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Preoperative radiographic views of the necrotic lunate with Lichtman classification IIIC. (A) X‐ray; (B) Computerized tomographic scanning; (C) Magnetic resonance image.
Source publication
Objective
To evaluate the feasibility of arthroplasty with varisized three‐dimensional(3D) printing lunate prosthesis for the treatment of advanced Kienböck's disease (KD).
Methods
From 2016 November to 2018 September, a retrospective study was performed for the patients of KD in our hospital. Five patients (two males, three females) were included...
Citations
... Finally, it should be noted that the interposition of a prosthesis must preserve the natural kinematics of the joint without causing additional mechanical constraints. The design of prostheses must therefore be inspired by real anatomical shapes and adapts as best as possible to the kinematics of the patient's joint [11]. ...
... Studies are based on the modeling and 3D design of prostheses identical to the opposite semi-lunar according to different templates [11,16] or the use of standardized prostheses [17]. In both cases, the prosthesis design is made of titanium (Ti-6Al-4V) because of its high biocompatibility and mechanical strength. ...
... One of the primary objectives of our study was the feasibility of a 3D modeling and design of a closed circuit prosthesis. The first track followed was the titanium used by Ma et al [11,16] and Wright Medical Technology [17]. It is an alloy of titanium, aluminum-6 and vanadium-4 (Ti-6Al-4V) according to ISO 5832-3 [18] and ASTM B348 grade 5 [19]. ...
Kienbock's disease is an avascular necrosis of the lunate bone of the hand, which manifests itself by pain in the wrist associated with a certain stiffness and above all a loss of clenching strength. If left untreated, the natural course of this disease is towards the progressive aggravation and destruction of the lunate and then the whole wrist. In the advanced stages of the disease, the lunate becomes too damaged to be preserved. Several surgical techniques can be considered, including the placement of an implant. In this perspective, the present paper deals with the modelling and the realization of a lunate implant. To do this, we first used scanner images provided by the Cheikh Zaid International University Hospital in Rabat (Morocco) in order to obtain a 3D reconstruction of the semilunar bone. The measurements carried out on this reconstruction allowed us to determine the parameters necessary for its modelling. In a second step, we proceeded to the choice of the material taking into account several criteria such as biocompatibility, elastic limit, cost, ... Finally, we proceeded to the 3D printing of a prototype. The results obtained are satisfactory and could contribute to a better management of patients suffering from Kienbock disease.
... Short et al. (2005) have shown that the scapholunate ligament stabilizes the lunate bone during the wrist movements (i.e. flexion/extension and radial/ulnar deviation) and the current case-report (Xie et al., 2018) or case-series (Ma et al., 2020) with 3-D-printed patient-specific lunate implants have used suture tunnels and sutures to mimic the function of these important stabilizing ligaments. Despite uncertainties about the success of using patient-specific lunate implants to treat Kienböck's disease in general, it might be worth considering other design strategies that can improve their function. ...
We studied the three-dimensional (3-D) shape variations and symmetry of the lunate to evaluate whether a contralateral shape-based approach to design patient-specific implants for treatment of Kienböck’s disease is accurate. A 3-D statistical shape model of the lunate was built using the computed tomography scans of 54 lunate pairs and shape symmetry was evaluated based on an intraclass correlation analysis. The lunate shape was not bilaterally symmetrical in (1) the angle scaphoid surface – radius-ulna surface, (2) the dorsal side and the length of the side adjacent to the triquetrum, (3) the orientation of the volar surface, (4) the width of the side adjacent to the scaphoid, (5) the skewness in the coronal plane and (6) the curvature of bone articulating with the hamate and capitate. These findings suggest that using the contralateral lunate to design patient-specific lunate implants may not be as accurate as it is intended.
Additive Manufacturing has immersed the medical field, especially in reconstructive surgery, allowing the creation of a 3D model resembling the anatomical structure of interest. Due to Osteonecrosis also referred to as Kienböck’s disease; carpal bones especially the lunatum are concerned the most with those technologies especially since a prosthetic replacement is an obligation when it comes to advanced stages of this disease. In this article, we propose a method based on direct 3D reconstruction based on volume rendering directly on patients’ medical images (CT scans) to preserve the anatomical shape. For that purpose, we utilized 3D slicer software to create a 3D model based on different cuts of CT scan images. The resulting model was satisfactory, as it was similar to the lunate bone structure preserving all its anatomical characteristics and dimensions. The proposed approach helps in creating a prosthetic replacement with the exact anatomical shape and structure of the bone of interest respecting the dimensions, curves, and facets.
