Online Exclusive

3-D Printer Redefines Reconstructive Surgery


Posted in Orthopedics by Camilla Andersson on January 15, 2013

Orthopaedic surgeon Justin Cobb is applying 3-D printing technology to a surgical procedure that could revolutionise orthopaedic adult reconstructive knee operations. Cobb holds the Chair in orthopaedic surgery in the Surgery and Cancer department at the world-renowned Imperial College Healthcare NHS Trust based in Charing Cross Hospital Campus in West London.


The process involves the use of 3-D printing technology to create technically complex bespoke solutions by means of pre-operative modelling. It is also used to help in the planning of surgery and creation of osteotomy intraoperative cutting guides and patterns for titanium fixation plates. In this case, the technology will help to rebuild a soldier’s knee ripped apart by gunshot wounds. “This operation using 3-D printing technology is a world first for reconstructive surgery providing total liberation to the surgeon and opening up a completely new approach to the operation,” says Cobb.

 Objet Eden250 3D printer installed at the Lower Limb Arthroplasty Unit at Charing Cross Hospital

With the assistance of Research Associate Susannah Clarke, PhD, who has expertise in computational analysis of total joint replacement, Cobb installed the Objet (Rehovot, Israel) Eden 250 3D printer in January 2012. It was supplied by OPS Ltd (Derby, UK), which has worked closely with the Lower Limb Arthroplasty Unit at Charing Cross Hospital. Their goal was to develop a patient-matched process of conserving as much of the original functional and healthy joint tissue as possible while reducing the need for ligament reconstruction to help speed recovery.

The new surgical process helps to realign the leg by using pre-operative 3-D modelling followed by modelling the fixation plate and a series of cutting guides to accurately and more quickly reconfigure damaged areas of bone. This avoids the anxiety and full trauma associated with cutting the limb and replacing the whole joint. The Objet 3D printer also has created models for the customisation of the fixation plates used across the periphery of the joint. The custom knee implants which are designed and produced by specialist Stanmore Implants (Elstree, UK) are then robotically inserted into the patient.

Over the first six months following installation, the Objet 3D printer has been used in approximately 80 different trials plus three clinical trial experiments to research elements of the process on difficult and complex cases. Any variation in the positioning of a replacement knee can ultimately hinder the durability of the implant and function of the joint. Precision and skill have to be regarded as the most critical elements of the whole operation.

Not only should the new approach to the process speed recovery, especially in young, otherwise healthy, limbs, it should add value by reducing key operating theatre times from around 40 to 30 minutes and considerably reduce costs. For instance, only one tray of surgical instruments will need to be sterilised instead of the customary four or five trays.

The new approach to reconstructive surgery should be able to re-establish the patient’s quality of life, adds Cobb. The Iraq war veteran, who was shot above and through the knee joint in 2008, remains virtually lame, says Cobb, despite previous operations.

The standard operating procedure typically makes use of handheld saws, cutters and metal jigs to guide bone preparation. The whole procedure relies on multiple X-rays and the expertise of the surgeon. Surgery can also be restricted by the use of off-the-shelf standard-size implants and variation in the limbs of different patients. The need to select from a variety of instruments can require the preparation and sterilisation of as many as five tray sets, all at added cost.

Realigned bone with custom replacement knee and fixation plate

Still a practicing surgeon, Cobb is devoted to the development of future-generation procedures and related products that improve the working environment of surgeons, help patients and reduce cost. He has helped to develop a method of using robotics to prepare the bone and apply patient-specific implant fixation. The process also helps re-alignment of the joint to overcome any distortion in the limb. Integrating 3-D printing into this process provides new opportunities to improve the surgical procedure.

The presurgery procedure will now include a low-radiation CT scan of the patient’s limb to capture multiple slice images of the joint and ligaments to create a personalised knee scan. This is built up into a SolidWorks 3D imaging model to provide an accurate visual address to the extent of damage to the limb. The data is then transferred to the Objet 3D printer, which produces a solid model from MED 610 biocompatible material that allows prolonged skin contact. The model imparts pre-operative visual and tactile information as well as intra-operative guidance to assist in surgery planning and performance.

During the surgical process, the Objet printer cutter guide is positioned on the bone; the formed slots guide a wedge shaped cut into the bone. The wedge is removed and the bone realigned to straighten the limb. The robot is then used to cut a curved void where the new bone implant is fitted.

 
Intraoperative cutter guide  

According to Clarke, who has prior 3-D printing experience in other areas of Imperial College, the Objet 3D printer was selected because of its simple interface and easy-to-clean design. Installation was trouble-free, the software linked directly to SolidWorks and integration with the surgical process was straightforward, she adds. “The machine fit exactly into the concept that Professor Cobb envisaged for the work he was doing to improve lower limb surgery,” says Clarke.

