Study on application of aerospace technology to improve surgical implants

The areas where aerospace technology could be used to improve the reliability and performance of metallic, orthopedic implants was assessed. Specifically, comparisons were made of material controls, design approaches, analytical methods and inspection approaches being used in the implant industry with hardware for the aerospace industries. Several areas for possible improvement were noted such as increased use of finite element stress analysis and fracture control programs on devices where the needs exist for maximum reliability and high structural performance

Current Trends in Improving of Artificial Joints Design and Technologies for Their Arthroplasty

There is a global tendency to rejuvenate joint diseases, and serious diseases such as arthrosis and arthritis develop in 90% of people over 55 years of age. They are accompanied by degradation of cartilage, joint deformities and persistent pain, which leads to limited mobility and a significant deterioration in the quality of life of patients. For the treatment of these diseases in the late stages, depending on the indications, various methods are used, the most radical of which are methods of joint arthroplasty and, in particular, total arthroplasty. Currently, total arthroplasty is one of the most effective and high-quality surgical operations at the relevant medical indications. However, complications may also arise after it, leading, inter alia, to the need for repeated surgical intervention. In order to minimize the likelihood of complications, the artificial joints used in total arthroplasty and the technology of their fabrication are constantly being improved, which leads to the emergence of new designs and methods for their integration with living tissues. At the same time, at the moment, the improvement of traditional designs and production technologies has almost reached the top of their art, and their further improvements can be insignificantly or are associated with the use of the most up-to-day technologies, allowing for friction couples with low tribological properties to provide for them high ones, for example, gradient increase hardness in the couple titanium alloy on titanium alloy. This paper presents the current state of traditional technical means and technologies for joint arthroplasty. The main attention is paid to the analysis of the latest technologies in the field of joint arthroplasty, such as osseointegration of artificial joints, the improvement of materials with the property of osteoimmunomodulation, the improvement of joint arthroplasty technologies based on the modeling of dynamic osteosynthesis, as well as the identification of possible unconventional designs of artificial joints that contribute to these technologies, predictive assessment of areas for technologies improvement.DFG, 414044773, Open Access Publizieren 2019 - 2020 / Technische Universität Berli

Recent Advances and Current Developments in Tissue Scaffolding

A bio-scaffold can be broadly termed as a structure used to substitute an organ either permanently or temporarily to restore functionality. The material that can be used varies with the application intended. Tissue engineering is one such application demanding certain requirements to be met before it is applied. One of the applications in tissue engineering is the tissue scaffold, which provides either a permanent or temporary support to the damaged tissues/organ until the functionalities are restored. A biomaterial can exhibit specific interactions with cells that will lead to stereotyped responses. The use of a particular material and morphology depends on various factors such as osteoinduction, osteoconduction, angiogenesis, growth rates of cells and degradation rate of the material in case of temporary scaffolds, etc. The current work reviews the state of art in tissue scaffolds and focuses on permanent scaffold materials and applications with a brief overview of temporary scaffold materials and their disadvantages

Recent trends, technical concepts and components of computer-assisted orthopedic surgery systems: A comprehensive review

Computer-assisted orthopedic surgery (CAOS) systems have become one of the most important and challenging types of system in clinical orthopedics, as they enable precise treatment of musculoskeletal diseases, employing modern clinical navigation systems and surgical tools. This paper brings a comprehensive review of recent trends and possibilities of CAOS systems. There are three types of the surgical planning systems, including: systems based on the volumetric images (computer tomography (CT), magnetic resonance imaging (MRI) or ultrasound images), further systems utilize either 2D or 3D fluoroscopic images, and the last one utilizes the kinetic information about the joints and morphological information about the target bones. This complex review is focused on three fundamental aspects of CAOS systems: their essential components, types of CAOS systems, and mechanical tools used in CAOS systems. In this review, we also outline the possibilities for using ultrasound computer-assisted orthopedic surgery (UCAOS) systems as an alternative to conventionally used CAOS systems.Web of Science1923art. no. 519

3D-printing techniques in a medical setting : a systematic literature review

Background: Three-dimensional (3D) printing has numerous applications and has gained much interest in the medical world. The constantly improving quality of 3D-printing applications has contributed to their increased use on patients. This paper summarizes the literature on surgical 3D-printing applications used on patients, with a focus on reported clinical and economic outcomes. Methods: Three major literature databases were screened for case series (more than three cases described in the same study) and trials of surgical applications of 3D printing in humans. Results: 227 surgical papers were analyzed and summarized using an evidence table. The papers described the use of 3D printing for surgical guides, anatomical models, and custom implants. 3D printing is used in multiple surgical domains, such as orthopedics, maxillofacial surgery, cranial surgery, and spinal surgery. In general, the advantages of 3D-printed parts are said to include reduced surgical time, improved medical outcome, and decreased radiation exposure. The costs of printing and additional scans generally increase the overall cost of the procedure. Conclusion: 3D printing is well integrated in surgical practice and research. Applications vary from anatomical models mainly intended for surgical planning to surgical guides and implants. Our research suggests that there are several advantages to 3D- printed applications, but that further research is needed to determine whether the increased intervention costs can be balanced with the observable advantages of this new technology. There is a need for a formal cost-effectiveness analysis

Equivalent Mid-Term Results of Open vs Endoscopic Gluteal Tendon Tear Repair Using Suture Anchors in Forty-Five Patients.

