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Book Details
Abstract
Get a quick, expert overview of the role of emerging 3D printing technology in orthopaedic surgery, devices, and implants. This concise resource by Drs. Matthew DiPaola and Felasfa Wodajo provides orthopaedic surgeons and residents with need-to-know information on the clinical applications of 3D printing, including current technological capabilities, guidance for practice, and future outlooks for this fast-growing area.
- Covers basic principles such as engineering aspects, software, economics, legal considerations, and applications for education and surgery planning.
- Discusses 3D printing in arthroplasty, trauma and deformity, the adult and pediatric spine, oncology, and more.
- Includes information on setting up a home 3D printing "plant" and 3D printing biologics.
- Consolidates today’s available information on this burgeoning topic into a single convenient resource
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| 3D Printing in Orthopaedic Surgery | i | ||
| 3D Printing in Orthopaedic Surgery | iii | ||
| Copyright | iv | ||
| List of Contributors | v | ||
| Building the Future of Orthopedics: One Layer at a Time | ix | ||
| Contents | xi | ||
| I - 3D PRINTING PRINCIPLES | 1 | ||
| 1 - An Introduction to 3D Printing—Past, Present, and Future Promise | 1 | ||
| INTRODUCTION | 1 | ||
| 3D PRINTING: FROM PAST TO PRESENT | 2 | ||
| First Era (Late 1970s to Early 1980s)—Proto Additive Manufacturing | 3 | ||
| Second Era (Mid-1980s to 1990)—Introduction of Additive Manufacturing | 3 | ||
| Third Era (1990–2005)—Computational Capabilities Increase and Industrial 3D Printing Matures | 4 | ||
| Fourth Era (2005–2012)—Rapid Expansion and Increased Awareness of 3D Printing | 4 | ||
| Fifth Era (2012–2017/Present)—New Materials and Technologies and Second-Generation 3D Printing | 5 | ||
| Sixth Era (Present)—New Materials and Advanced Biomedical 3D Printing | 5 | ||
| UNDERSTANDING THE COMPONENTS, PROCESSES, MATERIALS, AND CLASSIFICATIONS OF 3D PRINTING | 6 | ||
| 3D Printing Technologies and Processes | 6 | ||
| ENERGY-BASED TECHNOLOGIES | 6 | ||
| MATERIAL DEPOSITION–BASED TECHNOLOGIES | 7 | ||
| Combination Energy-Material Deposition Technologies | 8 | ||
| THE 3D PRINTING TRIAD: THE HARDWARE, SOFTWARE, AND MATERIAL | 9 | ||
| MEDICAL 3D PRINTING | 11 | ||
| THE FUTURE OF MEDICAL 3D PRINTING | 14 | ||
| REFERENCES | 14 | ||
| 2 - Basics of 3D Printing: Engineering Aspects | 17 | ||
| INTRODUCTION TO 3D PRINTING | 17 | ||
| HISTORY OF 3D PRINTING | 17 | ||
| APPLICATIONS OF 3D PRINTING | 18 | ||
| Food | 18 | ||
| Construction | 18 | ||
| Art | 19 | ||
| Automobile | 19 | ||
| Aviation | 19 | ||
| Medical Applications | 19 | ||
| Archeology | 19 | ||
| TYPES OF TECHNOLOGY | 19 | ||
| Vat Photopolymerization | 20 | ||
| Stereolithography (SLA) | 20 | ||
| Digital Light Processing | 20 | ||
| Material Extrusion | 21 | ||
| Powder Bed Fusion (PBF) | 23 | ||
| Laser Sintering | 23 | ||
| Melting | 24 | ||
| Directed Energy Deposition (DED) | 24 | ||
| Binder Jetting (BJ) | 24 | ||
| Material Jetting (MJ) | 25 | ||
| Sheet Lamination (SL) | 25 | ||
| 3D PRINTING WORKFLOW | 26 | ||
| Preprocessing | 26 | ||
| Step 1: Preparing the CAD model | 26 | ||
| Step 2: STL conversion | 26 | ||
| Step 3: Uploading the part to the printer | 27 | ||
| Processing | 27 | ||
| Step 4: Printer setup | 27 | ||
