Feb 2, 2017 | By Benedict

In what has been described as a UK first, a man from Studley in Warwickshire has been given a custom-built 3D printed titanium sternum and ribs after having part of his own removed. He is the first patient in England and only the second in the world to receive such treatment.

Cardiothoracic surgeon Ehab Bishay (left) and Edward Evans

It is surely a great thing for medicine (and for patients) that the range of customizable 3D printed titanium implants is widening by the day. From your foot to your skull, there is now a large collection of 3D printable solutions that can be used to treat bone problems and injuries in an effective and patient-specific manner. In England, 60-year-old Edward Evans recently benefitted from one of the most modern implant technologies available: a 3D printed titanium sternum and ribs. After having part of his own sternum and ribs removed six years ago following a rare bone infection, Evans became only the second person in the world to receive this unique 3D printed medical treatment.

Although doctors have been able to create rib and sternum implants using cement, newer implants made from titanium boast several advantages, including a greater resistance to infection. And since infection was the reason for Evans’ life-changing surgery in 2011, the idea of getting a titanium implant massively appealed to the patient, as did the idea of shedding the vulnerability that had prevented him from playing sports and enjoying a normal life since the surgery.

Cardiothoracic surgeon Ehab Bishay offered Evans the chance to get a 3D printed titanium implant (and make British history) after reading of a similar case, the first of its kind, at University Hospital Salamanca in Spain. The party responsible for the 3D printed implant given to the patient in Spain was Anatomics, an Australian medical device company, and Bishay sought them out to see if they could repeat the trick.

Surgeon and BBC presenter Gabriel Weston with a prototype of the 3D printed implant

Anatomics, keen to get on board with the project, put Bishay in touch with doctors in Salamanca who had been part of that original case. The Spanish team passed on their experience, and both Bishay and Evans decided they wanted to attempt the 3D printing process. Bishay, however, suggested a few modifications to the technique used in Spain, in order to better suit Evans and his specific condition.

“They had used a synthetic mesh behind the implant in the first operation, to reduce the chance of the lungs herniating between the titanium rods that replicated the ribs,” Bishay explained. “Unfortunately that mesh became infected and they had to remove it during a second operation. Instead we asked Anatomics to coat these rods with porous polyethylene to add bulk so we did not have to use a mesh.”

Using CT scans of Evans’ chest, Anatomics was able to create a precisely fitting 3D printed titanium implant that was eventually fabricated on an SLM 3D printer. Since the 3D printed device was successfully implanted in a four-four operation last September, Evans has enjoyed significant improvement in chest wall movement and lung function. He recovered on a specialist thoracic ward, assisted by a team of nurses and dedicated physiotherapists. The surgery itself was carried out by a multi-disciplinary team that included plastic surgeon Haitham Khalil, a number of thoracic anesthetists, and specialist theatre nurses.

Australian company Anatomics offers a range of medical services

The healthy state of Evans, who made a full recovery after five months, has inspired the medical team involved to continue using 3D printing where appropriate. “Although cement is tried and tested we believe that custom-built 3D printed titanium implants may have certain advantages which we are looking to show,” Bishay said. “Titanium is more resistant to infection, lightweight, tough, and since it exactly replicates the defect, it means that the operative time is reduced as it slots in. It should also offer a better cosmetic result.”

Now that he is able to occasionally enjoy the odd sporting activity, safe in the knowledge that his body is adequately protected, Evans is similarly delighted with the results of the medical 3D printing procedure. “I feel more confident now,” he said. “My chest now feels like it did before.  Whatever I do now—simple or difficult—I feel better doing it.  I can even fall over, knowing that my heart and lungs are protected, and that’s something I couldn’t do before.”

Evans’ story was recently told on the BBC TV series Trust Me, I’m a Doctor.

 

 

Posted in 3D Printing Application

 

 

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