Customized Lattice Structures Tailored to Mimic Patients’ Bone Anisotropic Properties and Microarchitecture for Joint Reconstruction Applications

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Total joint arthroplasty (TJA) has successfully solved many patients’ problems with arthritis, trauma, and inflammatory disorders. Despite a well-performed surgery, some patients, unfortunately, have less favorable outcomes characterized by multiple different issues such as ongoing pain, swelling, instability, infection, and inflammation, which cause aseptic loosening and risk of bone fracture. Those complications bring challenges to orthopedic surgeons and patients, because they lead to a large proportion of revision surgery that places a heavy economic burden on the health care system. Hence, investigation and development of customized lattice structures and texture tailored to mimic closely patients’ trabecular bone, like stiffness distribution.

This manuscript provides updated research direction, results, mechanisms, and discussion of promoting the orthopedic implant materials targeting the issues mentioned above. The authors made a significant contribution to the field. 

To check space between word and unit throughout the manuscript, for example:

Line 285-287: “pore size of 0.490–1.100mm exhibit a reasonable performance in vivo. The reported bore size (Table 4), ranges from 0.720 to 1.580 mm.”

Line 22: To add a space before 1 “ules:1- characterization of geometry”. 

 

Author Response

Response to Reviewer 1 Comments

 

1. Summary

Thank you very much for taking the time to review this manuscript. Please find the detailed responses below and the corresponding revisions/corrections highlighted/in track changes in the re-submitted files.

Your comment on the quality of the manuscript “This manuscript provides updated research direction, results, mechanisms, and discussion of promoting the orthopedic implant materials targeting the issues mentioned above. The authors made a significant contribution to the field”, is appreciated.

Authors Responses are in black to Reviewer 1 comments and Suggestions are in red:

To check space between word and unit throughout the manuscript

Corrections followed your above recommendation were done throughout the manuscript.

Line 22: To add a space before 1 “ules: 1- characterization of geometry.

That section was completely removed from the abstract of revised manuscript and highlighted in the submitted file.

Reviewer 2 Report

Comments and Suggestions for Authors

Title: The title is too long.

 

Abstract: The abstract is excessively lengthy and does not adequately describe the process of lattice implantation.

 

Lines 48-49: Some authors argue that it is the fourth leading cause of THA failure.

 

Lines 55-56: The relevance of 3D printing at this point is unclear.

 

Lines 103 onwards: Replace the section title with "2. Materials and Methods."

 

Lines 114-115: Specify the software used, including brand, version, and manufacturer. This information is lacking in most cases throughout the presented work.

 

Line 118: Clarify the reason for using cylinders.

 

Line 123: The sentence is inappropriate.

 

Lines 125-127: This paragraph is poorly constructed and requires rewriting. Replace the citation with a standardized one.

 

Lines 129-143: There's a mixture of methods, results, and discussion that needs better structuring. The expressed deviation is too large and unreliable, and it's unclear if the aim is to discuss or just indicate methodologies.

 

Line 151: Paragraph titles are too long.

 

Table 3: Reference the source where this composition has been published.

 

Line 218: This section is brief enough to be included elsewhere.

 

Line 224: Do not begin a section by introducing two figures that have not been previously referenced in the text.

 

Lines 257-264: The conclusion of the work belongs in the Conclusion section.

 

There are too many figures that do not contribute, and tables should be in black and white without background colors. The bibliography is short and not up-to-date.

Author Response

Response to Reviewer 2 Comments

1. Summary

Thank you very much for taking the time to review this manuscript. Please find the detailed responses below and the corresponding revisions/corrections highlighted/in track changes in the re-submitted files

2. Point-by-point response to Comments and Suggestions for Authors.

Authors Responses are in black to Reviewer 2 comments and Suggestions are in red:

Title: The title is too long.

 Title length has been reduced to be “Customized Lattice Structures Tailored to Mimic Closely Patients’ Bone Anisotropic Properties and Microarchitecture”.

Abstract: The abstract is excessively lengthy and does not adequately describe the process of lattice implantation.

