Pioneering Sternal Reconstruction Using a Patient-Specific Titanium Implant

Challenge

A 70-year-old female patient was diagnosed with a sternal tumor involving the central portion of the sternum over an area approximately 7 cm in length. The patient had a history of multiple malignancies, including colorectal cancer and thyroid cancer. Achieving complete oncological resection required removal of a substantial portion of the sternum while preserving chest wall stability and maintaining protection of the intrathoracic organs.

Conventional implants are unable to accurately replicate patient-specific anatomy or address the exact extent of the resulting defect. The clinical team therefore sought a solution that would enable anatomically accurate reconstruction with the highest possible level of precision.

Solution

Based on the patient’s CT imaging data, a patient-specific titanium sternal implant was designed and manufactured. The design and development process resulted from close collaboration between the operating surgeon and biomedical engineers and included modeling of the implant’s final geometry, anatomical contours, fixation features, and attachment points for soft tissue reconstruction.

The implant was manufactured using laser powder bed fusion technology from a titanium alloy, enabling the production of highly complex implant geometries with exceptional dimensional accuracy and patient-specific customization. The implant was designed to accommodate the anatomical conditions at the implantation site, allowing for optimal anatomical fit and preservation of the natural chest wall contour.

The titanium alloy used offers high mechanical strength, low weight, excellent biocompatibility, and long-term stability within the body. When required, the manufacturing technology also allows the incorporation of porous structures to support biological integration of the implant.

Results

The procedure was performed at the Department of Thoracic Surgery, Jessenius Faculty of Medicine, Comenius University and Martin University Hospital. During surgery, the tumor-involved portion of the sternum was resected and replaced with the patient-specific titanium implant. The operation lasted approximately two and a half hours and was completed without complications.

Thanks to the precise anatomical fit of the implant, continuity of the chest wall, its mechanical stability, and its protective function for vital organs were successfully preserved. Preoperative digital planning also contributed to an excellent aesthetic outcome while maintaining full functionality of the chest wall.

Significance of Personalized Manufacturing

This clinical case demonstrates the capabilities of additive manufacturing for reconstructing extensive skeletal defects. The combination of medical imaging, digital planning, and patient-specific implant manufacturing enables the development of solutions precisely tailored to an individual’s anatomy.

Patient-specific implants can significantly contribute to preserving the function of reconstructed anatomical structures, improving surgical accuracy, and optimizing clinical outcomes in complex oncological and reconstructive procedures.

Source: Klinika hrudníkovej chirurgie má za sebou unikátnu operáciu: Martinskí lekári odstránili veľkú časť hrudnej kosti a nahradili ju titánovým implantátom vyrobeným na mieru, Zdravotnícke noviny, 20. apríl 2017.