3D Topology Optimization and Mesh Dependency for Redesigning Locking Compression Plates Aiming to Reduce Stress Shielding

Al-Tamimi, Abdulsalam Abdulaziz

doi:10.18063/ijb.v7i3.339

Cited by 6 publications

(3 citation statements)

References 25 publications

(28 reference statements)

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“…PEEK grafts have been shown to exhibit lower rates of subsidence than solid titanium for TLIF [12][13][14] in part due to the modulus of elasticity of PEEK (3.5 GPa) being closer to that of native bone (0.02-2 GPa for trabecular bone and 3-30 GPa for cortical bone) than titanium (100-110 GPa). [12][13][14] However, PEEK is also chemically inert and therefore resists cell adhesion, 15 thus inhibiting graft fusion. 16,17 A novel 3D-printed porous titanium (pTi) cage was approved in 2017 by the Food and Drug Administration.…”

mentioning

confidence: 99%

Subsidence after lateral lumbar interbody fusion using a 3D-printed porous titanium interbody cage: single-institution case series

Alan

Vodovotz

Muthiah

et al. 2022

Journal of Neurosurgery: Spine

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OBJECTIVE Cage subsidence is a well-known phenomenon after lateral lumbar interbody fusion (LLIF), occurring in 10%–20% of cases. A 3D-printed porous titanium (pTi) cage has a stiffness that mimics the modulus of elasticity of native vertebrae, which reduces stress at the bone-hardware interface, lowering the risk of subsidence. In this study, the authors evaluated their institutional rate of subsidence and resultant reoperation in patients who underwent LLIF using a 3D-printed pTi interbody cage. METHODS This is a retrospective case series of consecutive adult patients who underwent LLIF using pTi cages from 2018 to 2020. Demographic and clinical characteristics including age, sex, bone mineral density, smoking status, diabetes, steroid use, number of fusion levels, posterior instrumentation, and graft size were collected. The Marchi subsidence grade was determined at the time of last follow-up. Outcome measures of interest were subsidence and resultant reoperation. Univariable logistic regression analysis was performed to assess the extent to which clinical and operative characteristics were associated with Marchi grade I–III subsidence. Significance was assessed at p < 0.05. RESULTS Fifty-five patients (38 with degenerative disc disease and 17 with adult spinal deformity) were treated with 97 pTi interbody cages with a mean follow-up of 18 months. The mean age was 63.6 ± 10.1 years, 60% of patients were female, and 36% of patients had osteopenia or osteoporosis. Patients most commonly underwent single-level LLIF (58.2%). Sixteen patients (29.1%) had posterior instrumentation. The subsidence grade distribution was as follows: 89 (92%) grade 0, 5 (5%) grade I, 2 (2%) grade II, and 1 (1%) grade III. No patients who were active or prior smokers and no patients with posterior instrumentation experienced graft subsidence. No clinical or operative characteristics were significantly associated with graft subsidence. One patient (1.8%) required reoperation because of subsidence. CONCLUSIONS In this institutional case series, subsidence of pTi intervertebral cages after LLIF occurred in 8% of operated levels, 3% of which were grade II or III. Only 1 patient required reoperation. These reported rates are lower than those reported for polyetheretherketone implants. Further studies are necessary to compare the impact of these cage materials on subsidence after LLIF.

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confidence: 99%

Subsidence after lateral lumbar interbody fusion using a 3D-printed porous titanium interbody cage: single-institution case series

Alan

Vodovotz

Muthiah

et al. 2022

Journal of Neurosurgery: Spine

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“…How to design appropriate porosity and prosthesis shape under the condition of reducing weight and saving cost still needs research. Meanwhile, the traditional materials like titanium and tantalum metal prostheses might have high density and are easy to produce stress shielding, [27] which may lead to long-term complications including prosthesis loosening, periprosthetic osteoporosis and osteolysis [28] . As there were so many biomaterials which can be chosen for bone defect reconstruction, how to choose the most suitable prosthesis material according to various types of bone defects is an important subject that needs further research.…”

Section: Discussionmentioning

confidence: 99%

Limb-salvage surgery using personalized 3D-printed porous tantalum prosthesis for distal radial osteosarcoma

2021

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Rationale: Three-dimensional (3D) printing has been widely utilized for treating the tumors of bone and soft tissue. We herewith report a unique case of distal radial osteosarcoma who was treated with a 3D printed porous tantalum prosthesis.Patient concerns: A 58-year-old Chinese male patient presented to our clinic complaining about a 6-month history of a progressive pain at his right hand, associated with a growing lump 2 months later.Diagnosis: Osteosarcoma of distal radius confirmed by percutaneous biopsy and tumor biopsy.Interventions: A limb-salvage surgery was performed with a 3D printed porous tantalum prosthesis, combined with the postoperative chemotherapy for 4 cycles.Outcomes: At 2-year follow-up, complete pain relief and satisfactory functional recovery of his right wrist were observed.Lessons: Personalized 3D printed prosthesis is an effective and feasible method for treating the osteosarcoma and reconstruction of complex bone defects.Abbreviations: 3D = three-dimensional, CT = computed tomography, CTA = computed tomography angiography, DICOM = digital imaging and communications in medicine, POD = postoperative day, ROM = range of motion.

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“…The implant holes, screws and bone models were considered as non-design regions. Based on a previous mesh convergence study [24], all models in the finite element analysis considered quadratic tetrahedron elements C3D10, and the considered number of elements is shown in Table 1. In order to simulate the no friction or contact of the Locking Compression Plate technique, a gap of 0.5 mm was imposed between the bone and plate.…”

Section: Finite Element Proceduresmentioning

confidence: 99%

Topology Optimization of Patient-Specific Custom-Fit Distal Tibia Plate: A Spiral Distal Tibia Bone Fracture

Al-Tamimi

2022

Applied Sciences

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Currently, bone fractures are commonly treated with bone fixation plates that present rigid designs and stiff biometals (e.g., Ti-6Al-4V) that increase the probability of stress shielding happening during bone remodeling by shielding the required stress stimuli for adequate healing. This can lead to medical implant loosening, bone resorption and possible bone refracture. In this paper, an initial custom-fit bone plate is designed to be treated based on the computer tomography imaging of a patient suffering from distal tibia spiral fracture. The initial bone plate was redesigned to reduce the risk of bone being stress shielded. Topology optimization were implemented to redesign the bone plates by minimizing the strain energy and reducing the total plate’s volume in three different cases (25%, 50% and 75%). A bone-plate construct was assembled and examined using finite element analysis considering load conditions of the patient’s gait and the tibia bone being loaded with 10% of the bodyweight. The bone stresses were evaluated in order to compare the topology optimized plates with the initial design. The findings show that with higher volume, load transfer reduction increases in the fractured area and reduces the risk of stress shielding. Topology optimization is a viable approach for building custom-fit distal tibia plates for spiral distal tibia fracture.

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3D Topology Optimization and Mesh Dependency for Redesigning Locking Compression Plates Aiming to Reduce Stress Shielding

Cited by 6 publications

References 25 publications

Subsidence after lateral lumbar interbody fusion using a 3D-printed porous titanium interbody cage: single-institution case series

Subsidence after lateral lumbar interbody fusion using a 3D-printed porous titanium interbody cage: single-institution case series

Limb-salvage surgery using personalized 3D-printed porous tantalum prosthesis for distal radial osteosarcoma

Topology Optimization of Patient-Specific Custom-Fit Distal Tibia Plate: A Spiral Distal Tibia Bone Fracture

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