| Step 5: Part manipulation and build | 27 | ||
| Postprocessing | 27 | ||
| Step 6: Remove the part | 27 | ||
| Step 7: Cleaning/Final touchups | 27 | ||
| 3D SCANNING | 27 | ||
| ADVANTAGES OF 3D PRINTING | 28 | ||
| LIMITATIONS OF 3D PRINTING | 28 | ||
| SUMMARY | 29 | ||
| REFERENCES | 29 | ||
| 3 - From CT and MR Images to 3D Printed Models—Software Basics for the Surgeon | 31 | ||
| INTRODUCTION | 31 | ||
| STEPS IN WORKFLOW CREATING A MEDICAL 3D MODEL5 (FIG. 3.1) | 31 | ||
| Step 1: Ideation | 31 | ||
| Step 2: Image Acquisition | 33 | ||
| Step 3: Image Segmentation | 34 | ||
| Step 4: Mesh Model Creation, Smoothing, and Preparing for Print Process | 36 | ||
| Step 5: Printing | 36 | ||
| Step 6: Postprint Processing/Polishing | 37 | ||
| Step 7. Validation and Quality Control | 37 | ||
| Tips, Tricks, and Traps | 37 | ||
| CONCLUSION | 39 | ||
| REFERENCES | 39 | ||
| 4 - Economic and Regulatory Perspectives on Additive Manufacturing | 41 | ||
| 3D PRINTING—SOME ECONOMIC CONSIDERATIONS | 41 | ||
| INNOVATION | 44 | ||
| 3D PRINTING: A REGULATORY PERSPECTIVE | 45 | ||
| General Principles of Regulation | 45 | ||
| History of FDA Regulation of 3D Printing | 45 | ||
| Assumptions Underpinning Medical Regulation | 46 | ||
| The FDA Review Process | 47 | ||
| FDA Guidance in December 2017 | 47 | ||
| Conclusions | 48 | ||
| REFERENCES | 48 | ||
| II - OVERVIEW OF 3D PRINTING IN ORTHOPEDICS | 49 | ||
| 5 - Additive Manufacturing of Arthroplasty Implants | 49 | ||
| THE BASICS | 49 | ||
| ADDITIVE MANUFACTURING IN MEDICAL APPLICATIONS | 50 | ||
| Additive Manufacturing of Custom and Patient-Specific Arthroplasty Implants | 50 | ||
| WHERE ARE WE HEADING? THE FUTURE OF AM IN TOTAL JOINT IMPLANTS | 52 | ||
| REFERENCES | 53 | ||
| FURTHER READING | 53 | ||
| 6 - 3D Printing for Education and Surgical Planning in Orthopedic Surgery | 55 | ||
| INTRODUCTION | 55 | ||
| Systematic Reviews | 55 | ||
| EDUCATION | 55 | ||
| Patient Education | 56 | ||
| Anatomy Education | 56 | ||
| Teaching Pathoanatomy | 56 | ||
| Surgical Simulation | 57 | ||
| 3D MODELS FOR SURGICAL PLANNING | 58 | ||
| Spine | 59 | ||
| Trauma | 60 | ||
| Orthopedic Oncology | 60 | ||
| Sports Medicine | 60 | ||
| Joint Preservation | 60 | ||
| Total Joint Arthroplasty | 61 | ||
| Pediatric Orthopedic Surgery | 61 | ||
| Foot and Ankle Surgery | 61 | ||
| CONCLUSION | 61 | ||
| REFERENCES | 61 | ||
| 7 - 3D Printing for Commercial Orthopedic Applications: Advances and Challenges | 65 | ||
| HISTORY OF 3D PRINTING IN MEDICINE AND ORTHOPEDIC APPLICATIONS | 65 | ||
| Presurgical Anatomic Modeling | 67 | ||
| Patient-Matched Implants | 68 | ||
| Patient-Matched Primary Total Joint Components | 69 | ||
| Patient-Matched Revision Total Joint Components | 69 | ||
| Patient-Matched Oncologic Reconstruction Components | 70 | ||
| Patient-Matched Fixation Plates | 71 | ||
| Total Joint Arthroplasty Planning and Templating | 71 | ||
| Corrective Osteotomy/Fixation Planning and Templating | 72 | ||
| 3D Printing for Off-The-Shelf Implants (Metal or Polymeric) | 73 | ||
| REASONS FOR TODAY'S HIGH INTEREST IN 3D PRINTING IN MEDICINE | 75 | ||
| Mainstream Knowledge of 3DP | 75 | ||
| 3D Printed Products Impacting the Consumer Market | 75 | ||
| In-Hospital 3D Printing (Point-of-Care Manufacturing) Opening up Discussion/Applications | 75 | ||
| Materials Expansion | 75 | ||
| FDA Regulation of Medical Devices | 76 | ||
| Humanitarian Use Devices | 79 | ||
