Discovering Trabecular Titanium
What, how, and why it is unique for orthopedic implants
Trabecular Titanium (TT) is a pioneering 3D-printed technology unique to Enovis, developed to enable the creation of unprecedented shapes in orthopedics.It is a highly porous biomaterial that offers reliable fixation[2,6-9], enhanced biological features[10-17], and proven performance[18-86].
TT is a technological differentiator following an orthopedics-first investment in 3D printing that started in 2005. Originally developed to address surgeons’ need for a strong primary fixation and to overcome conventional materials’ limitations, it has been engineered to tailor the porous part and the bulk substrate, enabling limitless design solutions to align with a surgeon’s vision and address individual patient needs.
It was patented in 2007 and afterward the first implant, a primary acetabular cup, was launched[18]. Enovis has continued to develop and master the technology, combined with close collaboration with surgeons, which is now reflected in a comprehensive product portfolio. This has been informed by our heritage in 3D printing to provide proven performance, continually innovate to drive the next generation of implants, and empowering surgeons with adaptable implants from standard to fully customized, allowing surgeons to meet every patient’s needs.
Our partnerships with orthopedic surgeons around the world enable TT to address a wide range of clinical challenges.
WHAT IS TT
What is Trabecular Titanium?
Trabecular Titanium (TT) is a unique 3D-printed technology tailored to produce a highly porous biomaterial. It is a unique, interconnected, open structure composed of a matrix of complex 3D hexagonal cells[1].
The 3D geometry and features of the technology are optimized to support bone formation and neovascularization. These overarching mechanical properties make it outperform as a material for medical implants. The 65% porosity and the average pore diameter of 640µm are tailored to emulate bone architecture and function, while its regular matrix ensures mechanical properties are predictable, controllable, and cleanability[1-6].TT is recognized by orthopedic surgeons globally as market-leading next-generation technology. It is made from titanium, a material that has long been used in reconstructive orthopedics.
Unlike traditional coatings that typically have an interface, TT has a seamless continuity between the highly porous structure and the bulk substrate that eliminates the risk of detachment resulting in a very high adhesion strength (>86 Mpa), including no reports of TT mechanical failure across published studies[1,3,18-86].
In addition, the low elastic modulus of TT structure is 1.1 GPa, which is closer to that of trabecular bone (0.6 Gpa) than comparable conventional materials. This results in a physiological load transfer, reduced risk of stress shielding, and bone mineral density patterns similar or superior to surrounding or contralateral bone[3].
HOW IS TT MADE?
How is Trabecular Titanium made?
Trabecular Titanium is a unique tailored 3D Printing technology (known as 3DP). 3D Printing, also known as additive manufacturing, is a process of building three-dimensional shapes layer by layer, informed by a digital 3D model, pushing the boundaries of geometries beyond traditional subtractive manufacturing processes.
The base material of TT is Titanium powder. To build up a 3D structure in TT, the digital 3D model with optimized topology is converted into tailored proprietary instructions that guide the 3D printing machines. Titanium powder is selectively melted layer by layer with a high-energy beam in one step process enabling the development of any design with seamless continuity between the bulk substrate and a highly porous structure.The intrinsic versatility of the 3DP manufacturing process means that TT enables the development of limitless geometries that can be tailored to deliver innovative design implants and suit the specific needs of a patient.
WHY TT?
Why should I choose Trabecular Titanium?
TT brings three distinct benefits: reliable fixation[2,6-9], enhanced biological features10-17, and proven performance.[18-86]Reliable fixation
The repetition of TT regular cellular structure determines a macro-roughness, that combined with a specific micro-roughness, is responsible for a high friction between TT and cancellous bone. This results in increased primary stability of TT implants compared to conventional non-3DP materials, even in case of bone defects[6-8,28,80,83]
Enhanced biological features
Studies show that the unique structure of TT creates an optimal microenvironment for new bone formation and neovascularization, responsible secondary stability[11-17].
In vitro studies proved that human stem cells (hASC, BM-hMSC) on TT can adhere, proliferate and differentiate into osteoblasts with deposition of mineralized extracellular matrix (ECM) regardless the presence of osteogenic factors- and that extracellular matrix formation was significantly higher than with other biomaterials. These studies confirmed how the macro- and micro-structure are responsible for osteoinductive behavior[11-14]. Genetic expression analysis also found that TT supports osteoblast proliferation and differentiation[12].
