Surgeons embrace 3D printed implants to save NHS time and cash From complex reconstructive facial surgery to dentures and hip implants, surgeons across the UK are using 3D printing to improve treatments and save time and money for the National Health Service. 3D printing, or additive manufacturing, has been around since the 1980s, but it is only in recent years that advances in the technology mean it is playing a bigger role in healthcare. Hospitals have long used it to make plastic anatomical models that mean surgery can be planned and practised before operations. Studies have shown this can reduce operating time for certain procedures by as much as 30 per cent. But a growing number of surgeons and dentists are working with industrial designers and engineering companies to use the technology to produce custom-made 3D printed implants for complex orthopaedic and facial reconstruction procedures. 3D printing works by building objects up layer by layer, creating more accurate shapes than can be made using traditional techniques such as cast moulds or carving them out from chunks of material. Satyajeet Bhatia, a consultant maxillofacial surgeon at the University Hospital of Wales in Cardiff, has worked with a team of neurosurgeons and ophthalmologists, and PDR, a design agency, to print implants to help reconstruct the faces of patients with craniofacial tumours. The implants are typically made out of peek - a biocompatible polymer - or titanium. One of the advantages is that you do not have problems with the facial aesthetics. It is highly specific and precise," says Mr Bhatia. Previously, reconstructive surgery would have required the surgeon to harvest bone for transplantation from elsewhere in the body. This comes with additional pain, risks and complications for the patient. In March, surgeons at Morriston Hospital in Swansea used 3D printed implants, to reconstruct the face of a man who had been in a serious motorbike accident. Last year, a London dental company Dawood and Tanner used 3D printing technology to make a facial prosthesis for Eric Moger, a man who lost half his face because of cancer. Other examples include titanium 3D printed hip implants. Materialise, a Belgium-based 3D printing company that works with UK hospitals, has done 10 of these operations in the UK through its subsidiary Mobelife, with three more to be performed this year. The benefits have been proven for an awful long time, it's just about getting it more integrated into the existing NHS work flows and knowing when to use it Sean Peel, PDR These typically involve patients who have already had multiple hip operations on the NHS, meaning the bone has worn down. By 3D printing a custom implant, the patient is less likely to need another operation. 200 patients have been treated globally with our custom-made implants. Clinical reports indicate no failure so that means you immediately solve the problem. Yes it's more expensive initially but in the long term it saves money," says Jeroen Dille, director of Materialise's clinical unit. 3D printing can also help shorten operations, an important factor for the NHS where theatre time can cost as much as £60 a minute, according to Replica 3DM, a 3D printing company set up to service NHS trust hospitals. Shorter surgery times can also help reduce infection risk and speed up recovery. But experts agree it is unlikely to replace traditional manufacturing in the medical field. "There are a lot of niche applications where [its] value is huge . . . but it won't suit everything," says Mr Dille. A team of experts - including PDR and British engineering company Renishaw - is working on a three-year project, funded by Innovate UK, the government innovation agency, that focuses on advancing the use of design and 3D printing technologies in cranio-maxillofacial surgery. "The benefits have been proven for an awful long time, it's just about getting it more integrated into the existing NHS work flows and knowing when to use it," explains Sean Peel from PDR. NHS dentists are also adopting the technology. Cardiff University Dental Hospital is working with Renishaw to use 3D metal printing technology to make cobalt chrome dentures. This new technology has shown that it improves the fit of dentures and prevents miscasts, which can be costly. "The great thing is there's no hit and miss as with traditional casting techniques," says Roger Maggs, senior chief dental laboratory manager at Cardiff. The hospital and Renishaw are looking at using the technology in more NHS hospitals. In Cardiff alone, the process could be used on the 350 dentures it makes each year. While 3D printing is being adopted enthusiastically by some, experts believe there needs to be a more coherent strategy in the NHS. "There is no NHS strategy as far as I can see," says Phil Reeves of Econolyst, a 3D printing consultancy. It's very sporadic and it tends to be beholden to individual surgeons or technicians. Surgery success Julie Nurse is walking around with a 3D printed titanium plate above her left eyebrow after undergoing a complex craniofacial operation in May, writes Tanya Powley. The 47-year-old had the operation after surgeons discovered a bone tumour that was pressing on her optic nerve, leaving her with limited sight in her left eye. The pains in my head were absolutely terrible. It was like a pressure cooker," says Ms Nurse, who lives in the village of Pontiets, west Wales. Surgeons at the University Hospital of Wales in Cardiff removed the benign tumour and replaced it with the custom-made titanium plate. "It is so impressive how the techniques have improved," she says. I've been getting better each day but on the whole, to look at me, you wouldn't think I'd had an operation. As 3D printing develops, the technology could be used for more applications, including printed eyes, heart valves and prosthetics. Sheffield-based consultancy Fripp Design and Research has worked with Manchester Metropolitan University to develop technology that prints custom-made artificial eyes. This speeds up the traditional process - it can take between two and three days for the eye to be handmade and painted. Fripp and MMU are hoping to receive European quality standard accreditation before launching the product to customers over the next 12 months. Other collaborative ventures, such as Replica 3DM and Southampton University are seeking government funding to build a 3D bone printer. It would print a porous coral-like scaffold structure of hydroxyapatite, and could be used in areas such as cleft pallet surgery. Matthew Sherry, managing director of Replica 3DM, says the project will take two years. David Wimpenny, manufacturing technology manager at the Manufacturing Technology Centre, one of the government's catapult centres, says the potential for 3D printing in the NHS is huge. We as an industry have to make the case in terms of efficiencies. In one respect it's an additional cost, but the cost benefits that it yields in terms of efficiency outweigh that cost," he says.