Lars‐Erik Rännar

Purpose The purpose of this paper is to study the use of the additive manufacturing (AM) method, electron beam melting (EBM), for manufacturing of customized hip stems. The aim is to investigate EBM's feasibility and commercial potential in comparison with conventional machining, and to map out advantages and drawbacks of using EBM in this application. One part of the study concerns the influence on the fatigue properties of the material, when using the raw surface directly from the EBM machine, in parts of the implant. Design/methodology/approach The research is based on a case study of manufacturing a batch of seven individually adapted hip stems. The stems were manufactured both with conventional machining and with EBM technology and the methods were compared according to the costs of materials, time for file preparation and manufacturing. In order to enhance bone ingrowths in the medial part of the stem, the raw surface from EBM manufacturing is used in that area and initial fatigue studies were performed, to get indications on how this surface influences the fatigue properties. Findings The cost reduction due to using EBM in this study was 35 per cent. Fatigue tests comparing milled test bars with raw surfaced bars indicate a reduction of the fatigue limit by using the coarse surface. Originality/value The paper presents a detailed comparison of EBM and conventional machining, not seen in earlier research. The fatigue tests of raw EBM‐surfaces are interesting since the raw surface has shown to enhance bone ingrowths and therefore is suitable to use in some medical applications.

The purpose of this article was to describe the workflow from imaging, via virtual design, to manufacturing of patient-specific titanium reconstruction plates, cutting guide and mesh, and its utility in connection with surgical treatment of acquired bone defects in the mandible using additive manufacturing by electron beam melting (EBM). Based on computed tomography scans, polygon skulls were created. Following that virtual treatment plans entailing free microvascular transfer of fibula flaps using patient-specific reconstruction plates, mesh, and cutting guides were designed. The design was based on the specification of a Compact UniLOCK 2.4 Large (Synthes(®), Switzerland). The obtained polygon plates were bent virtually round the reconstructed mandibles. Next, the resections of the mandibles were planned virtually. A cutting guide was outlined to facilitate resection, as well as plates and titanium mesh for insertion of bone or bone substitutes. Polygon plates and meshes were converted to stereolithography format and used in the software Magics for preparation of input files for the successive step, additive manufacturing. EBM was used to manufacture the customized implants in a biocompatible titanium grade, Ti6Al4V ELI. The implants and the cutting guide were cleaned and sterilized, then transferred to the operating theater, and applied during surgery. Commercially available software programs are sufficient in order to virtually plan for production of patient-specific implants. Furthermore, EBM-produced implants are fully usable under clinical conditions in reconstruction of acquired defects in the mandible. A good compliance between the treatment plan and the fit was demonstrated during operation. Within the constraints of this article, the authors describe a workflow for production of patient-specific implants, using EBM manufacturing. Titanium cutting guides, reconstruction plates for fixation of microvascular transfer of osteomyocutaneous bone grafts, and mesh to replace resected bone that can function as a carrier for bone or bone substitutes were designed and tested during reconstructive maxillofacial surgery. A clinically fit, well within the requirements for what is needed and obtained using traditional free hand bending of commercially available devices, or even higher precision, was demonstrated in ablative surgery in four patients.