In vivo studies have shown that TT promotes effective osseointegration, with 68% in-growth in trabecular bone and 87% in-growth in cortical bone - increasing bone formation compared to traditional coatings[16].Bone implant contact was found to be superior to other materials in both healthy and osteoporotic bone[15].
The effective osteointegration of TT has been confirmed also by ex-vivo study comparing bone retrieved TT acetabualr cups with conventional cups. TT cups delivered consistently higher bone formation within the porous structure and spread across the surface, both at the pole and equator, compared to convenationl cups made of advanced porous non 3DP cups[17].
In vitro studies proved that human stem cells (hASC, BM-hMSC) on TT can adhere, proliferate and differentiate into osteoblasts with deposition of mineralized extracellular matrix (ECM) regardless the presence of osteogenic factors- and that extracellular matrix formation was significantly higher than with other biomaterials. These studies confirmed how the macro- and micro-structure are responsible for osteoinductive behavior[11-14]. Genetic expression analysis also found that TT supports osteoblast proliferation and differentiation[12].
In vivo studies have shown that TT promotes effective osseointegration, with 68% in-growth in trabecular bone and 87% in-growth in cortical bone - increasing bone formation compared to traditional coatings[16].Bone implant contact was found to be superior to other materials in both healthy and osteoporotic bone[15].
The effective osteointegration of TT has been confirmed also by ex-vivo study comparing bone retrieved TT acetabualr cups with conventional cups. TT cups delivered consistently higher bone formation within the porous structure and spread across the surface, both at the pole and equator, compared to convenationl cups made of advanced porous non 3DP cups[17].
Proven performance
A trusted combination of tailored 3D-printed technology and consistent material properties drives clinical outcomes. While each design serves a distinct application, TT is the same trusted technology that delivers consistent material properties, proven structural integrity and reliability.
Enovis’ TT products have been tested extensively by internal and third-party researchers in both laboratory and real-world settings. This body of research has established TT implants as reliable, high-quality orthopedic products with proven survivorship and clinical outcomes reported in literature[18-86].
Enovis’ TT products have been tested extensively by internal and third-party researchers in both laboratory and real-world settings. This body of research has established TT implants as reliable, high-quality orthopedic products with proven survivorship and clinical outcomes reported in literature[18-86].
Why Enovis
Why should I trust Enovis?
We are the pioneers of 3D printing in orthopedics and remain the sole manufacturer of Trabecular Titanium. Our comprehensive range of TT products are designed with surgeons, for surgeons, to meet the specific needs of patients.
Enovis’ research into TT, which began in 2005, sought to address the need for a strong primary fixation that could overcome the geometrical limitations of traditional materials.It was patented in 2007 and afterward the first implant, a primary acetabular cup[18], was launched. Since 2007, we have continually innovated with new designs and manufacturing techniques to further enhance and evolve our products. Today, we offer standard TT-based products for hip, shoulder, elbow, and knee joints, as well as bespoke ProMade implants that help to restore motion in the most complex cases. Our products cater for both primary and revision surgeries, even in most complex cases.[18-86]
TT technology embodies our commitment to restoring motion for life and empowering orthopedic surgeons to confidently address patients’ needs.
