Patients in the world who undergo total knee replacement surgery are increasingly younger (50 percent are under age 65). One in five patients is dissatisfied with the outcome surgical outcome in total knee replacement. All this would require a treatment individualized, which would greatly decrease the risk of dissatisfaction, with the goal of proper correct sizing of the implanted components with respect to the anatomy of the individual patient. [1]

How is a PERSONALIZED KNEE PROTHESIS constructed with 3D PRINTING?
It starts with a three-dimensional CT reconstruction of the patient’s knee, the
characteristics and anatomical parameters of his knee, which is different from every other patient in the world. Based on this data, the most correct geometry is chosen and designed; then, the prosthesis is fabricated through 3D printing, faithfully reconstructed to the dimensions specific dimensions of that patient. [2,3]

What is the difference between a STANDARD prosthesis and a PERSONALIZED prosthesis?
In standard prostheses we use sizes ranging from 5 to 16 possibilities, depending on the type of prosthesis you have chosen to perform the procedure. It is exactly like a dress, you choose the size that is most comfortable and congruent, but none of them fit perfectly on the knee of that patient. The 3D printing technology currently in use makes over 170 sizes available.
The patient will get a custom-made implant as if it were an elegant and precise tailoring suit that fits perfectly, does not create “overhang” (mechanical conflict) in the back of the knee, allows greater flexion and improved patellofemoral kinematics than standard prostheses (Fig. 1). [3] Wireless precision sensors are used during the procedure, which, applied to the patient, allow the bony cuts necessary to allocate the custom-made prosthesis to be made (Fig. 2). [4] Thus, in this technique there is a marriage of multiple state-of-the-art technologies.

Protesi di ginocchio
Fig. 1 Custom knee prosthesis that reproduces like a "tailored suit" the size of the patient's knee.
Protesi di ginocchio
Fig. 2 Precision computer-assisted system with wireless sensors that, applied to the patient, make it possible to perform the bone cuts necessary to allocate the custom-made prosthesis. (Marcheggiani Muccioli et al, Int. Orthop. 2023 see bibliography)

Who could undergo this type of surgery?
The candidate patient is relatively young, has often suffered ligament or
menisci around the age of 20, is motivated to still play sports after surgery, and is not excessively overweight. Having verified clinical and radiographic feasibility, the patient performs approximately
30 days earlier a 3D CT scan on which the prosthesis to be printed is designed. Subsequently to its fabrication, the prosthesis will undergo conventional testing and, before being implanted, it will obtain a CE certification. Our patient will then be provided with a new knee uniquely constructed and 3D printed.

Curriculum of Prof. Marcheggiani Muccioli

Giulio Maria Marcheggiani Muccioli, MD, PhD has distinguished himself in the field of orthopedics, starting with a degree with honors in Medicine and Surgery, obtained from the University of Bologna in 2006, followed by a specialization with honors in Orthopedics and Traumatology at the Rizzoli Orthopedic Institute of Bologna and a PhD in Surgical Sciences.

His career includes the academic role of Associate Professor in Orthopedics at the Faculty of Medicine and Surgery of the University of Bologna, where he researches in the field of biomechanics and pathology of the lower and upper limbs.

He has expanded his skills through international fellowships, including experiences in the United Kingdom, Japan and USA, consolidating himself as an Orthopedic Surgeon with extensive practical experience (he performs over 250 operations per year).

Finally, he contributes significantly every year to the training of new generations of doctors through university teaching in multiple medical and surgical disciplines.

He is one of the 10 Italian surgeons who over the last 20 years have been selected by the American Knee Society to participate in the prestigious John Insall Fellowship on Prosthetic Knee Surgery.

His wrote over 250 scientific publications. He attended more than 100 international meetings. This demonstrates his commitment towards innovation in the treatment of knee and shoulder pathologies, and in the advancement of new surgical techniques.

Bibliography

1. Personalisation and customisation in total knee arthroplasty: the paradox of custom knee implants. Saffarini M, Hirschmann MT, Bonnin M. Knee Surg Sports Traumatol Arthrosc. 2023 Apr;31(4):1193-1195. doi: 10.1007/s00167-023-07385-0.

2. Functional knee phenotypes: a call for a more personalised and individualised approach to total knee arthroplasty? Hirschmann MT, Behrend H. Knee Surg Sports Traumatol Arthrosc. 2018 Oct;26(10):2873-2874. doi: 10.1007/s00167-018-4973-8.

3. Personalized Hip and Knee Joint Replacement. Rivière C, Vendittoli PA, editors. Personalized Hip and Knee Joint Replacement [Internet]. Cham (CH): Springer; 2020. doi: 10.1007/978-3-030- 24243-5.

4. Intra- and inter-operator reliability assessment of a novel extramedullary accelerometer-based smart cutting guide for total knee arthroplasty: an in vivo study. Marcheggiani Muccioli GM, Alesi D, Russo A, Lo Presti M, Sassoli I, La Verde M, Zaffagnini S. Int Orthop. 2023 Jan;47(1):83-87. doi: 10.1007/s00264-022-05571-2.

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