 The abstract has been shortened from 36 lines to 30 lines and it is now adequately describes the development process for novel design and manufacturing of Customized Lattice Structures Tailored to Mimic Closely Patients’ Bone Anisotropic Properties and Microarchitecture.

Lines 48-49: Some authors argue that it is the fourth leading cause of THA failure.

Aseptic loosening caused by stress shielding and the use of unreliable bone cement, are the most concern of revision rates for both TKA and THA, [3-5].

Lines 55-56: The relevance of 3D printing at this point is unclear.

In recent years, researchers have discovered an effective solution for repairing bone defects caused by diseases or trauma, using the power of additive manufacturing (3D-printing) and the outstanding properties of Ti6Al4V (titanium alloy).  Additive manufacturing (3D printing) by Laser Powder Bed Fusion (L-PBF) system used for building all investigated designs in the present research. It is the most cost, and quality effective manufacturing method for building complex lattice structures.

Lines 103 onwards: Replace the section title with "2. Materials and Methods."

 Section 2 title is replaced with “Materials and Methods”

Lines 114-115: Specify the software used, including brand, version, and manufacturer. This information is lacking in most cases throughout the presented work.

Element software from Next-Gen Engineering Design Software (nTop) [15] is used to generate the 3D models of the lattices. Details are listed in Reference [15].

Line 118: Clarify the reason for using cylinders.

Results presented in section 2.1, Characterization of geometry, microarchitecture, and stiffness properties of bones was published previously somewhere else [14]. Present authors summarized the findings of ref [14] and presented in the present article to link them to the new presented work. Justification of using cylindrical specimen in the referenced work is based on the capability of used Micro-CT scanner for more accurate measurements in scanning cylindrical specimen.

Line 123: The sentence is inappropriate.

This sentence was replaced with “with newly developed implants”.

Lines 125-127: This paragraph is poorly constructed and requires rewriting. Replace the citation with a standardized one.

The entire paragraph is cited from previously published work [14] that was planned to support our new research for development of customized metallic lattice structures tailored to mimic closely patients’ bone properties. We (authors) believe that citation is more appropriate in this case than standard one in order to avoid misrepresentation or interpretation of the reported findings.   

Lines 129-143: There's a mixture of methods, results, and discussion that needs better structuring. The expressed deviation is too large and unreliable, and it's unclear if the aim is to discuss or just indicate methodologies.

The micro-CT scans of investigated bone reported in Ref [14] and cited within lines 129-143; reveal that the trabecular bone is highly anisotropic and heterogeneous. The expressed deviation (standard Deviation) is too large, which support the conclusion that trabecular bone is highly anisotropic and heterogeneous. Therefore, designing and building optimized implants for joint and dental reconstruction must consider these variations on properties in their designs.

Line 151: Paragraph titles are too long.

 Paragraph titles is replaced with new one “ 2.2.Module 2: Effective Design of Lattice Structures.”.

Table 3: Reference the source where this composition has been published.

Source of reported composition: “EOS Titanium Ti64 Material Data Sheet. EOS GmbH - Electro Optical Systems 2023”, is placed above the Table.

Line 218: This section is brief enough to be included elsewhere.

Section 2.5 Evaluation of Geometric Features of Printed Lattices, is short but very important in the parametric analysis of tested designs. Its importance is similar to section 2.6. Characterization of Stiffness and Strength of Investigated Lattice Structures. Therefore, authors believe that section 2.5 should stay standalone section.

Line 224: Do not begin a section by introducing two figures that have not been previously referenced in the text.

Figures 9 and 10 are located now below the introductory text.

Lines 257-264: The conclusion of the work belongs in the Conclusion section.

 These lines are now removed and placed in the conclusion section.

There are too many figures that do not contribute, and tables should be in black and white without background colors. The bibliography is short and not up-to-date.

All reported figures are necessary for supporting the present research. All tables are now in black and white without background colors. The present bibliography has 18 relevant references with seven of them during 2016-2024. There are three crucial publications and reviews 2022-2024 included in presented bibliography.

Reviewer 3 Report

Comments and Suggestions for Authors

 

I read the paper “Developing Customised Lattice Structures Tailored to Mimic Closely Patients’ Bone Anisotropic Properties and Microarchitecture for Joint 3 Reconstruction Applications” with great interest. This article in my opinion describes trabecular bone manufacturing technology with properties near a patient-specific one and is very important in the field for other researchers. I recommend accepting it, but still have some remarks, which in my opinion, can improve the quality of the article:

-       The authors motioned that module 2 is a continuation of module 1, which was introduced in the 2.1 section, but I missed during the reading where the description of module 2 begins. Just after reading carefully previous published article of module 1, I understud, the module 2 description begins in the 2.2 section. It would be nice to direct mentioning the beginning of module 2;

-       The authors use the porosity term for description of material properties, but in bone mechanics the more appropriate is BV/TV (bone volume-total volume ratio). Therefore, replacing porosity by BV/TV would simplify understanding of numeric values without any calculation in mind;

-       It would be nice to see in Figure 11 or in an additional table the exact properties of the investigated lattice for each curve, in case other researchers can incorporate your curves into their future models or can use these curves for validation purposes. They cannot do it because Figure 11 currently plays only an illustrative role.

-       The last remark is about the importance of cortical bone influence on the mechanical properties of bone. Maybe the authors can mention that in discussions of current work limitations or share their vision of how to develop the more adequate bone-like 3D printed geometry for understanding how it works as a system.

Author Response

Response to Reviewer 3 Comments

1. Summary

Thank you very much for taking the time to review this manuscript. Please find the detailed responses below and the corresponding revisions/corrections highlighted/in track changes in the resubmitted files.

Your comment on the quality of the manuscript “This article in my opinion describes trabecular bone manufacturing technology with properties near a patient-specific one and is very important in the field for other researchers. I recommend accepting it.”, is appreciated.

2. Point-by-point response to Comments and Suggestions for Authors.

Authors Responses are in black to Reviewer 3 comments and Suggestions are in red:

-       The authors motioned that module 2 is a continuation of module 1, which was introduced in the 2.1 section, but I missed during the reading where the description of module 2 begins. Just after reading carefully previous published article of module 1, I understood, the module 2 description begins in the 2.2 section. It would be nice to direct mentioning the beginning of module 2.

This was fixed on line 154 of the edited manuscript. Module 2 description start at “2.2.Module 2: Effective Design of Lattice Structures. Structures Adjusted to Match Bone stiffness distribution.

-       The authors use the porosity term for description of material properties, but in bone mechanics the more appropriate is BV/TV (bone volume-total volume ratio). Therefore, replacing porosity by BV/TV would simplify understanding of numeric values without any calculation in mind.

We used BV/TV (bone volume-total volume ratio) in our previous publication [14] when we were dealing with patient bone properties, but in this manuscript, we are now dealing with metal structure where porosity is the appropriate term to describe this property.

-       It would be nice to see in Figure 11 or in an additional table the exact properties of the investigated lattice for each curve, in case other researchers can incorporate your curves into their future models or can use these curves for validation purposes. They cannot do it because Figure 11 currently plays only an illustrative role.

The exact measured properties for design (Exp.) # 6 are displayed in Table 4 as an example of the extracted properties of investigated designs. The results presented in Table 4 show that they were obtained from three different samples of the same design for increased reliability of the measurements. The results of the other eight designs are available with the corresponding author. Nevertheless, the average modulus of elasticity and average yield strength recorded for all nine designs are presented in Table 6.

-       The last remark is about the importance of cortical bone influence on the mechanical properties of bone. Maybe the authors can mention that in discussions of current work limitations or share their vision of how to develop the more adequate bone-like 3D printed geometry for understanding how it works as a system.

The importance of cortical bone influence on the mechanical properties of bone, was already reported in the conclusions of our published work (module 1), [14]. Our vision of how the presented results would lead to adequate bone-like metallic lattice structures, is presented in the conclusions of the present article.