The Use of Layered Freeform Fabrication Technologies to Produce Tissue Engineering Scaffolds for Skull Patches

Congenital skull defects in infants are difficult to correct using metal plates due to the growth of the skull. Tissue engineering of bone patches could be the answer to help such patients. Custom scaffolds have been designed based on Computed Tomography (CT) images of the patient’s skull. An in-house developed single screw extruder, casting and a commercial laser cutter has been evaluated in the fabrication of pure polycaprolactone (PCL) scaffolds as well as PCL mixed with hydroxyapatite (HA) scaffolds. Evaluation criteria for each process included the ability to maintain an optimal pore size for cells to proliferate, inclusion of micro surface properties for cell adhesion, incorporation of hydroxyapatite, and ability to maintain desired shape. The mechanical properties of the fabricated scaffolds will be presented in this paper as well as initial cell seeding results with human adipose-derived adult stem (hADAS) cells.Mechanical Engineerin

Powder removal from Ti-6Al-4V cellular structures fabricated via electron beam melting

Direct metal fabrication systems like electron beam melting (EBM) and direct metal laser sintering (also called selective laser melting) are gaining popularity. One reason is the design and fabrication freedom that these technologies offer over traditional processes. One specific feature that is of interest is mesh or lattice structures that can be produced using these powder-bed systems. One issue with the EBM process is that the powder trapped within the structure during the fabrication process is sintered and can be hard to remove as the mesh density increases. This is usually not an issue for the laser-based systems since most of them work at a low temperature and the sintering of the powder is less of an issue. Within the scope of this project, a chemical etching process was evaluated for sintered powder removal using three different cellular structures with varying mesh densities. All meshes were fabricated via EBM using Ti6Al4V Footnote Information powder. The results are promising, but the larger the structures, the more difficult it is to completely remove the sintered powder without affecting the integrity of the mesh structure

Custom-designed orthopedic implants evaluated using finite element analysis of patient-specific computed tomography data: femoral-component case study

<p>Abstract</p> <p>Background</p> <p>Conventional knee and hip implant systems have been in use for many years with good success. However, the custom design of implant components based on patient-specific anatomy has been attempted to overcome existing shortcomings of current designs. The longevity of cementless implant components is highly dependent on the initial fit between the bone surface and the implant. The bone-implant interface design has historically been limited by the surgical tools and cutting guides available; and the cost of fabricating custom-designed implant components has been prohibitive.</p> <p>Methods</p> <p>This paper describes an approach where the custom design is based on a Computed Tomography scan of the patient's joint. The proposed design will customize both the articulating surface and the bone-implant interface to address the most common problems found with conventional knee-implant components. Finite Element Analysis is used to evaluate and compare the proposed design of a custom femoral component with a conventional design.</p> <p>Results</p> <p>The proposed design shows a more even stress distribution on the bone-implant interface surface, which will reduce the uneven bone remodeling that can lead to premature loosening.</p> <p>Conclusion</p> <p>The proposed custom femoral component design has the following advantages compared with a conventional femoral component. (i) Since the articulating surface closely mimics the shape of the distal femur, there is no need for resurfacing of the patella or gait change. (ii) Owing to the resulting stress distribution, bone remodeling is even and the risk of premature loosening might be reduced. (iii) Because the bone-implant interface can accommodate anatomical abnormalities at the distal femur, the need for surgical interventions and fitting of filler components is reduced. (iv) Given that the bone-implant interface is customized, about 40% less bone must be removed. The primary disadvantages are the time and cost required for the design and the possible need for a surgical robot to perform the bone resection. Some of these disadvantages may be eliminated by the use of rapid prototyping technologies, especially the use of Electron Beam Melting technology for quick and economical fabrication of custom implant components.</p

Evolution of design considerations in complex craniofacial reconstruction using patient-specific implants

Previously published evidence has established major clinical benefits from using Computer Aided Design (CAD), Computer Aided Manufacturing (CAM), and Additive Manufacturing (AM) to produce patient-specific devices. These include cutting guides, drilling guides, positioning guides, and implants. However, custom devices produced using these methods are still not in routine use – particularly by the UK National Health Service (NHS). Oft-cited reasons for this slow uptake include: a higher up-front cost than conventionally-fabricated devices, material-choice uncertainty, and a lack of long-term follow-up due to their relatively recent introduction. This paper identifies a further gap in current knowledge – that of design rules, or key specification considerations for complex CAD/CAM/AM devices. This research begins to address the gap by combining a detailed review of the literature with first-hand experience of interdisciplinary collaboration on five craniofacial patient case-studies. In each patient case, bony lesions in the orbito-temporal region were segmented, excised, and reconstructed in the virtual environment. Three cases translated these digital plans into theatre via polymer surgical guides. Four cases utilised AM to fabricate titanium implants. One implant was machined from PolyEther Ether Ketone (PEEK). From the literature, articles with relevant abstracts were analysed to extract design considerations. 19 frequently-recurring design considerations were extracted from previous publications. 9 new design considerations were extracted from the case studies – on the basis of subjective clinical evaluation. These were synthesised to produce a design considerations framework to assist clinicians with prescribing and design engineers with modelling. Promising avenues for further research are proposed

