FREEDOM OF DESIGN TO MEET PATIENTS’ AND SURGEONS’ REQUIREMENTS

Thanks to the extreme versatility the additive manufacturing technology offers the
possibility of creating customized solutions to cope with the most complex
situations, which cannot be faced with standard systems.

In many years of clinical experience, Permedica has developed an important know-how
in 3D printing to offer the surgeon ad-hoc solutions for the treatment of
particular clinical scenarios.

Technology TRASER® (Trabecular Laser Melted Titanium) makes it possible to create systems of any shape and design to best adapt to the clinical case of interest.

MANUFACTURING PROCESS

Starting from the diagnostic images CT-Scan our R&D department analyzes the case in collaboration with the surgeon to determine the most suitable solution.

Once the study is approved by the surgeon, the components are realized by a 3D printer from titanium powder.

TRASER® (Selective Laser Melting) is an additive manufacturing technology that selectively fuses together specific portions of a thin layer of titanium powder using a laser beam to create solid objects.

At the end of the printing process the components are removed from the support, subjected to heat treatment and sandblasting, then to subsequent traditional mechanical processing to obtain the finished implant.

SOLUTIONS FOR HIP, KNEE AND SHOULDER

Custom made solutions play an increasing crucial role either for the creation of components with a specific design in order to address particular clinical scenarios (bone losses, complex anatomies, fractures or post-traumatic complications, hardware in situ) and to produce implants of small dimensions, for example for treatment of patients with dwarfism.

CLINICAL CASE [1]

CLINICAL HISTORY

Male patient, 32y old; dwarfism; 1.08m/30 kg of bodyweight.
In the anamnesis continuous daily pain in the right hip with restricted range of movement. Important clinical limitations. Pain killers dependent.

CLINICAL EXAMS

Walk: limping right side; Duchenne/Trendelenburg negative.
ROM : F/E 30-10-0°, ER/IR 20-0-10°, ABD/ADD 10-0-20°.
Radiologically: DDH: developmental dysplasia of the hip with secondary osteoarthritis (Crowe II, Paprosky IIb).

SURGERY

Total hip replacement is performed, using an allograft out of the femoral head, fixed with
several screws to build up the lateral acetabular rim.
Then a TRASER® Trabecular Titanium custom made cup of 30mm diameter is inserted without using bone cement and fixed with some trabecular bone screws.
On the femoral side, a customized selective laser melted femoral stem is implanted, created with the same TRASER technology; reposition with a metal femoral head on a UHMWPE insert.

RESULT

The final result is stable with a perfect covering of the cup implant and central seating of the TRASER custom made cup.

FOLLOW-UP

4 months after surgery perfect walk.
No crutches since the second month postoperatively; no limping.
Joint function : F/E 120-0-20, ER/IR in 90° of flexion 40-0-30.
Radiologically the implant is stable; bone graft is stable, the cup is integrated.

[1] Memminger M, Banci L, Meoli A. Bilateral Total Hip Replacement in Dwarfism With a Custom Laser-Printed Trabecular Acetabular Shell. Orthopedics. 2019 Sep 1;42(5):e477-e479.