Amit Bhanot of India was, in his own words, “a perfectly normal kid who enjoyed bicycling, playing cricket and other sports” until 1991, when he began feeling a sharp pain in his groin and right leg. This was the beginning of several difficult years of visiting different hospitals and receiving different diagnoses and treatments; meanwhile he was losing mobility in his right hip. In 2000, Bhanot was diagnosed with ankylosing spondylitis, a severe form of arthritis that can cause the joints to fuse. Bhanot’s case had advanced to the point that his right hip joint had fused and his left was beginning to be affected as well.
In 2007, Bhanot had a total hip replacement on his right hip, and one on his left in 2008. His mobility returned, but by 2017 he was experiencing pain again and was informed that he might need to get a revision done in a few years. This led Bhanot, now 39, to the orthopedic surgery division of All India Institute of Medical Sciences (AIIMS), the largest public hospital in India. There he met with Professor Rajesh Malhotra, Head of Orthopedics, who noted that Bhanot had already lost a large part of his pelvic bone and that the implant was failing. This type of bone loss, he knew, could not be corrected with conventional surgery techniques or with an off-the-shelf implant.
Malhotra then turned to Sanjay Kumar Pathak and his company Global Health Care, which had been responsible for creating the first 3D printed titanium vertebrae in India last year.
“We started with a CT scan which was than handed over to a senior scientist named Dr. Vijay Meena who runs a government owned design and printing facility,” Pathak told 3DPrint.com.
“The CT data was full of (artifacts) because of pre existing metal implant and it was a challenge to segment the data set. We created many bone models with implant and by separating existing implant and was printed in plastic at our FDM machines. Than the first prototype was created and was brought to Prof Malhotra only to find out multiple changes required in the design due to anatomical and surgical technique related issues. This way one after another seven prototypes were made and finally one proto was approved. I immediately cleared for printing in titanium and after some logistic problems the implant was printed in EOS Titanium Ti64ELI.”
Once the 3D printed titanium implant, another first in India, was brought to Bhanot’s doctors, they realized that it was too smooth to be fixed in a cemented cup. Pathak went to Gaurav Luhtra and his company Auxein, where technicians helped to create several 2-5 mm angular pits on the surface of the implant. An additional hole was also drilled in the implant to fit a screw that would affix the implant to the pubic bone. Finally, the implant was returned to Professor Malhotra and his team, who inspected it and ultrasonically cleaned it before turning it over to the hospital for multiple rounds of sterilization.
On April 25th, 2018, the revision surgery was performed. It was a difficult nine-hour surgery as it involved a large number of major blood vessels and nerves. But the patient is now recovering nicely and should be able to walk without pain or limited mobility.
The surgical team included:
- Professor Rajesh Malhotra, Head of Orthopedics
- Professor Vivek Trikha, Specialist Orthopedic Surgeon for Pelviacetabular Surgeries and Trauma
- Dr. Deepak Gautam, Specialist, Hip Replacement Surgery
- Professor Biplam Mishra, Professor of Surgery and Specialist in Vascular Surgery
- Professor Anjan Trikha and Dr. Manpreet Kaur, Anesthesia and ICU
It’s unfortunate that Bhanot had to go through so many years of suffering before finally receiving an implant that would fit perfectly and allow him full, pain-free mobility, but cases like his will become less and less common as 3D printing is more frequently used to create custom implants for the first surgery, eliminating the need for revisions later. Many patients like him are still suffering from pain and mobility issues after initial implants, but 3D printing technology is enabling doctors like the above to give these patients the relief they were never able to achieve before.
For further detail, Pathak can be contacted at firstname.lastname@example.org.
Discuss this and other 3D printing topics at 3DPrintBoard.com or share your thoughts below.[Images provided to 3DPrint.com by Sanjay Kumar Pathak]