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Surgeons frequently use Paediatric Orthopaedic Implants to correct complex hip deformities through proximal femoral osteotomy (PFO). While conventional solid implants provide essential stability, their high stiffness often causes stress shielding. This phenomenon reduces the mechanical load transferred to the growing bone, potentially leading to bone resorption. Consequently, researchers are exploring additively manufactured cellular architectures to optimize implant design. Triply periodic minimal surface (TPMS) lattices have emerged as a promising solution due to their favorable strength-to-stiffness ratios.
A recent study utilized a patient-specific digital-twin workflow to evaluate a novel TPMS-integrated Ti-6Al-4V implant. The research team coupled neuromusculoskeletal (NMSK) simulations with finite element analysis (FEA) to assess bone-implant mechanics. They applied NMSK-derived joint and muscle forces to measure von Mises stresses and micromotion. Furthermore, they analyzed cortical mechanical stimulus using strain energy density. Therefore, this comprehensive approach ensured a realistic assessment of how these Paediatric Orthopaedic Implants interact with living tissue during daily activities like walking.
The results showed that all evaluated implants remained well below the material yield-strength threshold. Both conventional and TPMS designs exhibited bone-implant micromotion within acceptable limits for stable fixation. However, the TPMS-integrated design demonstrated significant advantages in load sharing. Specifically, it increased distal cortical strain energy density by 25% compared to standard solid plates. Moreover, the TPMS implant reduced the cortical volume falling below the disuse threshold. This indicates a more natural mechanical stimulus for the growing femur. Additionally, the lattice design generated a more uniform strain distribution near screw interfaces, which may improve long-term stability.
These engineering metrics suggest that TPMS designs meet initial mechanical requirements while enhancing compatibility with growing bone. Nevertheless, the study marks only a proof-of-concept. Future research must focus on experimental validation and fatigue characterization. Multi-subject studies will also be necessary to confirm these benefits across diverse patient populations. As additive manufacturing evolves, these Paediatric Orthopaedic Implants could revolutionize how surgeons treat hip deformities in children.
Stress shielding occurs when a metal implant carries the majority of the mechanical load, "shielding" the underlying bone from natural stress. In children, this can interfere with healthy bone growth and remodeling.
TPMS lattices are 3D-printed structures that allow engineers to fine-tune the stiffness of an implant. By matching the mechanical properties of the bone more closely, they ensure better load sharing and reduce the risk of bone loss.
While this study shows structural feasibility and safety in computer simulations, these implants require further fatigue testing and clinical trials before they become standard in surgical practice.
Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or replace professional judgment. Refer to the latest local and national guidelines for clinical practice.
References
Ebrahimzadeh Dehaghani A et al. A TPMS-integrated paediatric proximal femoral osteotomy implant demonstrates structural feasibility and improved load sharing: An in silico proof-of-concept study. Comput Biol Med. 2026 Jun 17. doi: undefined. PMID: 42308584.
Facco G et al. The use of 3D printed models for the pre-operative planning of surgical correction of pediatric hip deformities: a case series and concise review of the literature. Acta Biomed. 2021;92(6):e2021221.
Ziegler C, Endres F. Osteotomies of the pediatric hip joint. Oper Orthop Traumatol. 2026. doi: 10.1007/s00064-026-00812-w.
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