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[11]. Gastaldi G, Asti A, Scaffino MF, Visai L, Saino E, Cometa AM et al. Human adipose-derived stem cells (hASCs) proliferate and differentiate in osteoblast-like cells on trabecular titanium scaffolds. Journal of Biomedical Materials Research - Part A 2010; 94: 790-799. *
[12]. Sollazzo V, Palmieri A. Trabecular Titanium Induces Osteoblastic Bone Marrow Stem Cells Differentiation. Journal of Biotechnology & Biomaterials 2011; 01. doi:10.4172/2155- 952x.1000102. *
[13]. Benazzo F, Botta L, Scaffino MF, Caliogna L, Marullo M, Fusi S et al. Trabecular titanium can induce in vitro osteogenic differentiation of human adipose derived stem cells without osteogenic factors. Journal of Biomedical Materials Research - Part A 2014; 102: 2061-2071. *
[14]. Caliogna L, Berni M, Gastaldi G, Grassi FA, Jannelli E, Mosconi M, Salatin S, Burelli S, Toninato R, Pressacco M, Pasta G. Trabecular Titanium architecture drives human mesenchymal stem cells proliferation and bone differentiation. International Journal of Molecular Science 2025, 26(13), 6354; https://doi.org/10.3390/ijms26136354.*
[15]. Bondarenko S, Dedukh N, Filipenko V, Akonjom M, Badnaoui AA, Schwarzkopf R. Comparative analysis of osseointegration in various types of acetabular implant materials. HIP International 2018; 28: 622-628. *
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DELTA TT [18]. Registro Regionale di Implantologia Protesica Ortopedica (R.I.P.O.) - Regional Register of Orthopaedic Prosthetic Implantology, Emilia Romagna Italy. Ad hoc report on Delta TT cup (Overall data 2007-2021), June 2024. [19]. Aiba H, Watanabe N, Inagaki T, Fukuoka M, Murakami H. Differences among the observers in the assessments of Japanese orthopedic association hip scores between surgeons and physical therapists and the correlations to patients’ reported outcomes after total hip arthroplasty. BMC Musculoskelet Disord. 2022 Jan 03; 23:27. [20]. Aleixo H, Camelo N, Carvalho L, Fernandes L, Castro D, Lino T, Araújo NS. Cementless total hip replacements without femoral osteotomies in severe dysplasia cases - valid option. Hip Int 2016;26(Suppl 2):S81. [21]. Arshad H, Malagelada F, Bates P, Culpan P. Acute fixation and total hip replacement for the management of acetabular fracture in patients over 55. Hip Int. 2015;25(Suppl 1): S50-S51. [22]. Bistolfi A, Cimino A, Lee GC, Ferracini R, Maina G, Berchialla P, Massazza G, Massè A. Does metal porosity affect metal ion release in blood and urine following total hip arthroplasty? A short-term study. Hip Int. 2018 Sep;28(5):522-530. [23]. Cha Y, Lee SY, Bae JH, Kang YJ, Baek JH, Kang JS, Park CH, Kim S, Yoo JI. Comparing Stability, Gait, and Functional Score after 40-mm Dual-Mobility Hip Arthroplasty to 36-mm Head Hip Arthroplasty in Elderly Hip Fracture Patients. Clin Orthop Surg. 2025 Feb;17(1):62-70. [24]. Grappiolo G, La Camera F, Della Rocca A, Mazziotta G, Santoro G, Loppini M. Total hip arthroplasty with a monoblock conical stem and subtrochanteric transverse shortening osteotomy in Crowe type IV dysplastic hips. Int Orthop. 2019 Jan;43(1):77-83. [25]. Innocenti M, Guido D, Cozzi Lepri A, Maritato E, Carulli C, Matassi F, Civinini R. Proximal femoral replacement: A salvage treatment of cephalomedullary nails' mechanical failures in the elderly population. Injury. 2021 Jul;52(7):1868-1874. [26]. Jannelli E, Boggio E, Castelli A, Pasta G, Grassi FA, Mosconi M. Trabecular titanium acetabular cup in patients with medial femoral neck fracture: Survivorship analysis and clinical and radiological outcomes. World J Orthop. 2025 Mar 18;16(3):100481. [27]. Klaassen AD, van Loon J, Willigenburg NW, Koster LA, Kaptein BL, van der Hulst VPM, Haverkamp D, Moojen DJF, Poolman RW. Comparison of 5-year cup and stem migration between ceramic-on-ceramic and ceramic-on-polyethylene bearing in press-fit total hip arthroplasty: a randomised controlled trial using radiostereometric analysis. Hip Int. 2024 Nov;34(6):701-716.
