3D printer
In the world of Orthopaedics, complex limb deformities can be difficult to understand fully for patients, trainees, and sometimes surgeons. The deformities can be in multiple planes which are often obscured from view. Adopting the latest 3D printing technology has overcome this barrier to understanding by producing 1:1 scale replicas of the limb anatomy. The 3D printed bone can be used to rehearse a surgical technique before it is performed in real life. Mistakes can also be contemplated and this leads to safer more successful operations. The ability to trial various orthopaedic implants on a test model before actually inserting into a patient ensures that the best fit is achieved and no single use implants are wasted. When the 3D models are created, they mimic real bone and surgeons describe their feel as being very realistic.
Contact Details
- Andrew Simpson
- [email protected]
- Dave Ferguson
- [email protected]
- Sharon Brown
- [email protected]
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Patients have told us that it’s been really helpful being able to physically see their joint/bone rather than looking at a 2D version and my surgeon colleagues have agreed that it’s made things clearer for them too.”
On several occasions when discussed in a Trauma Meeting, clinicians suggested the possible benefits of having a model of the fractures could help make clinical decisions for treatment and also be helpful to show patients when discussing their treatment, especially if the patient is bed bound and images cannot be easily shown.
For example, Mr F has a problem with both his elbows – they are both severely painful and stiff. In fact, he has an unknown rheumatological condition which has destroyed most of his joints. This has led to some loss of bone and very abnormal anatomy. Standard “off the shelf” elbow joint replacements rely on having some normal anatomy and costs £2k. If the anatomy is too deformed then the only other option is a custom made elbow hinge which costs between £20-30k and is usually manufactured in Europe. When a surgeon assesses the elbow imaging, they often err on the side of caution if they are in doubt and choose the custom elbow to avoid the situation of being left without a workable implant after starting surgery. This adds delays to the waiting list and extra expense for the health service.
Similar problems also occur in the trauma setting, especially in major trauma patients, with the added complexity of a more urgent timescale for decision making and getting patient to theatre.
The innovation is a printer which can convert 2D scans into 3D models to allow clinicians and researchers to print 3D anatomy for training, surgical templating and patient education.
The project works to produce and test implants on bone models before surgery occurs. Cross sectional imaging such as CT and MRI scans are loaded into modelling software and sent to a 3D printer. They are checked for quality and accuracy before being assembled into workbenches for implant testing. The end result is a confirmation on whether or not a standard implant can be used for a procedure. The case example for Mr F highlights this point. His elbow joint was printed out with the null hypothesis that standard implants will not work. After making the necessary cuts to the model bone, we were able to show not only that the £2k implant would work, but also the best way to insert it for maximum function and longevity. Mr F proceeded with successful surgery and was delighted with the results. He is now waiting for the same procedure on his left elbow. This has saved the healthcare service £18-28k. Mr F was shown his model before surgery and it was used as part of his informed consent process. The case is also being used to help train our future doctors.
A 3D printer was purchased in September 2020 at a cost of £7,500, along with some other requirements to make the lab suitable. A total of £12,000 was invested using innovation funding with the aim of facilitating a new stream of project work at James Cook University Hospital. It has been used to print over 50 anatomic models ranging from ankles, feet, knees, elbows, hands, femurs and even a whole pelvis. Four staff, which make up the Clinical Measurement Section of Medical Physics, have all been trained in the use of the software and hardware to provide the service alongside Dave Ferguson and the kit is used on a regular basis for both training and service purposes. A further £3,500 funding has been made available in November 2021 to upgrade the CE marked and FDA approved software.
An elderly lady with polytrauma was admitted to hospital with a complex distal femur fracture. As part of her emergency care, she received a CT scan and her case was discussed in the trauma meeting. It was felt that a model to show the patient would be helpful to talk about her treatment. Due to other injuries, she was bedbound, and it was not possible to show her any images of her injuries. A 3D model was computer generated using her CT scans and scheduled for printing in Polylactic acid (PLA) material. The model was successfully used to show the patient on the ward to assist with shared decision making and consent.
A gentleman with severe inflammatory arthropathy of both elbows was in need of an elbow replacement but consultant upper limb surgeon Mr McVie was unsure whether the elbow was too deformed to be able to insert a standard elbow replacement. We printed out his elbow joint to test the implants with our colleagues at Zimmer Biomet and answer this clinical question. After making the necessary cuts to the model bone, we were able to show not only that the £2k implant would work, but also the best way to insert it for maximum function and longevity. The gentleman proceeded with successful surgery and was delighted with the results. He is now waiting for the same procedure on his left elbow. The gentleman was shown his model before surgery and it was used as part of his informed consent process. Mr McVie fed back stating, “The case went well and the model was really cool. It gave me confidence to use the generic elbow replacement”. The saving for the NHS with this one case was in the magnitude of tens of thousands of pounds.
These examples show the benefit to patient, staff and the economics of healthcare. The patients were provided with a further aspect around the care and treatment provided, which allowed for shared decision making and interest which was not available previously. Staff were provided with new opportunities and confidence to pursue options with access to the models and collaborate with industry partners to look at potential outcomes. The Trust was able to save money in purchasing a suitable alternative to what could have been an expensive alternative and developed new skills for staff.
The AHSN have offered support around the branding of the service and expanding our 3D printing capabilities which will be incorporated into the agreement South Tees offer the AHSN as an Innovation Pathway Partner.
We are currently offering the 3D printing service to the Trauma and Orthopaedics Department within the Trust with the intention to offer to further specialities. We have been approached by South Tyneside and Sunderland Trauma department to provide some models. We are currently process mapping the service and also looking at branding.
It is breath-taking to be able to turn a 2D CT scan into a 3D model that can be held by the patient, used for planning surgery and used for medical education.