Laser polishing of 3D printed mesoscale components

Laser polishing of various engineered materials such as glass, silica, steel, nickel and titanium alloys, has attracted considerable interest in the last 20 years due to its superior flexibility, operating speed and capability for localised surface treatment compared to conventional mechanical based methods. The paper initially reports results from process optimisation experiments aimed at investigating the influence of laser fluence and pulse overlap parameters on resulting workpiece surface roughness following laser polishing of planar 3D printed stainless steel (SS316L) specimens. A maximum reduction in roughness of over 94% (from ∼3.8 to ∼0.2 μm Sa) was achieved at the optimised settings (fluence of 9 J/cm2 and overlap factors of 95% and 88–91% along beam scanning and step-over directions respectively). Subsequent analysis using both X-ray photoelectron spectroscopy (XPS) and glow discharge optical emission spectroscopy (GDOES) confirmed the presence of surface oxide layers (predominantly consisting of Fe and Cr phases) up to a depth of ∼0.5 μm when laser polishing was performed under normal atmospheric conditions. Conversely, formation of oxide layers was negligible when operating in an inert argon gas environment. The microhardness of the polished specimens was primarily influenced by the input thermal energy, with greater sub-surface hardness (up to ∼60%) recorded in the samples processed with higher energy density. Additionally, all of the polished surfaces were free of the scratch marks, pits, holes, lumps and irregularities that were prevalent on the as-received stainless steel samples. The optimised laser polishing technology was consequently implemented for serial finishing of structured 3D printed mesoscale SS316L components. This led to substantial reductions in areal Sa and St parameters by 75% (0.489–0.126 μm) and 90% (17.71–1.21 μm) respectively, without compromising the geometrical accuracy of the native 3D printed samples

Assessment of learning curves in complex surgical interventions: a consecutive case-series study

Background: Surgical interventions are complex, which complicates their rigorous assessment through randomised clinical trials. An important component of complexity relates to surgeon experience and the rate at which the required level of skill is achieved, known as the learning curve. There is considerable evidence that operator performance for surgical innovations will change with increasing experience. Such learning effects complicate evaluations; the start of the trial might be delayed, resulting in loss of surgeon equipoise or, if an assessment is undertaken before performance has stabilised, the true impact of the intervention may be distorted. Methods: Formal estimation of learning parameters is necessary to characterise the learning curve, model its evolution and adjust for its presence during assessment. Current methods are either descriptive or model the learning curve through three main features: the initial skill level, the learning rate and the final skill level achieved. We introduce a fourth characterising feature, the duration of the learning period, which provides an estimate of the point at which learning has stabilised. We propose a two-phase model to estimate formally all four learning curve features. Results: We demonstrate that the two-phase model can be used to estimate the end of the learning period by incorporating a parameter for estimating the duration of learning. This is achieved by breaking down the model into a phase describing the learning period and one describing cases after the final skill level is reached, with the break point representing the length of learning. We illustrate the method using cardiac surgery data. Conclusions: This modelling extension is useful as it provides a measure of the potential cost of learning an intervention and enables statisticians to accommodate cases undertaken during the learning phase and assess the intervention after the optimal skill level is reached. The limitations of the method and implications for the optimal timing of a definitive randomised controlled trial are also discussed

Celecoxib does not appear to affect prosthesis fixation in total knee replacement: A randomized study using radiostereometry in 50 patients

Background and purpose After joint replacement, a repair process starts at the interface between bone and cement. If this process is disturbed, the prosthesis may never become rigidly fixed to the bone, leading to migration—and with time, loosening. Cox-2 inhibitors are widely used as postoperative analgesics, and have adverse effects on bone healing. This could tamper prosthesis fixation. We investigated whether celecoxib, a selective Cox-2 inhibitor, increases prosthesis migration in total knee replacement (TKR)

The effects of exercise and weight loss in overweight patients with hip osteoarthritis: design of a prospective cohort study

BACKGROUND: Hip osteoarthritis (OA) is recognised as a substantial source of disability, with pain and loss of function as principal symptoms. An aging society and a growing number of overweight people, which is considered a risk factor for OA, contribute to the growing number of cases of hip OA. In knee OA patients, exercise as a single treatment is proven to be very effective towards counteracting pain and physical functionality, but the combination of weight loss and exercise is demonstrated to be even more effective. Exercise as a treatment for hip OA patients is also effective, however evidence is lacking for the combination of weight loss and exercise. Consequently, the aim of this study is to get a first impression of the potential effectiveness of exercise and weight loss in overweight patients suffering from hip OA. METHODS/DESIGN: This is a prospective cohort study. Patients aged 25 or older, overweight (BMI > 25) or obese (BMI > 30), with clinical and radiographic evidence of OA of the hip and able to attend exercise sessions will be included. The intervention is an 8-month exercise and weight-loss lifestyle program. Main goal is to increase aerobic capacity, lose weight and stimulate a low-calorie and active lifestyle. Primary outcome is self-reported physical functioning. Secondary outcomes include pain, stiffness, health-related quality of life and habitual activity level. Weight loss in kilograms and percentage of fat-free mass will also be measured. DISCUSSION: The results of this study will give a first impression of potential effectiveness of exercise and weight loss as a combination program for patients with OA of the hip. Once this program is proven to be effective it may lead to postponing the moment of total hip replacement. TRIAL REGISTRATION NUMBER: NTR1053