.

“The implant contained a porous lattice to allow for tissue integration.”

During the patient’s hand reconstruction surgery at Greenslopes Private Hospital in Queensland, Dr. Rowe implanted the 3D printed titanium metacarpal. D’Urso tells us that “Dr Rowe is very pleased with initial results!”

Okay, so the patient didn’t actually end up being a real Wolverine, as only a very small portion of his bones were replaced with metal, but he was still part of something pretty amazing. Innovations like this one are what make 3D printing so important in the medical field. While I imagine the patient still didn’t have the easiest recovery – he did lose the bones in the middle of his hand, after all – I’m willing to bet his quality of life will be better with a 3D printed implant made specifically for his hand than it would be with an off-the-shelf implant, or worse, no implant at all.

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Duke University’s 3D Printing Innovation Lab Allows Surgeons to Create Accurate 3D Printed Medical Training Models

3D printers in Duke University’s Innovation Co-Lab [Image: Innovation Co-Lab Studio]

3D printing is becoming increasingly more accessible and affordable in many industries, including the medical field. We often see the technology used for the purposes of creating accurate training models and simulators, so that medical professionals can practice surgeries and procedures ahead of time – this not only saves on costs, but can also allow surgeons to offer a better level of care.

Tawfig Khoury, MD, an otolaryngology (ear and throat) resident at Duke University, is focused on the latter, and uses 3D printing to improve patient care. He makes 3D printed medical models of the ear’s delicate temporal bones, which are later used for the purposes of medical training.

“One focus of my research has been taking CT scans of temporal bones, and printing an exact, patient-specific replica. Our residents can then practice drilling and performing other tests without having to work on an actual patient,” Dr. Khoury explained.

Tawfiq Khoury, MD, Otolaryngology
Resident

Dr. Khoury works on his 3D printed models at the university’s Innovation Co-Lab Studio, which contains a network of over 80 3D printers, ranging from MakerBot and Markforged to Ultimaker and Formlabs, that have been used for various projects since the facility began to really grow last year and explore new uses for 3D printing at the university.

“With recent renovations, we now have a state-of-the-art facility, with high-end equipment across an entire floor dedicated to the lab,” Dr. Khoury said.

“The Innovation Lab is a great example of how different departments across the hospital, as well as other healthcare groups, residents, and students, can work together to create something of value for the community.”

The lab, previously described as a “creativity incubator,” also includes 3D scanning equipment, CNC machines and laser cutters, digital modeling workstations, and a multitude of electronics.

Physicians from several of the university’s medical specialties, including cardiology, neurosurgery, and neurology, use the patient record system Epic to access an ordering system in order to have medical models 3D printed in the studio from ultrasounds and CT and MRI scans. Occasionally, the Innovation Co-Lab Studio can provide its 3D printing services at no cost if the 3D printed replica models are created specifically for patient care.

One of the 80 3D printers in Duke University’s Innovation Co-Lab Studio [Image: Cara O’Malley]

In order to receive and handle requests for 3D prints from around the world, the studio uses 3DPrinterOS, the popular online cloud management system, as a service to the university’s community. 3DPrinterOS users have access to an online, live-streaming video of the project while it’s being 3D printed.

Since the facility’s expansion, a wider community of users have been taking advantage of its services. The expansion also gives Dr. Khoury the opportunity to, according to a post by Scott Behm with Duke’s Department of Surgery, “set his sights on some short- and long-term goals.”

Dr. Khoury feels that 3D printing, even though it can already create accurate models for the purposes of medical training, can go even further at the university. Before his residency at Duke is complete, he hopes to set up an efficient system in order to assist patients with facial trauma who must have maxillofacial reconstruction surgery. His main goal in this is to enable the routine creation of 3D printed models for eventual use in implants for this type of procedure.

Someday in the future, Dr. Khoury believes that we will be able to rely on 3D printers as a way to create organic replacement organs or body parts out of bioink or hydrogel, such as an eardrum, which can then be infused with live cells and implanted in a patient’s body.

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Using Patient-Specific 3D Printed Surgical Guides for Total Knee Replacement

While surgery has always, ultimately, been about the patient, it hasn’t always been patient-centered. Historically, patients have not had an easy time of understanding exactly what their surgery entails and have often been treated as if they were ancillary to the surgical problem presented. This can’t all be blamed on uncaring medical staff, as most people involved in medicine do care and care profoundly. Instead, it has largely been a result of resources and standing custom. Surgical procedures are complicated and difficult to understand, hence the reason why experts are the ones who address them, and the pressure and stress involved in going into a procedure largely blind has made it difficult for surgeons to relax and broaden their focus to include the patient beyond the problem.

