Patient-Specific Lattice Implants for Segmental Femoral and Tibial Reconstruction (Part 2): CT-Based Personalization, Design Workflows and Validation—A Review

Abstract

Patient-specific lattice implants (PSLIs) and modular porous scaffolds have emerged as promising solutions for treating diaphyseal segmental defects of the femur and tibia, particularly where conventional reconstruction methods fall short. This second part of our two-part review focuses on how current studies transform computed tomography (CT) and (Formula presented.) CT datasets into architected lattice implants, as well as how these constructs are fabricated and numerically, mechanically, biologically, and clinically verified. We outline imaging pipelines, including Digital Imaging and Communications in Medicine (DICOM) acquisition, segmentation, contralateral mirroring, and Hounsfield Units (HU)–density–elasticity mapping, and show how these choices impact finite element (FE) models and print-ready geometries. Next, lattice design strategies and mixed-material concepts are compared and linked to specific additive manufacturing routes in metals, polymers, and bioceramics, such as laser powder bed fusion (LPBF), electron beam melting (EBM), fused deposition modeling (FDM), material jetting, and extrusion-based bioprinting. Methodological overviews of linear–elastic models and homogenized finite element (FE) models, along with bench-top mechanical tests, in vitro cell assays, in vivo animal studies, and early clinical series, are utilized to categorize the studies into four pathways: simulation (S), mechanical (E_mech), biological (E_bio), and validation (V). Based on the reviewed literature, we establish a general workflow for CT implants. We identify common gaps in the process, observe insufficient reporting of imaging and modeling details, note a lack of data on fatigue and remodeling, and recognize the limited size of clinical cohorts. Additionally, we provide practical recommendations for developing more standardized and scalable planning pipelines. Part 1 of this two-part review studied defect patterns, anatomical location, and fixation strategies for patient-specific lattice implants used in femoral and tibial segmental reconstruction, with emphasis on how defect morphology and subregional anatomy influence construct selection and mechanical behavior. It established a defect- and fixation-centered review that provides the clinical and anatomical context for the workflow and validation analysis presented in Part 2.