Since its installation, the Objet machine has been regarded as a solution looking for additional problems to solve. It has been used to produce half sets of vice clamps to fixture, for instance, 20 bones for stress testing. With the form moulded into the vice jaws, each bone is set in the same presentation, ensuring process repeatability without losing time on re-alignment.

Intraoperative cutting guides now take about two hours to produce for surgical use by Cobb. These guides help to optimise the process and thus reduce the time for cutting the limb from around 12 minutes to approximately 7.5 minutes.

At Imperial, the Objet Eden 3D 250 printer uses only the MED 610 material but has the capability to work with up to 10 different materials including ABS, polypropylene and transparent materials with a variety of colours and physical characteristics. The process is based on using 16-micron print layers (30 micron can be used in high-speed mode) to create models accurate within 0.1 to 0.3 mm. The models are realistic and useable for form, fit and function, prototyping and testing.

The Objet Eden 250 3D printer has the capacity to produce models measuring 260 x 260 x 200 mm. Postcuring is not required and, as at Imperial, the models are cleaned by means of a semi-high-pressure jet.

Andrew Fulton
is Managing Director, OPS Ltd, Faraday House, Tomlinson Business Park, Foston, Derbyshire DE65 5DJ, UK
tel. + 44 1283 585 933
e-mail: andrew@ogpuk.com
www.ops-uk.com

 



Find more content on:
No votes yet


Login to post comments

Comment viewing options

Select your preferred way to display the comments and click "Save settings" to activate your changes.

Hmmmmm

Bismillahirrahmanirrahim hopefully both keywords I can be first on google, and generate a lot of profit made me.
Obat Nafsu Makan Berlebih
Obat Pengurang Nafsu Makan
Obat Penekan Nafsu Makan

I recently came across your

I recently came across your blog and have been reading along. I thought I would leave my first comment. I don't know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often.
Canada Goose Rea

Positive site, where did u

Positive site, where did u come up with the information on this posting?I have read a few of the articles on your website now, and I really like your style.backlinks service

A very awesome blog post. We

A very awesome blog post. We are really grateful for your blog post. You will find a lot of approaches after visiting your post.
quiz game for kids

First You got a great blog .I

First You got a great blog .I will be interested in more similar topics. i see you got really very useful topics i will be always checking your blog thanks
Dot Matrix Printer Manufacturer

This was actually what I was

This was actually what I was looking for, and I am glad to came here ! Thanks for sharing the such information with us.

Japanese Artwork

I really like the dear

I really like the dear information you offer in your articles. I’m able to bookmark your site and show the kids check out up here generally. Im fairly positive theyre likely to be informed a great deal of new stuff here than anyone else!play online slots

This content is written very

This content is written very well. Your use of formatting when making your points makes your observations very clear and easy to understand. Thank you!biking vietnam

This is really a nice and

This is really a nice and informative, containing all information and also has a great impact on the new technology. Thanks for sharing it
Carry on sizes

containing all information

containing all information and also has a great impact on the new technology. Thanks for sharing it taxi in ajmer

Best store for affordable

Best store for affordable kitchens and baths items, unique kitchen gadgets, branded kitchen decor sets, kitchenette appliances & all must have kitchen tools.
Unique Kitchen Gadgets

I discovered your site ideal

I discovered your site ideal for me. It consists of wonderful and useful posts. I've read many of them and also got so much from them. In my experience, you do the truly amazing.
learn more here

I have to voice my passion

I have to voice my passion for your sharpness in writing and giving acknowledges to people. The post should have magnificent guidance on this important matter.

Learn more about Salli Gainsford

I definitely really liked

I definitely really liked every part of it and i also have you saved to fav to look at new information in your site.
made to measure window blinds

Through this post, I know

Through this post, I know that your good knowledge in playing with all the pieces was very helpful. I notify that this is the first place where I find issues I've been searching for. You have a clever yet attractive way of writing.
click here

Love to read it,Waiting For

Love to read it,Waiting For More new Update and I Already Read your Recent Post its Great Thanks.
Crosswater Taps

Love to read it,Waiting For

Love to read it,Waiting For More new Update and I Already Read your Recent Post its Great Thanks.
painter

It was wondering if I could

It was wondering if I could use this write-up on my other website, I will link it back to your website though.Great Thanks.
neck pain

I was actually captured with

I was actually captured with the piece of resources you have got here. Big thumbs up for making such wonderful blog page
parket

This is such a great resource

This is such a great resource that you are providing and you give it away for free. I love seeing blog that understand the value of providing a quality resource for free.
low obl backlinks

I am very enjoyed for this

I am very enjoyed for this blog. Its an informative topic. It help me very much to solve some problems. Its opportunity are so fantastic and working style so speedy.
https://www.twitter.com/newspaper_cat/status/583015267229265920