DELTA REVISION TT [28]. Cacciola G, Giustra F, Bosco F, De Meo F, Bruschetta A, De Martino I, Risitano S, Sabatini L, Massè A, Cavaliere P. Trabecular titanium cups in hip revision surgery: A systematic review of the literature. Annals of Joint. October 2023;8. [29]. Cozzi Lepri A, Innocenti M, Galeotti A, Carulli C, Villano M, Civinini R. Trabecular titanium cups in acetabular revision arthroplasty: analysis of 10-year survivorship, restoration of center of rotation and osteointegration. Arch Orthop Trauma Surg. 2021 Oct 31; doi.org/10.1007/s00402- 021-04243-x. [30]. De Meo F, Cacciola G, Bellotti V, Bruschetta A, Cavaliere P. Trabecular Titanium acetabular cups in hip revision surgery: mid-term clinical and radiological outcomes. Hip Int. 2018 December;28(S2):61-5. [31]. Gallart X, Fernández-Valencia JA, Riba J, Bori G, García S, Tornero E, Combalía A. Trabecular TitaniumTM cups and augments in revision total hip arthroplasty: clinical results, radiology and survival outcomes. Hip Int. 2016 Sep 29;26(5):486-491. [32]. Munegato D, Bigoni M, Sotiri R, Bruschetta A, Omeljaniuk RJ, Turati M, Rossi A, Zatti G. Clinical and radiological outcomes of acetabular revision with the Delta Revision TT cup. Hip Int. 2018;28(S2):54-60. [33]. Patel A, Hayes T, Whittingham-Jones P, Davies N, Waters T. Early stability and ingrowth of 3D trabecular titanium in revision acetabular reconstruction. Hip Int. 2014;24(5):495. [34]. Perticarini L, Rossi SMP, Fioruzzi A, Jannelli E, Mosconi M, Benazzo F. Modular tapered conical revision stem in hip revision surgery: mid- term results. BMC Musculoskelet Disord. 2021 Jan 6;22(1):29. [35]. Perticarini L, Rossi SMP, Medetti M, Benazzo F. Clinical and radiological outcomes of acetabular revision surgery with trabecular titanium cups in Paprosky type II and III bone defects. J Orthop Traumatol. 2021 Mar 6;22(1):9. [36]. Steno B, Kokavec M, Necas L. Acetabular revision arthroplasty using trabecular titanium implants. Int Orthop. 2015 Mar;39(3):389-95 [37]. Waters T, Davies N, Whittingham-Jones P, Schaller G. Acetabular Revision with Trabecular Titanium - 120 cases with a 2-year minimum follow-up. Hip Int. 2015;25(Suppl 1): S104. [38]. Migaud H, Common H, Girard J, Huten D, Putman S. Acetabular reconstruction using porous metallic material in complex revision total hip arthroplasty: A systematic review. Orthop Traumatol Surg Res. 2019 Feb;105(1S):S53-S61.
TT ACETABULAR PLATES [39]. Ding H, Mao Y, Yu B, Zhu Z, Li H, Yu B, Huang J. The use of morselized allografts without impaction and cemented cage support in acetabular revision surgery: a 4- to 9-year follow-up. J Orthop Surg Res. 2015 May 23; 10:77. [40]. Di Laura A, Henckel J, Wescott R, Hothi H, Hart AJ. The effect of metal artefact on the design of custom 3D printed acetabular implants. 3D Printing in Medicine. December 2020;6(1).
SMR AXIOMA TT [41]. Lopiz Y, García-Fernández C, Arriaza A, Rizo B, Marcelo H, Marco F. Midterm outcomes of bone grafting in glenoid defects treated with reverse shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2017;26(9):1581-1588. [42]. Makki D, Balbisi B, Arshad MS, Monga P, Bale S, Trail I, Walton M. Assessing the required glenoid peg penetration in native scapula when bone graft is used during primary and revision shoulder arthroplasty. Shoulder and Elbow. 2022;14(3):269-277. [43]. Malhas A, Granville-Chapman J, Robinson P, Brookes-Fazakerley S, Walton M, Monga P, Bale S, Trail I. Reconstruction of the glenoid using autologous bone-graft and the SMR Axioma TT metal- backed prosthesis. Shoulder & Elbow. 2018;100(B):1609-17. [44]. Merolla G, Tartarone A, Sperling JW, Paladini P, Fabbri E, Porcellini G. Early clinical and radiological outcomes of reverse shoulder arthroplasty with an eccentric all-polyethylene glenosphere to treat failed hemiarthroplasty and the sequelae of proximal humeral fractures. International Orthopaedics. 2017;41(1):141-148. [45]. Seybold D, Schildhauer TA, Geßmann J. Shoulder prosthesis replacement options: New implants, treatment algorithms and clinical results. Orthopade. 2018;47(5):398-409. [46]. Singh J, Odak S, Neelakandan K, Walton MJ, Monga P, Bale S, Trail I. Survivorship of autologous structural bone graft at a minimum of 2 years when used to address significant glenoid bone loss in primary and revision shoulder arthroplasty: a computed tomographic and clinical review. Journal of Shoulder and Elbow Surgery. 2021;30(3):668-678.
SMR HYBRID TT [47]. Bitzer A, Rondinelli S, Hurwit DJ, Sonnenfeld JJ, Hong IS, