Does implantation site influence bone ingrowth into 3D-printed porous implants?

Spine J. 2019 Nov;19(11):1885-1898. doi: 10.1016/j.spinee.2019.06.020. Epub 2019 Jun 28.


Background context: The potential for osseointegration to provide biological fixation for implants may be related to anatomical site and loading conditions.

Purpose: To evaluate the influence of anatomical site on osseointegration of 3D-printed implants.

Study design: A comparative preclinical study was performed evaluating bone ingrowth in cortical and cancellous sites in long bones as well as lumbar interbody fusion with posterior pedicle screw stabilization using the same 3D-printed titanium alloy design.

Methods: 3D-printed dowels were implanted in cortical bone and cancellous bone in adult sheep and evaluated at 4 and 12 weeks for bone ingrowth using radiography, mechanical testing, and histology/histomorphometry. In addition, a single-level lumbar interbody fusion using cages based on the same 3D-printed design was performed. The aperture was filled with autograft or ovine allograft processed with supercritical carbon dioxide. Interbody fusions were assessed at 12 weeks via radiography, mechanical testing, and histology/histomorphometry.

Results: Bone ingrowth in long bone cortical and cancellous sites did not translate directly to interbody fusion cages. While bone ingrowth was robust and improved with time in cortical sites with a line-to-line implantation condition, the same response was not found in cancellous sites even when the implants were placed in a press fit manner. Osseointegration into the porous walls with 3D porous interbody cages was similar to the cancellous implantation sites rather than the cortical sites. The porous domains of the 3D-printed device, in general, were filled with fibrovascular tissue while some bone integration into the porous cages was found at 12 weeks when fusion within the aperture was present.

Conclusion: Anatomical site, surgical preparation, biomechanical loading, and graft material play an important role in in vivo response. Bone ingrowth in long bone cortical and cancellous sites does not translate directly to interbody fusions.

Keywords: 3D printing; Additive manufacturing; Animal model; Bone ingrowth; Histology; Interbody fusion.

MeSH terms

  • Animals
  • Biomechanical Phenomena
  • Cancellous Bone / physiology
  • Cancellous Bone / surgery*
  • Cortical Bone / physiology
  • Cortical Bone / surgery*
  • Lumbar Vertebrae / physiology
  • Lumbar Vertebrae / surgery*
  • Osseointegration / physiology*
  • Porosity
  • Printing, Three-Dimensional*
  • Prostheses and Implants*
  • Prosthesis Design
  • Sheep
  • Spinal Fusion / instrumentation
  • Titanium


  • Titanium