Background:
Three-dimensional (3D) printing technology allows for patient-specific anatomical reconstruction. This study aims to summarize and critique the current literature on 3D-printed carpal bone implants used in various carpal pathologies.
Methods:
Web of Science, PubMed, Scopus, Google Scholar, and Cochrane Central Register of Controlled Trials databases were searched from January 1901 to October 2022. PRISMA guidelines were adhered to, and the study was registered on PROSPERO. Articles utilizing 3D printed carpal bone implants were selected based on pre-determined inclusion and exclusion criteria. The outcomes included intraoperative/postoperative complications, visual analogue score (VAS), disabilities of the arm, shoulder and hand (DASH) score, radial and ulna deviation. The Murad tool was used to assess the quality of case reports and the Newcastle Ottawa scale was used to assess the observational studies.
Results:
A total of 6 studies comprising of 47 patients (34 males) were included. The average age was 35.3 years and indications for 3D printed implants included Fenton syndrome, Kienböck’s disease, and scaphoid non-union with and without necrosis. The overall postoperative VAS ranged from 0 to 1.4 and a significant reduction was noted from preoperatively with both rest and loading. The overall postoperative DASH score ranged from 9.2 to 25 and significant improvement was noted from preoperatively. The radial deviation ranged from 16.4° to 28.5° and while ulna deviation was from 23.8° to 36.4°. Only one complication was reported in included studies, a dislocation of the prosthesis. The overall quality of included studies was poor.
Conclusion:
3D-printed carpal bone implants improved outcomes in pain and function with minimal complications. The current study only reported only one complication postoperatively with no intraoperative complications. These results suggest that while 3D-printed carpal bone implants are still being optimized, large-scale clinical studies comparing the current options with the standard of care would provide better insights for recommendations and counseling.
With the ability to produce components with complex and precise structures, additive manufacturing or 3D printing techniques are now widely applied in both industry and consumer markets. The emergence of tissue engineering has facilitated the application of 3D printing in the field of biomedical implants. 3D printed implants with proper structural design can not only eliminate the stress shielding effect but also improve in vivo biocompatibility and functionality. By combining medical images derived from technologies such as X-ray scanning, CT, MRI, or ultrasonic scanning, 3D printing can be used to create patient-specific implants with almost the same anatomical structures as the injured tissues. Numerous clinical trials have already been conducted with customized implants. However, the limited availability of raw materials for printing and a lack of guidance from related regulations or laws may impede the development of 3D printing in medical implants. This review provides information on the current state of 3D printing techniques in orthopedic implant applications. The current challenges and future perspectives are also included.
The use of three-dimensional (3-D) technology in upper extremity surgery has the potential to revolutionize the way that hand and upper limb procedures are planned and performed. 3-D technology can assist in the diagnosis and treatment of conditions, allowing virtual preoperative planning and surgical templating. 3-D printing can allow the production of patient-specific jigs, instruments and implants, allowing surgeons to plan and perform complex procedures with greater precision and accuracy. Previously, cost has been a barrier to the use of 3-D technology, which is now falling rapidly. This review article will discuss the current status of 3-D technology and printing, including its applications, ethics and challenges in hand and upper limb surgery. We have provided case examples to outline how clinicians can incorporate 3-D technology in their clinical practice for congenital deformities, management of acute fracture and malunion and arthroplasty.
Although the etiology of Kienbӧck’s disease is not fully understood, it has been associated with potential risk factors, including anatomic, mechanical, and traumatic causes. The principal purpose of treatments for Kienbӧck’s disease is to reduce or eliminate these risk factors to achieve direct or indirect revascularization of the diseased lunate. A variety of treatment options have been introduced in the clinical field. Direct revascularization techniques mainly include pedicled or vascularized bone grafting. After sequestrectomy of the diseased lunate, the defect is filled with viable bone with a native blood supply. Direct revascularization techniques are generally applied to treat Lichtman’s stage II and IIIA Kienbӧck’s disease. To unload the lunate, radial osteotomy or capitate shortening is often performed simultaneously. Indirect techniques aim to achieve revascularization by reducing excessive force on the lunate. The indirect techniques include radial shortening or ulnar lengthening, open or closing radial wedge osteotomy, capitate shortening, limited intercarpal fusion, and core decompression. Direct or indirect revascularization techniques are not indicated for patients with lunate fragmentation or a severely collapsed lunate. Such patients generally undergo lunate excision with or without replacement arthroplasty for symptomatic relief as an alternative to revascularization techniques. Salvage procedures, such as proximal row carpectomy or total wrist fusion, are also proposed for patients with unsuccessful revascularization or for those with advanced disease with osteoarthritic changes in the wrist. The treatment target for stage IV is not only the diseased lunate but also radiocarpal or midcarpal osteoarthritis. Salvage procedures for symptomatic relief are indicated in stage IV.
Lunate excision arthroplasty is one of the first surgical procedures considered for the treatment of Kienbӧck’s disease. This procedure is generally performed for patients with lunate fragmentation or a severely collapsed lunate without pan-osteoarthritic changes throughout the wrist. Based on the radiographic staging system by Lichtman, lunate excision arthroplasty is considered suitable for patients with stage III (especially stage IIIB and IIIC) and stage IV Kienbӧck’s disease, especially for those with osteoarthritis localized at the radioscaphoid joint. Some studies report good clinical outcomes after simple lunate excision without interposing any biological or synthetic material in the remaining space for Kienbӧck’s disease. In contrast, other studies also show that lunate excision without replacement arthroplasty accelerates carpal collapse. To avoid such anatomical disruption, lunate excision with replacement arthroplasty has been developed. The procedures are classified into two categories: replacement arthroplasty using a prosthesis, and replacement arthroplasty using biological tissue. Historically, the most common type of prosthesis is a silicone rubber implant. However, some reports showed radiographic findings indicating wear-particle synovitis in response to the silicone rubber prosthesis postoperatively. Therefore, silicone replacement arthroplasty for Kienbӧck’s disease is discouraged. Regarding replacement arthroplasty using biological tissue, the most common procedure seems to be palmaris longus tendon replacement. Previous clinical studies suggest that lunate excision arthroplasty using the palmaris longus tendon provides acceptable clinical outcomes for advanced Kienbӧck’s disease, despite the radiographic progression of pathological changes, such as carpal collapse or osteoarthritic changes. To prevent these pathological changes, the author recommends lunate excision arthroplasty using a palmaris longus tendon ball with an osseous core for advanced Kienbӧck’s disease.
Unlabelled:
Three-dimensional printing for medical applications in surgery of the upper extremity has gained in popularity as reflected by the increasing number of publications. This systematic review aims to provide an overview of the clinical use of 3D printing in upper extremity surgery.
Methods:
We searched the databases PubMed and Web of Science for clinical studies that described clinical application of 3D printing for upper extremity surgery including trauma and malformations. We evaluated study characteristics, clinical entity, type of clinical application, concerned anatomical structures, reported outcomes, and evidence level.
Results:
We finally included 51 publications with a total of 355 patients, of which 12 were clinical studies (evidence level II/III) and 39 case series (evidence level IV/V). The types of clinical applications were for intraoperative templates (33% of a total of 51 studies), body implants (29%), preoperative planning (27%), prostheses (15%), and orthoses (1%). Over two third of studies were linked to trauma-related injuries (67%).
Conclusion:
The clinical application of 3D printing in upper extremity surgery offers great potential for personalized approaches to aid in individualized perioperative management, improvement of function, and ultimately help to benefit certain aspects in the quality of life.
Background: Total wrist arthroplasty is an effective treatment for end-stage wrist arthritis from all causes. However, wrist prostheses are still prone to complications such as prosthesis loosening and periprosthetic fractures after total wrist arthroplasty. This may be due to the wrist prosthesis imprecise matching with patient’s bone. In this study, we designed and developed a personalized three-dimensional printed microporous titanium artificial wrist prosthesis (3DMT-Wrist) for the treatment of end-stage wrist joint, and investigated its safety and effectiveness.
Methods: Total wrist arthroplasty was performed using 3DMT-Wrist in 14 cases of arthritis between February 2019 and December 2021. Preoperative and postoperative visual analog scale scores, QuickDASH scores, wrist range of motion, and wrist grip strength were evaluated. Data were statistically analyzed using the paired samples t-test.
Results: After 19.7 ± 10.7 months of follow-up, visual analog scale decreased from 66.3 ± 8.9 to 6.7 ± 4.4, QuickDASH scores decreased from 47.4 ± 7.3 to 28.2 ± 7.6, grip strength increased from 5.6 ± 1.4 to 17.0 ± 3.3 kg. The range of motion improved significantly in palmar flexion (30.1° ± 4.9° to 44.9° ± 6.5°), dorsal extension (15.7° ± 3.9° to 25.8° ± 3.3°), ulnar deviation (12.2° ± 3.9° to 20.2° ± 4.3°) and radial deviation (8.2° ± 2.3° to 16.2 ± 3.1). No dislocation or loosening of the prosthetic wrist joint was observed.
Conclusion: Total wrist arthroplasty using 3DMT-Wrist is a safe and effective new treatment for various types of end-stage wrist arthritis; it offers excellent pain relief and maintains the range of motion.
