Biomechanical comparison of titanium alloy additively manufactured and conventionally manufactured plate-screw constructs.

AIMS: To biomechanically compare the bending stiffness, strength and cyclic fatigue of titanium additively manufactured (AM) and conventionally manufactured (CM) limited contact plates (LCP) of equivalent dimensions using plate-screw constructs.

METHODS: Twenty-four 1.5/2.0-mm plate constructs (CM: n = 12; AM: n = 12) were placed under 4-point bending conditions. Data were collected during quasi-static single cycle to failure and cyclic fatigue testing until implants plastically deformed or failed. Bending stiffness, bending structural stiffness, and bending strength were determined from load displacement curves. Fatigue life was determined as number of cycles to failure. Median test variables for each method were compared using Wilcoxon rank sum test within each group with significance set at p < 0.05. Fatigue data was also analysed by the Kaplan-Meier estimator of survival function.

RESULTS: There was no evidence for a difference in bending stiffness and bending structural stiffness between AM and CM constructs. However, AM constructs exhibited greater bending strength (median 3.07 (min 3.0, max 3.4) Nm) under quasi-static 4-point bending than the CM constructs (median 2.57 (min 2.5, max 2.6) Nm, p = 0.006). Number of cycles to failure under dynamic 4-point bending was higher for the CM constructs (median 164,272 (min 73,557, max 250,000) cycles) than the AM constructs (median 18,704 (min 14,427, max 33,228) cycles; p = 0.02). Survival analysis showed that 50% of AM plates failed -by 18,732 cycles, while 50% CM plates failed at 78,124 cycles.

CONCLUSIONS AND CLINICAL RELEVANCE: Additively manufactured titanium implants, printed to replicate a conventional titanium orthopaedic plate, were more prone to failure in a shorter fatigue period despite being stronger in single cycle to failure. Patient-specific implants made using this process may be brittle and therefore not comparable to conventionally manufactured orthopaedic implants. Careful selection of their use on a case/patient-specific basis is recommended.