| Practice of Medicine | 79 | ||
| Custom Devices Versus Patient-Matched Devices | 80 | ||
| Expanded Access/Compassionate Use | 80 | ||
| FDA Guidance on 3D Printing | 80 | ||
| Technological Advancements Ahead | 80 | ||
| Future Directions and Conclusions | 81 | ||
| REFERENCES | 81 | ||
| III - 3D PRINTING IN ORTHOPAEDICS:SUBSPECIALTIES | 85 | ||
| 8 - 3D Printing in Orthopedics: Upper Extremity Trauma and Deformity | 85 | ||
| INTRODUCTION | 85 | ||
| 3D-PRINTED GUIDES AND PLATES FOR PRIMARY FRACTURE FIXATION | 85 | ||
| Scaphoid Fracture | 85 | ||
| Distal Radius Fracture Fixation With 3D-Printed Plates | 86 | ||
| Distal Humerus Fracture Fixation With a 3D-Printed Plate | 86 | ||
| 3D OSTEOTOMY GUIDES FOR UPPER EXTREMITY MALUNION CORRECTION | 87 | ||
| Supracondylar Malunion, Cubitus Varus, and Cubitus Valgus | 88 | ||
| Distal Humerus Correctional Osteotomy | 88 | ||
| Both-Bone Malunion | 88 | ||
| Monteggia Malunion | 88 | ||
| Distal Radius Malunion | 89 | ||
| 3D-PRINTED MODEL | 90 | ||
| Clavicle Fracture Models and Prebending Plates | 90 | ||
| Proximal Humerus Fracture Model | 90 | ||
| Elbow Fracture Model | 90 | ||
| Radial Head Fracture Model | 90 | ||
| 3D-PRINTED INSTRUMENTS, AND PROSTHESES | 91 | ||
| Instruments | 91 | ||
| 3D-Printed Prosthesis | 91 | ||
| CONCLUSION | 92 | ||
| REFERENCES | 92 | ||
| 9 - Three-Dimensional Printing Technology in Foot and Ankle Surgery | 95 | ||
| INTRODUCTION | 95 | ||
| DEFORMITY CORRECTION | 95 | ||
| CASE 111 | 95 | ||
| CASE 2 | 97 | ||
| JIGS | 97 | ||
| CASE 3 | 97 | ||
| 3D-PRINTED IMPLANTS | 98 | ||
| FOOT AND ANKLE–SPECIFIC 3D PRINTING CONSIDERATIONS | 99 | ||
| INNOVATION | 104 | ||
| REFERENCES | 104 | ||
| 10 - 3D Printing in Spine Surgery | 105 | ||
| INTRODUCTION | 105 | ||
| PATIENT-SPECIFIC IMPLANT GUIDES | 106 | ||
| Cervical Spine | 110 | ||
| Thoracic Spine | 111 | ||
| Lumbar Spine | 112 | ||
| Future Direction | 113 | ||
| PATIENT-SPECIFIC IMPLANTS | 113 | ||
| Cervical Spine | 114 | ||
| Thoracic Spine | 114 | ||
| Lumbar Spine | 114 | ||
| Surface Coating | 114 | ||
| Legal and Regulatory Considerations | 118 | ||
| Future Direction | 119 | ||
| 3D PRINTING FOR PREOPERATIVE PLANNING AND EDUCATION | 119 | ||
| CONCLUSION | 121 | ||
| REFERENCES | 121 | ||
| FURTHER READING | 122 | ||
| 11 - Pediatric Hip and Acetabulum | 123 | ||
| HIP DYSPLASIA | 123 | ||
| SLIPPED CAPITAL FEMORAL EPIPHYSIS | 126 | ||
| AVASCULAR NECROSIS/PERTHES WITH HIP DYSPLASIA | 129 | ||
| Comparison of Planned and Executed Osteotomies | 131 | ||
| DISCUSSION | 131 | ||
| REFERENCES | 134 | ||
| 12 - Pediatric Spine and Extremity | 137 | ||
| INTRODUCTION | 137 | ||
| COMPLEX SPINAL DEFORMITIES ASSOCIATED WITH MYELOMENINGOCELE | 137 | ||
| Neuromuscular and Congenital Scoliosis | 137 | ||
| Congenital Kyphosis | 139 | ||
| Neuromuscular Scoliosis and Pelvic Anomaly | 141 | ||
| Congenital Kyphosis and Scoliosis | 141 | ||
| Congenital Kyphosis Following Neonatal Kyphectomy | 143 | ||
| THE USE OF CUSTOM THREE-DIMENSIONAL PRINTED GUIDES FOR PEDIATRIC UPPER EXTREMITY OSTEOTOMIES | 143 | ||
| Indications/Contraindications | 143 | ||
| Planning and Surgical Technique | 143 | ||
| Case Example: DRUJ Instability After Pediatric Forearm Malunion | 146 | ||
| CURRENT CLINICAL LITERATURE | 146 | ||
| REFERENCES | 149 | ||
| 13 - 3D Printing in Orthopedics—Upper Extremity Arthroplasty | 151 | ||
| INTRODUCTION | 151 | ||
| PRINCIPLES IN IMPLANT PLACEMENT | 152 | ||
| Anatomic Total Shoulder Arthroplasty | 152 | ||
| Reverse Total Shoulder Arthroplasty | 153 | ||
| Two-Dimensional versus Three-Dimensional CT Imaging | 154 | ||
| Use of 3D Planning in the Assessment of Glenoid Pathology and Virtual Implant Templating | 155 | ||
| Patient-Specific Guides | 159 | ||
| 3D Printed Implants in Shoulder Arthoplasty | 164 | ||
| Application of 3D Planning in Elbow Arthritis | 165 | ||
| CONCLUSION | 166 | ||
| REFERENCES | 167 | ||
| 14 - 3D Printing in Hip and Knee Arthroplasty | 171 | ||
| ROLE OF 3D PRINTING IN LOWER EXTREMITY ARTHROPLASTY | 171 | ||
| HIP | 171 | ||
| 3D RAPID PROTOTYPING | 171 | ||
| KNEE | 172 | ||
| Patient-Specific Instrumentation | 173 | ||
| Implants | 174 | ||
| CONCLUSION | 175 | ||
| REFERENCES | 175 | ||
| FURTHER READING | 176 | ||
| 15 - 3D Printing in Orthopedic Oncology | 179 | ||
| INTRODUCTION | 179 | ||
| Basic Concepts in Oncologic Surgery | 179 | ||
| CT and MRI Imaging | 180 | ||
| Segmentation | 181 | ||
| CHALLENGES IN ONCOLOGY SURGERY | 181 | ||
| Planning an Adequate Margin is Based Mostly on the Findings of MRI Imaging | 181 | ||
| Deciding Upon the Surgical Approach and Soft Tissue Exposure. | 182 | ||
| SURGICAL RECONSTRUCTION CHALLENGES | 182 | ||
| 3D Models | 183 | ||
| 3D-PRINTED SURGICAL TOOLS | 186 | ||
| General Design | 186 | ||
| 3D-PRINTED CUSTOM IMPLANTS | 190 | ||
| CONCLUSION | 193 | ||
| REFERENCES | 193 | ||
| FURTHER READING | 194 | ||
| IV - FUTURE OF 3D PRINTING | 195 | ||
| 16 - Setting Up Your Own Home 3D Printing “Plant” | 195 | ||
| INTRODUCTION | 195 | ||
| Orthopedic 3D Printing From the Home and Office | 195 | ||
| 3D Printing Technology | 196 | ||
| PRINTERS | 197 | ||
| Stereolithography | 197 | ||
| Digital Light Processing | 198 | ||
| Selective Laser Sintering | 198 | ||
| Multi-Jet Modeling | 198 | ||
| Fused Deposition Modeling | 198 | ||
| MATERIALS | 199 | ||
| Acrylonitrile Butadiene Styrene | 199 | ||
| Polylactic Acid | 201 | ||
| Polyvinyl Alcohol | 201 | ||
| Nylon (Polyamide) | 201 | ||
| Flexible | 201 | ||
| Where Can You Buy the Material? | 202 | ||
| GETTING STARTED WITH 3D PRINTING | 202 | ||
| Modeling: The Preprinting Phase | 202 | ||
| Where can you get 3D models? | 202 | ||
| How can you make your own models? | 202 | ||
| Can you simply scan real objects and print them? | 202 | ||
| How should you go about printing models? | 202 | ||
| 3D Printers: Hardware | 203 | ||
| Essential Hardware | 204 | ||
| How a 3D Printer Works: The Anatomy of a 3D Printer | 204 | ||
| Extruder | 204 | ||
| Hot End | 204 | ||
| Print Bed | 204 | ||
| How to Choose a 3D Printer | 204 | ||
| 3D Printers: What to Look for When Comparing Printers | 206 | ||
| Price | 206 | ||
| Build Platform Size | 206 | ||
| Filament Type | 206 | ||
| Reviews | 206 | ||
| Customer Support | 206 | ||
| Print Speed | 206 | ||
| Resolution | 207 | ||
| How to Transform Your CT Imaging Into a 3D Printed File | 207 | ||
| CONCLUSION | 207 | ||
| REFERENCES | 208 | ||
| FURTHER READING | 208 | ||
| Index | 209 | ||
| A | 209 | ||
| B | 209 | ||
| C | 209 | ||
| D | 210 | ||
| E | 210 | ||
| F | 210 | ||
| G | 210 | ||
| H | 210 | ||
| I | 211 | ||
| J | 211 | ||
| K | 211 | ||
| L | 211 | ||
| M | 211 | ||
| N | 212 | ||
| O | 212 | ||
| P | 212 | ||
| Q | 213 | ||
| R | 213 | ||
| S | 213 | ||
| T | 214 | ||
| U | 215 | ||
| V | 215 | ||
| W | 215 | ||
| Z | 215 |