I am unable to read articles

I am unable to read articles online very often, but I’m glad I did today. This is very well written and your points are well-expressed. Please, don’t ever stop writing.
Luggage

GMTC

O God please give the slave sale that exceed 60 bottles, so that the servants could appease the family of servants of God, and also make a great boss is satisfied.
Obat China Penambah Nafsu Makan
Obat Tradisional Asam Lambung
Obat Asam Lambung

I really like the dear

I really like the dear information you offer in your articles. I’m able to bookmark your site and show the kids check out up here generally. Im fairly positive theyre likely to be informed a great deal of new stuff here than anyone else!
Article Marketing

Kurawa

The fruit does not fall far from the tree.
Makanan yang Membuat Anda Tidak Mudah lapar

Satnight

You were like the sea breeze continued to blow every day there is no stopping, just like the feeling I to you, there will be no stopping until he picked me up.
Green World Indonesia

I am preparing a research

I am preparing a research paper and collecting information on this topic. Your post is one of the better that I have read.
the venus factor ebook

Rollet

A promise that will keep the success it only to people who work hard, for the lazy own risk only as a result, would be derailed despite not when.
Obat Syaraf Kejepit
Obat Gatal di Telapak Kaki
Obat Penambah Nafsu Makan
Obat Penahan Nafsu Makan
Obat Asam Lambung Naik Ke Tenggorokan

Linda

So what we get drunk? So what we smoke weed? We’re just having fun, We don’t care who sees. So what we go out? That’s how it's supposed to be,Living young and wild and free.
Suplemen Kekurangan Vitamin C

This is such a great resource

This is such a great resource that you are providing and you give it away for free. I love seeing blog that understand the value of providing a quality resource for free.
cerrajero Vigo

Great things you’ve always

Great things you’ve always shared with us. Just keep writing this kind of posts.The time which was wasted in traveling for tuition now it can be used for studies.Thanks
Daikin luftvärmepump

Nice to be visiting your blog

Nice to be visiting your blog again, it has been months for me. Well this article that i’ve been waited for so long. I need this article to complete my assignment in the college, and it has same topic with your article. Thanks, great share.
sacramento auto repair

This blog is so nice to me. I

This blog is so nice to me. I will keep on coming here again and again. Visit my link as well..
Vera bradley

I have read your article, it

I have read your article, it is very informative and helpful for me.I admire the valuable information you offer in your articles. Thanks for posting it..
john

Thank you very much for

Thank you very much for writing such an interesting article on this topic. This has really made me think and I hope to read more.
free stuff

You know your projects stand

You know your projects stand out of the herd. There is something special about them. It seems to me all of them are really brilliant!
SEO backlink

Nice post! This is a very

Nice post! This is a very nice blog that I will definitively come back to more times this year! Thanks for informative post.
List Academy Review

hat I will definitively come

hat I will definitively come back to more times this year! Thanks for informative post.
הסעות בלונדון

I really appreciate the kind

I really appreciate the kind of topics you post here. Thanks for sharing us a great information that is actually helpful. Good day!
air conditioning repair Albuquerque

Thanks for posting this info.

Thanks for posting this info. I just want to let you know that I just check out your site and I find it very interesting and informative. I can't wait to read lots of your posts.
Miami waterfront properties

You have a real ability for

You have a real ability for writing unique content. I like how you think and the way you represent your views in this article. I agree with your way of thinking. Thank you for sharing.
inseminacion

Thanks for posting this info.

Thanks for posting this info. I just want to let you know that I just check out your site and I find it very interesting and informative. I can't wait to read lots of your posts.
pink bongs for sale

Great articles and great

Great articles and great layout. Your blog post deserves all of the positive feedback it’s been getting.
highster

Produk kesehatan yang sudah

Produk kesehatan yang sudah terbukti akan khasiat nya dalam menyembuhkan penyakit secara alami dan terbukti aman dan memang alami menyembuhkan penyakit Obat tipes untuk anak yang bagus | Obat pelancar BAB | Obat jantung lemah

I read a article under the

I read a article under the same title some time ago, but this articles quality is much, much better. How you do this..CTET Notification

very interesting post.this is

very interesting post.this is my first time visit here.i found so mmany interesting stuff in your blog especially its discussion..thanks for the post!
timber floor installation

Wonderful article, thanks for

Wonderful article, thanks for putting this together! This is obviously one great post. Thanks for the valuable information and insights you have so provided here.
Removalists Melbourne

Your music is amazing. You

Your music is amazing. You have some very talented artists. I wish you the best of success.
Salvation Diet

Your content is nothing short

Your content is nothing short of brilliant in many ways. I think this is engaging and eye-opening material. Thank you so much for caring about your content and your readers.
electrical contractors perth