Background: Osseointegrated implants for transfemoral amputees facilitate direct load transfer between the prosthetic limb and femur; however, implant loosening is a common complication, and the associated implant-bone loads remain poorly understood. This case study aimed to use patient-specific computational modeling to evaluate bone-implant interface loading during standing and walking in a transfemoral amputee with an osseointegrated implant prior to prosthesis loosening and revision surgery. Methods: One male transfemoral amputee with an osseointegrated implant was recruited (age: 59-yrs, weight: 83 kg) and computed tomography (CT) performed on the residual limb approximately 3 months prior to implant failure. Gait analyses were performed, and the CT images used to develop a finite element model of the patient's implant and surrounding bone. Simulations of static weight bearing, and over-ground walking were then performed. Findings: During standing, maximum and minimum principal strains in trabecular bone adjacent to the implant were 0.26% and −0.30%, respectively. Strains generated at the instant of contralateral toe-off and contralateral heel strike during walking were substantially higher and resulted in local trabecular bone yielding. Specifically, the maximum and minimum principal strains in the thin layer of trabecular bone surrounding the distal end of the implant were 1.15% and −0.98%, respectively. Interpretation: Localised yielding of trabecular bone at the interface between the femur and implant in transfemoral amputee osseointegrated prosthesis recipients may present a risk of implant loosening due to periprosthetic bone fracture during walking. Rehabilitation exercises should aim to produce implant-bone loading that stimulates bone remodelling to provide effective bone conditioning prior to ambulation.

As additive manufacturing of polymeric materials is becoming more prevalent throughout industry and research communities, it is important to ensure that 3D printed parts are able to withstand mechanical and environmental stresses that occur when in use, including the sub-critical cyclic loads that could result in fatigue crack propagation and material failure. There has so far been only limited research on the fatigue behavior of 3D printed polymers to determine which printing or material parameters result in the most favorable fatigue behavior. To better understand the effects of the printing technique, printing materials, and printing parameters on the fatigue behavior of 3D printed materials, we present here an overview of the data currently available in the literature including fatigue testing protocols and a quantitative analysis of the available fatigue data per type of the AM technology. The results of our literature review clearly show that, due to the synergism between printing parameters and the properties of the printed material, it is challenging to determine the best combination of variables for fatigue resistance. There is therefore a need for more experimental and computational fatigue studies to understand how the above-mentioned material and printing parameters affect the fatigue behavior.