3D technology is making great contributions to medicine, from aiding in research to assisting in the preparation of students to practice medicine to producing the tools necessary to perform better operations. It is being integrated into the surgical theater and changing the face of surgery as we know it. One of the ways it is doing this is through the provision of a greatly improved ability to plan for the procedure. 3D technology not only allows the medical team a sneak preview, 3D printing can create models of the particular areas to be addressed and allow surgeons to study them in advance. This helps minimize surprises and therefore reduces the stress on both the patient and the medical staff.

The staff at Orthoparc in the Netherlands has figured out another way to help create and deliver the best in patient centered care. Using 3D technology, they have developed a method of patient-centered total knee replacement that allows a patient to walk in, in the morning, and walk out that same day. Such a possibility requires a highly interconnected team of specialists working together to ensure that not only does the patient get the knee replacement they need, but their psychological, nutritional, and whole health needs are met as well.

Dr. Saskia Boekhorst

One component of this is the integration of 3D printed, patient-specific surgical guides that take the uncertainty out of the procedure itself. These surgical guides are produced using data gathered about an individual patient’s knee and are fabricated in-house on a 3D printer. When placed upon the patient during surgery, they guide the surgeon to exactly where cuts need to be made in relationship to where the knee is resting. Dr. Saskia Boekhorst is an orthopedic surgeon at Orthoparc, and she described the impact these guides have had in her experience:

“I’m a big fan of the patient-specific knee guides because this technology allows me to place the components of the knee arthroplasty exactly in the right axis of the leg in all dimensions. The first one hundred cases I’ve double checked by manual measurements, because it was a different approach and I am very careful. But after seeing very nice and consistent results, I became convinced.”

This increase in precision means that the surgery is more exactly what the patient needs and reduces the risk of unnecessary or erroneous incisions. The surgical guides also make the surgery less invasive, removing the need to drill into the femur canal as in traditional knee replacement surgery procedures. They also help decrease the amount of time the patient has to spend in surgery, as Dr. Boekhorst explained:

“The positioning and alignment are already done by me within an interactive planning software in which I can rotate the knee in all directions and see how the prosthesis could be placed for a particular patient. You will never be able to see this in all these dimensions and directions with a real patient because of soft tissue.”

All of this adds up to mean that there is less anesthesia necessary and less powerful post surgery painkillers required. Not only does that reduce the risks associated with such powerful medicines but allows the patient to be more fully cognizant and mentally focused on an increased timeline, something which is necessary for the implementation of a physical therapy regimen.

It’s not just good for the patients, it also makes sense for the surgical team in terms of reducing stress and ensuring they are better prepared for the operation. In addition, using these guides means that fewer surgical tools need to be prepped and sterilized as the knee guides come in a comprehensive ‘knee in the box’ package that includes all the necessary instrumentation and two sizes of preselected implants to treat a single patient. This means less overhead and a reduction in logistics cost, something which allows the medical practice to reinvest its resources elsewhere, such as in its staff and patients.

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[Source/Images: Materialise]

Father Takes Up 3D Printing, and Founds New Company, to Create Son’s Custom Orthosis

Some of the most heartwarming aspects of the 3D printing industry involve the people who do everything they can to develop and provide affordable 3D printed prosthetics to people who need them the most. Just in time for Father’s Day, Formlabs has shared a beautiful story about a dad who worked tirelessly to help his young son walk on his own…and ended up helping others along the way.

Cerebral palsy (CP) causes more than 17 million people around the world to have limited control of their own bodies. Seven years ago, Nik, the son of Matej and Mateja Vlašič, was born one month early, and due to difficulties during childbirth, suffered brain damage that led to the diagnosis of CP, and an inability to stand or walk on his own.

To help CP patients walk, many doctors will prescribe standard orthoses meant to correct spine and limb disorders. Patients can purchase pre-made orthotics, and some can even be slightly modified to better fit the patient, but it’s not easy to use one device to help with several symptoms, and they can even lead to skin irritation and pain.

Custom orthoses, CNC machined based off of a plaster or foam box impression, generally fit better, but the cost can be astronomical, even with insurance, and delivery can take weeks. On top of that, children outgrow them quickly.

Matej, who has an engineering background, said, “Based on my knowledge, I knew that a piece of plastic could not cost so much money.”

Matej has worked hard all of Nik’s life to help him move on his own, even using ski boots to stabilize his ankles when he got older.

“When you’re looking at your child, you instinctively know what to do in order to help him. When Nik was unable to turn on his side, I decided to build a ramp so that he could easily flip on his belly. When he found out that this was fun, he was trying to do it all by himself,” Matej said.

