Effects of 3D printed surface topography and normal force on implant expulsion.

3D printing is a critical method for manufacturing metallic implants as it enables direct fabrication of intricate geometries and porous structures inaccessible to other manufacturing methods. Some common 3D printed porous structures are strut based (e.g. octet truss), triply periodic minimal surfaces (TPMS) (e.g. gyroid) or randomized (e.g. stochastic). When designed to be on the surface of bone interfacing implants, the surface porous region impacts short-term adhesion and friction, ultimately affecting implant stability prior to and during long-term osseointegration. In many orthopedic procedures, expulsion resistance is an essential design requirement, to prevent the risk of the implant migrating from the implantation site. While expulsion tests are universal, they are a poorly understood method to examine the bone-implant interface in determining the performance of an orthopedic implant. In this foundational study, we examine the expulsion behavior of metallic samples in synthetic Sawbone with systematically varied surface topography at increasing applied normal forces. The applied normal force and size of the sample were shown to have the strongest influence on expulsion force followed by surface structure. Compared to a polished sample control, certain 3D printed surface structures are up to 10x more expulsion resistant and should be considered in implants where prevention of implant migration before and during osseointegration is critical. Nonlinear relationships were discovered that reveal "crossover" in expulsion resistance as a function of applied load revealing that the ranking of the relative expulsion resistance of different samples can depend on the normal force selected. This new fundamental understanding has broad implications on both the design and potential standardized regulatory testing of textured orthopedic implants with tailored topologies.