By Dr Vikas Gupta
The IT revolution commenced with the advent of the World Wide Web developed at CERN, France. Since then the world has seen a rapid transformation in technology. Within our lifetimes, several technologies and products have become obsolete, replaced by novel, proficient mechanics across the spectrum. And a recent technological development that has taken the medical world by storm is 3D printing.
3D printing is part of a family of manufacturing technology called additive manufacturing. This describes the creation of an object by adding material to the object layer by layer. The process of 3D printing begins by making a graphic model of the object to be printed. These are usually designed using Computer-Aided Design (CAD) software packages, and this can be the most labour-intensive part of the process. One of the main benefits of 3D printing is that it allows the rapid prototyping of pretty much anything. The only real limitation to its usage is your imagination.
Some objects are simply too complex to be created in a more traditional manufacturing or prototyping processes like CNC milling or moulding. It is also a lot cheaper than many other traditional manufacturing methods. After the design, the next phase is digitally slicing the model to get it for printing. The slicing process breaks down the model into many layers. The design for each layer is then sent to the printer head to print, or lay down, in order.
Once the slicer program has worked its magic, the data is then sent to the printer for the final stage. From here, the 3D printer itself takes over. It will begin to print out the model according to the specific instructions of the slicer program using different methods, depending on the type of printer used. Thus, with a brief overview of the process being presented, let us delve into the usage of 3D printing in medical sciences, with an emphasis on orthopaedics.
According to a study published in the Global Health Journal, 3D models manufactured by 3D printing reduce developmental costs of medical parts and surgical planning time. Integrating 3D printing with orthopaedics helps in recognising and understanding the problem meticulously and ensures a greater guarantee of success in operations. This technology can enable doctors/surgeons to design, produce, recreate and plan operations more accurately, carefully, and economically. 3D models can assist specialists with a visual comprehension of the patient-particular pathology and life structures. Innovation in 3D printing initiated a blueprint for the virtual outline and execution of medical procedures.
The most significant opportunity for 3D printing in orthopaedics is that it assists in designing precise anatomical shapes and suggests that permeable bone substitution platforms can be incorporated into patient implants. It takes into consideration natural bone ingrowth, guaranteeing the steadiness of the implant over the long haul.
Some of the avenues in which 3D printing offers significant assistance are listed below by the author :
The orthopaedic medical procedure often runs into impediments in cases with large essential wounds with different bone discontinuity, and in those exhibiting bone deformations, Radiographs are utilized routinely for orthopaedic surgeries, yet they lack data on the exact 3D degree of bone imperfections. Here, 3D printing can successfully be used in these cases as it uses a 3D model which gives specific required results/data.
3D printing models are often used to assist in the surgical planning process for restorative osteotomies, with a specific end goal to pick up a more educational outline of the life systems and to enhance the detail of arranging, particularly in instances of insignificantly intrusive medical procedures. It produces an exact duplicate model of the patient’s influenced body organ/part, which can be viewed and felt. Different printed models of the hip, knees, and shoulders can be used to make the custom-fitted specific design of the injured part and used as patient-specific implants.
Surgery verification with reverse engineering
Another utilization of 3D printing is the identification of orthoses with the help of reverse engineering assistance with 3D scanners. This approach enables a consistent fitting to the patient’s life systems and streamlines the plan’s choice and the materials.
Customized tools and parts
The utilization of physical models for treatment arranging and perception, rather than the sole utilization of computed tomography (CT), magnetic resonance imaging (MRI) information or virtual remaking, enables the doctor to image different areas of the human body with greater accuracy.
AM diminishes the advancement time by enabling amendments to an item to be made ahead of schedule. Rapid prototyping (RP) allows for engineering, fabricating and assembling of items on time in the planned procedure, with the goal that the misstep can be amended and changes can be made while they are as yet economical. Dr Vikas Gupta, Consultant, Hand & Upper Extremity Surgery (orthopaedics) At Max Hospitals, cites the example of the procedure for removing a tumour to highlight the benefits of using 3D printing: “When removing a tumour, traditional methods of using a cast takes up time during which the tumour may grow in size. 3D printing effectively addresses this problem as the process is rapid.”
3D printing innovation can be used to improve specialists performing systems (operative procedure) accurately. Even a few printing technologies can produce mechanical bones, human tissues, and organs used directly to craft in the patient body. Printing particular customized gadgets for patients can be utilized to guarantee ideal screw direction and embed arrangement with insignificant presentation.
Procedures such as Templating and pre-contouring a Recon plate for acetabular fracture are manufactured by using 3D printing. The result shows improvement in surgical outcomes and reduced overall surgical time. In another case in which 3D printed jigs are used for total knee arthroplasty, which helps to improve overall performance.
“Beyond the cost-effective, time-saving elements, 3D printing allows for patient-specific products to be created, allowing for a wide range of modifications to meet the needs of individual patients. Also, 3D printing can be used in remote areas as all it requires is the printer and the material, thereby eliminating the need to carry around expensive, bulky equipment,” explains the author. The benefits promised by 3D printing are numerous. However, like most modern technologies, there are certain limitations in its usage as highlighted below:
The shape opportunity of 3D printing brings some new difficulties for implant creators and producers. Originators and makers need to consider the cleaning prerequisites of the instruments and embed them in the planning stage since the tremendous geometric flexibility can make all the more difficult cleaning requests
Bio-printable materials limitation
State-of-the-art 3D printing, particularly for the creation of implantable biomedical gadgets, is severely constrained by printable materials. Thus, elective material handling techniques are needed to address the materials that are not effectively printable.
Government directions, standardization and regulatory limitations
The institutionalization of 3D printing is a continuous procedure. Today, administrative offices are getting comfortable with 3D printing advancements. However, they still presumably force 3D printing– particular necessities on restorative gadget producers until the point when acknowledged norms are embraced and perceived by the administrative experts.
Bio-degradability and toxicity limitation
The degradation of the materials is a significant issue in the 3D stages. The usage of degraded materials may result in hypoxia and acidosis inside the systems. The entry of acidic debasement is dependent upon the level of acidosis, which may hurt the seeded cells and also the included cells.
Regardless of the limitations of this technology, 3D printing is set to revolutionise surgical procedures. Leading luminaries of the medical fraternity have voiced their support for the usage of 3D printing. The possibilities promised are astounding and 3D printing can ensure a far greater success rate compared to other existent technologies. And if the trajectory of technological advancement is any indication, one can claim that the mechanical limitations of 3D printing will soon be overcome.
Contemplating the future of this technology, Dr Gupta states, “Biological ink and matrix are becoming increasingly prevalent. And cells can be induced to grow in the biological matrix including stem cells. Thus, shortly organs could also be printed, giving a great boost to the medical fraternity. Long waiting times for organ transplants will soon be a relic of the past.” Thus, 3D printing offers several benefits and will soon be an indispensable technology in the medical fraternity.
Dr Vikas Gupta , Director – Orthopaedics and Head – Hand & Shoulder Surgery, Max Hospital, Gurgaon & Max Smart Super Specialty Hospital, Saket.
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