First 3-D Printed Ribcage Successfully Implanted

It’s a story Wolverine would appreciate. A 54-year-old Spanish man suffering from a cancer of the chest wall has received a 3-D-printed implant made of titanium alloy to replace his sternum and a section of his ribcage.

The patient’s surgical team at Salamanca University Hospital in Spain scanned his chest using high-resolution CT. From that they were able to develop a precise plan to remove the chest wall sarcoma and the portion of bone that it had invaded. The question was what they would replace it with. Learn more and see a video below.

After realizing the complex architecture of the implant they would need to replace the removed portion, the group reached out to Australian medical device company Anatomics and the country’s Commonwealth Scientific and Industrial Research Organization.

“When planning the surgery the whole team decided that a rigid implant was necessary because of protective reasons,” said surgical team member Dr. José Aranda, “to protect the thoracic organs, to ensure enough respiratory mechanics and of course also for cosmetic results. We thought, maybe we could create a new type of implant that we could fully customize to replicate the intricate structures of the sternum and ribs.”

The Australian team reviewed the CT data and decided that the best option would be to create a custom implant out of titanium alloy using an industrial 3-D printing technique called electron beam melting. In this type of additive manufacturing machine, a powerful beam of electrons is directed at a tray of powdered titanium. The beam melts the powder layer by layer according to a computer-assisted design blueprint of the object being made.

The team used this approach because it allowed them to build a complete prosthesis that included a rigid sternum and semi-flexible alloy rods to stand in for rib segments. This means the implant could be inserted into the patient without attachment plates and a minimum of screws to decrease the chances of long-term complications.



“While titanium implants have previously been used in chest surgery, designs have not considered the issues surrounding long term fixation,” Anatomics CEO Andrew Batty said. “Flat and plate implants rely on screws for rigid fixation that may come loose over time. This can increase the risk of complications and the possibility of reoperation.”

The collaborative build process, which included industrial and public research experts, was sent over to Spain after being completed in Australia.

“The operation was very successful,” Dr Aranda said. “Thanks to 3-D printing technology and a unique resection template, we were able to create a body part that was fully customized and fitted like a glove.

“To our knowledge, this is the first 3-D titanium printed sternum {made through} custom made processes. And, of course, for me the main important thing is the excellent functional and cosmetic results we have obtained.”

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