BackgroundLittle is known about the relative efficacy of open (OGR) vs endoscopic (EGR) gluteal tendon repair of gluteal tendon tears in minimizing pain and restoring function. Our aim is to compare these 2 surgical techniques and quantify their impact on clinical outcomes.MethodsAll patients undergoing gluteal tendon tear repair at our institution between 2015 and 2018 were retrospectively reviewed. Pain scores, limp, hip abduction strength, and the use of analgesics were recorded preoperatively and at last follow-up. The Hip disability and Osteoarthritis Outcome Score Junior and Harris Hip Score Section1 were obtained at last follow-up. Fatty degeneration was quantified using the Goutallier-Fuchs Classification (GFC). Statistical analysis was conducted using one-way analysis of variance and t-tests.ResultsForty-five patients (mean age 66, 87% females) met inclusion criteria. Average follow-up was 20.3 months. None of the 10 patients (22%) undergoing EGR had prior surgery. Of 35 patients (78%) undergoing OGR, 12 (27%) had prior hip replacement (75% via lateral approach). The OGRs had more patients with GFC ≥2 (50% vs 11%, P = .02) and used more anchors (P = .03). Both groups showed statistical improvement (P ≤ .01) for all outcomes measured. GFC >2 was independently associated with a worst limp and Harris Hip Score Section 1 score (P = .05). EGR had a statistically higher opioid use reduction (P < .05) than OGR. Other comparisons between EGR and OGR did not reach statistical significance.ConclusionIn this series, open vs endoscopic operative approach did not impact clinical outcomes. More complex tears were treated open and with more anchors. Fatty degeneration adversely impacted outcomes. Although further evaluation of the efficacy of EGR in complex tears is indicated, both approaches can be used successfully

Digital Orthopaedics: A Glimpse Into the Future in the Midst of a Pandemic.

BackgroundThe response to COVID-19 catalyzed the adoption and integration of digital health tools into the health care delivery model for musculoskeletal patients. The change, suspension, or relaxation of Medicare and federal guidelines enabled the rapid implementation of these technologies. The expansion of payment models for virtual care facilitated its rapid adoption. The authors aim to provide several examples of digital health solutions utilized to manage orthopedic patients during the pandemic and discuss what features of these technologies are likely to continue to provide value to patients and clinicians following its resolution.ConclusionThe widespread adoption of new technologies enabling providers to care for patients remotely has the potential to permanently change the expectations of all stakeholders about the way care is provided in orthopedics. The new era of Digital Orthopaedics will see a gradual and nondisruptive integration of technologies that support the patient's journey through the successful management of their musculoskeletal disease

A Current Overview of Materials and Strategies for Potential Use in Maxillofacial Tissue Regeneration

Tissue regeneration is rapidly evolving to treat anomalies in the entire human body. The production of biodegradable, customizable scaffolds to achieve this clinical aim is dependent on the interdisciplinary collaboration among clinicians, bioengineers and materials scientists. While bone grafts and varying reconstructive procedures have been traditionally used for maxillofacial defects, the goal of this review is to provide insight on all materials involved in the progressing utilization of the tissue engineering approach to yield successful treatment outcomes for both hard and soft tissues. In vitro and in vivo studies that have demonstrated the restoration of bone and cartilage tissue with different scaffold material types, stem cells and growth factors show promise in regenerative treatment interventions for maxillofacial defects. The repair of the temporomandibular joint (TMJ) disc and mandibular bone were discussed extensively in the report, supported by evidence of regeneration of the same tissue types in different medical capacities. Furthermore, in addition to the thorough explanation of polymeric, ceramic, and composite scaffolds, this review includes the application of biodegradable metallic scaffolds for regeneration of hard tissue. The purpose of compiling all the relevant information in this review is to lay the foundation for future investigation in materials used in scaffold synthesis in the realm of oral and maxillofacial surgery

Design and fabrication of 3D-printed anatomically shaped lumbar cage for intervertebra disc (IVD) degeneration treatment

Spinal fusion is the gold standard surgical procedure for degenerative spinal conditions when conservative therapies have been unsuccessful in rehabilitation of patients. Novel strategies are required to improve biocompatibility and osseointegration of traditionally used materials for lumbar cages. Furthermore, new design and technologies are needed to bridge the gap due to the shortage of optimal implant sizes to fill the intervertebral disc defect. Within this context, additive manufacturing technology presents an excellent opportunity to fabricate ergonomic shape medical implants. The goal of this study is to design and manufacture a 3D-printed lumbar cage for lumbar interbody fusion. Optimisations of the proposed implant design and its printing parameters were achieved via in silico analysis. The final construct was characterised via scanning electron microscopy, contact angle, x-ray micro computed tomography (μCT), atomic force microscopy, and compressive test. Preliminary in vitro cell culture tests such as morphological assessment and metabolic activities were performed to access biocompatibility of 3D-printed constructs. Results of in silico analysis provided a useful platform to test preliminary cage design and to find an optimal value of filling density for 3D printing process. Surface characterisation confirmed a uniform coating of nHAp with nanoscale topography. Mechanical evaluation showed mechanical properties of final cage design similar to that of trabecular bone. Preliminary cell culture results showed promising results in terms of cell growth and activity confirming biocompatibility of constructs. Thus for the first time, design optimisation based on computational and experimental analysis combined with the 3D-printing technique for intervertebral fusion cage has been reported in a single study. 3D-printing is a promising technique for medical applications and this study paves the way for future development of customised implants in spinal surgical applications