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3D Printing Technology in Revision Joint Replacement

Dr. Daniel K. Witmer

Written By Dr. Daniel Witmer

Total joint replacement is one of the most common procedures performed in the United States. By 2030, we expect over 1 million joint replacements to be performed per year. Overall, it is a wonderful and life changing procedure for the majority of patients who undergo it. Joint replacements, however, are artificial parts just like those on any machine. They can wear out, break, and become damaged over time. Typically, with normal use, this time period is usually 25 years or more. Falls, trauma or other damage to joints can accelerate this wear, along with other conditions such as infection.

When joint replacements wear out or fail, usually changing out one or two of the components is enough to fix the problem. Sometimes, however, the problem can be quite extensive and requires special reconstruction techniques to manage. As a tertiary referral center for the New England region, our team at the Hartford Hospital Bone and Joint Institute is skilled in managing all joint reconstructions or revisions from simple to highly complex.

Several new technologies have helped us change the way we manage joint replacement revisions over the past few years. One of the major ones is 3D printing technology. When we encounter joints that have extreme amounts of bone loss, prior techniques of reconstruction required assembling many parts together during surgery to “fill the gaps” in the bone. These older implants work, but are time consuming to assemble in the patient and difficult to hold together while doing so.

3D printing technology has allowed us to manage these defects in the bone differently. We are now able to get a CT (CAT) scan which will allow us to develop a computer model of the bone defect and a computer model of a customized implant that will fill it. The implant company then sends the plans to us and we review them with a special engineer to design the implant exactly to our specifications. The implant is then 3D printed with titanium metal, customized for that patient, and shipped to be used during surgery. This process takes 4-6 weeks typically. At the time of surgery, the custom implant is inserted into the defect and typically will “drop in” nicely as it has already been custom fit. 

During highly complex revision surgeries such as these, we have found at the Bone and Joint Institute that a team approach utilizing two of our Joint Replacement surgeons working together will allow these operations to be performed much quicker and easier for both surgeon and patient. This allows for less anesthesia and typically quicker recovery for the patient. Each member of our hospital team is critical in this process, from the OR staff, Nursing, PT, and our ancillary staff. Overall, this advanced technology has allowed us to provide safer solutions with quicker recovery for patients with complex hip and knee problems.

Dr. Daniel K. Witmer, Orthopedic Associates of Hartford, is a Board-Certified Orthopedic Surgeon specializing in complex hip and knee replacement and revision surgery, computer assisted surgery, cementless and partial knee replacement, and rapid recovery techniques enabling outpatient joint replacement for optimized patient recovery.  His clinical interests include cementless knee technology, joint kinematics, and treating fractures and complex problems around existing hip and knee replacements.  He has authored numerous publications and book chapters and has presented his work at national conferences.  He serves as a reviewer for the journal Arthroplasty Today.  He is an active member of the American Academy of Orthopedic Surgeons, the American Academy of Hip and Knee Surgeons, and the Connecticut Orthopedic Society. Learn more about Dr. Witmer.