An improved methodology for design of custom-made hip prostheses to be fabricated using additive manufacturing technologies

Purpose - The purpose of this paper is to present an improved methodology for design of custom-made hip prostheses, through integration of advanced image processing, computer aided design (CAD) and additive manufacturing (AM) technologies. Design/methodology/approach - The proposed methodology for design of custom-made hip prostheses is based on an independent design criterion for each of the intra-medullary and extra-medullary portions of the prosthesis. The intra-medullar part of the prosthesis is designed using a more accurate and detailed description of the 3D geometry of the femoral intra-medullary cavity, including the septum calcar ridge, so that an improved fill and fit performance is achieved. The extra-medullary portion of the prosthesis is designed based on the anatomical features of the femoral neck, in order to restore the original biomechanical characteristics of the hip joint. The whole design procedure is implemented in a systematic framework to provide a fast, repeatable and non-subjective response which can be further evaluated and modified in a preplanning simulation environment. Findings - The efficacy of the proposed methodology for design of custom-made hip prostheses was evaluated in a case study on a hip dysplasia patient. The cortical bone was distinguished from cancellous in CT images using a thresholding procedure. In particular the septum calcar ridge could be recognized and was incorporated in the design to improve the primary stability of the prosthesis. The lateral and frontal views of the prosthesis, with the patient's images at the background, indicated a close geometrical match with the cortical bone of femoral shaft, and a good compatibility with the anatomy of the proximal femur. Also examination of the cross sections of the prosthesis and the patient's intra-medullary canal at five critical levels revealed close geometrical match in distal stem but less conformity in proximal areas due to preserving the septum calcar ridge. The detailed analysis of the fitting deviation between the prosthesis and point cloud data of the patient's femoral intra-medullary canal, indicated a rest fitting deviation of 0.04 to 0.11 mm in stem. However, relatively large areas of interference fit of 0.04 mm were also found which are considered to be safe and not contributing to the formation of bone cracks. The geometrical analysis of the extra-medullary portion of the prosthesis indicated an anteversion angle of 12.5 degrees and a neck-shaft angle of 131, which are both in the acceptable range. Finally, a time and cost effective investment casting technique, based on AM technology, was used for fabrication of the prosthesis. Originality/value - The proposed design methodology helps to improve the fixation stability of the custom made total hip prostheses and restore the original biomechanical characteristics of the joint. The fabrication procedure, based on AM technology, enables the production of the customized hip prosthesis more accurately, quickly and economically.