The outbreak of the deadly coronavirus pandemic has not only exposed the shortcomings of the world’s health systems but has also highlighted the need to develop sophisticated technologies to predict and deal quickly with the outbreaks of future pandemics.
The University of Botswana has already started on this path with its ambitious and cutting edge 3D printing technology aimed at revolutionising treatment of diseases and improving the health of Batswana. 3D printing is one of the latest advances within the medical fraternity which has potential to enhance treatment of some of the deadly medical conditions.
A 17-year old female student is the beneficiary from this innovative medical technology. The teenager suffered with Ollier’s Disease a genetic condition characterised by noncancerous benign growths of cartilage that develops within the bones. The right side of her body was affected, resulting in shorter right upper and lower limbs. The University of Botswana’s Faculty of Medicine Regenerative Medicine Laboratory designed a hip implant to improve her student’s disability.
Principal project investigator, Dr Shathani Nkhwa, who is also a biomedical and biomaterial tissue engineer, said that before surgery, the student complained about a number of physical discomforts including:
- impaired and limited walking,
- low back pain, and
- self-image issues, which were due to a deformed (club foot and severe knocked knee) and much shorter right lower limb.
As treatment for the deformity and short leg, said Dr Nkhwa, she was offered corrective osteotomy and fixation with custom-made implant and surgical correction of the ankle. “The perceived advantage of our novel approach was that it would allow detailed pre-operative planning and design when using 3D printed models and in turn assist in the manufacturing of the right implant,” Dr Nkhwa said.
In addition, she noted that the use of traditional surgical approach and conventional implants would have been a challenge in terms of finding an appropriate-sized implant that fit well, given the patient’s abnormal and unique anatomy.
Constructing 3D anatomical model
Employing specialised design software, the patient’s CT scan was used to construct a 3D anatomical model of the defective site, explained Dr Nkhwa. The anatomical model file was printed at Botswana Institute of Technology Research and Innovation (BITRI). A surgeon used this anatomical model file to plan the proposed surgical procedure, as well as a design of the type of the required implant for the operation. Final implant design requirements were sent to Central University of Technology (CUT) in South Africa for implant development.
A few days post-surgery, the patient underwent comprehensive ankle and knee rehabilitation that lasted several months. She was last assessed in April 2021 where she demonstrated a slight leg-length difference between the two sides, normal knee alignment when compared to the opposite side, absence of limb and back pain, negligible limping, and ability to walk without an assistive device and without fatigue. Above all, she has returned to school has been successfully integrated into the community, said Dr Nkhwa.
She said: “We have thus identified niche key areas that can help drive forward the development and advancement of precision medicine and customised medical device fabrication in Botswana.” She added that “among the key areas of our interest are pre-surgical planning, medical device fabrication, and 3D printing for educational purposes”.
Patient specific 3D models derived from either CT or MRI scans have become increasingly useful tools for healthcare professionals as reference tools for pre-surgical planning, noted Dr Nkhwa. 3D printed anatomical models help doctors save time preparing for conducting surgery as they allow for intra-operative visualisation and device sizing or pre-fitting medical devices both for routine and highly complex procedures.
Reducing operating costs
With the 3D anatomical models, this also enables the doctor to explain better and demonstrate to the patient or medical students the extent of the medical problem, challenges that may be faced, as well as probable solutions; these steps are especially important in highly complex cases, such as in cases of tumour excision.
In the end, this leads to reduced operating room costs, improved patient safety, shorter recovery time, and reduced patient’s anxiety.
Furthermore, the patient’s enhanced understanding of the problem and process may boost their confidence in the doctor and the proposed solution. “Instead of using one-size-fits-all generic implants, we can offer surgeons an option to make available to patients unique treatments for complex cases,” says Dr Nkhwa. Lloyds Register Foundation, a UK-based charity organisation that supports research, innovation, and education to make the world a safer place, has funded their project to the tune of P376 781 (£25 000).
Using the same technology and in the context of the Covid-19, the faculty of medicine has also developed alternatives to standard care nasal swabs, respirator oxygen tube connectors and venturi devices (diluter). The 3D printed swabs are designed for oronasal Covid sample collection and are currently being further developed to enable better sample collection from the nose of the African demographic. The medical devices were 3D printed with biocompatible material. Once testing and further development have been completed, the medical devices will now be ready for the market; said Dr Nkhwa who was ably assisted by two co-investigators in Dr Thapelo Montshiwa (orthopaedic surgeon) and Dr Maikutlo Kebaetse (Rehabilitation Scientist).