Implants are used to replicate and replace the function of various hard structures in the body, including bones and joints. However, engineers continue to find new, creative uses for implants, with the Tel Aviv Medical Center and Hexagon recently partnering on a unique case. The team set out to solve a problem requiring immense precision—a fully personalized scapula implant for a cancer patient.
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The Patient’s Situation
The patient in question was a young person who had experienced months of excruciating pain and restricted shoulder movement. MRI imaging revealed extensive damage to the scapula (the shoulder blade) and the presence of an aggressive tumor infiltrating the surrounding muscles. The goal of the medical team was to remove affected bone while maintaining as much shoulder functioning as possible. Although the patient was treated with chemotherapy to shrink the tumor, removal of the scapula (known as a scapulectomy) was required. When the entire scapula is removed without reconstruction, shoulder functionality is lost, and patients can experience physical and mental health consequences.
Previous Approaches
Traditionally, once scapulectomies were performed, they were sometimes accompanied by reconstruction of either the scapula or glenohumeral joint—a ball-and-socket joint that connects your upper arm bone (humerus) and shoulder blade (scapula). Surgical options for reconstruction by arthroplasty (joint replacement) or bone allograft (donor bone reconstruction) typically require numerous conditions that not all patients can meet. These criteria include preservation of key muscles (including the deltoid, trapezius, and rhomboids), one of the rotator cuff muscles, or the acromion (the bony projection on the top of the scapula). However, if the tissues around the shoulder blade are so affected that surgeons must remove a large portion of them and cannot preserve important muscles like the trapezius, deltoid, or latissimus dorsi, then the only option is to perform a scapulectomy without the option of reconstruction.
Key Materials in Scapula Reconstruction
Typically, scapula reconstruction involves a metal prosthesis (made of titanium or other alloys or polyethylene), donor bone, or fixation hardware such as titanium plates and screws. Titanium wire may also be used to hold pieces of bone together, secure implant grafts, or stabilize prostheses or plates. Titanium is a popular material because it is strong, lightweight, and biocompatible. It is also corrosion-resistant, making it a good long-term option.
A New 3D-Printed Titanium Scapula
The Tel Aviv Medical Center and Hexagon took traditional reconstruction a step further by designing and implanting a customized 3D-printed titanium scapula that precisely mirrored the patient’s anatomy. The aim was to restore mobility and contribute to future treatments for complex skeletal surgeries. Some of the implant’s unique features include anchoring points for muscle attachment, an advanced lattice structure to facilitate the growth of connective tissue and muscles, and minimal surfaces to enhance joint mobility. The surgery took place, and the patient regained mobility within a matter of days, then moved on to rehabilitation to restore full shoulder function. The development underscores the value of investing in personalized solutions that promote efficient soft-tissue ingrowth. The scientists explained that bioactive 3D-printed implants such as these are the future of implantology. New printed materials, combined with powerful additive manufacturing and simulation software, enable creators to introduce smart, highly personalized implants into the field of surgery.
The Tel Aviv Medical Center and Hexagon have designed and created a new 3D implant for a patient in need of scapular reconstruction. It represents a major advance in implantology, as it offers several features that enable patients to maintain shoulder mobility, support muscle attachment, and recover function more effectively after complex tumor surgeries. The success of this surgery demonstrates that personalized, bioactive implants can expand treatment possibilities for patients whose options were once significantly narrower.
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