“He instantly felt confident, and you could see it in his eyes that he loved it and that he wanted to progress. This is what kept us going.”

Unfortunately, Nik’s short Achilles tendon and low muscle tone kept him on his toes.

“He was afraid of walking because his feet were in a really bad position,” said Petra Timošenko, Nik’s physiotherapist. “If he had tried to walk longer like that, he would have injured the bones and the joints.”

Matej knew he had to find a better way to help his son.

“The lack of comfort and high price combined with all the cons were enough that I decided to do something about it. I didn’t have the solution at that time, but I wanted to find a better way to design it,” Matej said. “I was just trying to help my son the best possible way.

“I didn’t know how orthoses are produced currently, so I was able to look outside of the box.”

He had heard of 3D printing, and after conducting some research, determined that the technology was accurate enough to create a properly-fitted orthosis. One of the benefits of 3D printing, especially in the healthcare field, is its ability to design customized products at a more affordable cost, and Matej was confident he could create a custom, 3D printed orthosis that would give Nik the correction and support he needed.

After a few attempts, Matej successfully digitized Nik’s feet, learned 3D modeling, and spent the next six months researching and experimenting, and eventually developed an innovative workflow, which starts with placing the patient’s feet, in the corrected, standing position, on a vacuum bag.

An iPad-mounted structure scanner scans the footprints from the bag, while the feet are also 3D scanned from above, and the data is merged and cleaned up into an accurate representation. The custom orthosis is designed right on the 3D scanned foot in CAD software, and then 3D printed in high resolution on a Form 2 3D printer with Durable Resin.

The first 3D printed prototype reached almost to Nik’s knee and kept him from walking freely, so Matej got to work on the second iteration, creating a prototype that fit inside a regular shoe. Finally, a successful prototype was created.

“In two or three days he was walking, and we were not needed to take care of him so that he doesn’t fall anymore,” Matej said. “The change was immediate, it was unbelievable.”

Nik’s orthosis is barely visible.

Just how braces align teeth, the 3D printed orthosis keeps Nik’s foot in the corrected position. It’s best to use orthoses at a young age, as children’s bodies can adapt while they grow. Physiotherapy also helps to strengthen ligaments and muscles.

“When he’d been using the orthosis for two or three months, for the first time, I saw Nik smiling,” said Timošenko. “After four or five months, he started to become faster and faster. His steps became longer, and his walking more smooth. He actually started to dance.

“Now I can do much more sophisticated exercise with him. We can run on a treadmill, we can jump, because I know that his feet are in the right position and I can’t cause any deformation to his bones or joints, that might, on the long term, require an operation to correct. If he didn’t have this orthosis, his feet would be in danger.”

Matej created four versions of Nik’s 3D printed orthosis.

“The first version gave him confidence and stabilized him. The second version improved his overall walking smoothness,” Matej explained. “Then the third helped him get better posture, and that’s when he really started to enjoy the walking and started to play around. The fourth orthosis corrected his right foot that was off the center of his body, so now he’s able to stand with his feet together in a straightened, upright position.”

After looking at the workflow, and measuring Nik’s feet with and without his 3D printed orthoses, certified orthotist and prosthetist Dejan Tašner knew that Matej had created a novel solution. He is able to make an affordable custom orthosis in less than 24 hours, and the devices are also comfortable.

“3D printing allows us to create orthotics with different thicknesses in different areas. We can apply a more thick area where it’s needed and minimal thickness to the areas where correction is not required,” Matej explained. “This is not possible with current solutions.

“Orthoses don’t need to hurt, only without pain can the children accept them.”

Matej and his wife decided to certify the workflow, which is now patent-pending, so the process and components will meet standard requirements for medical devices and allow for clinical trials. Matej quit his job to focus on 3D printed, patient-specific 3D printed children’s orthotics full-time and, together with Mateja, Tašner, and Timošenko, formed a new company called aNImaKe.

“At the moment, we are testing with several patients with different pathologies from age three to 11,” Tašner said. “We already see improvements in terms of biomechanics, which is the main goal. But also, crucially, a positive change in sentiment that the parents see in the daily life of their children because they need to feel comfortable to use the orthosis often enough to improve their walking.”

aNImaKe hopes to expand the technique to other parts of the body, such as a hand brace that helps young CP patients spread their fingers.

“We want to enlighten others in the medical industry about the tools that are available today to provide better options to the children,” Matej said. “Orthotics should be built for a person, and should treat only the symptoms, not be standardized solutions that put them in boxes.”

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[Source/Images: Formlabs]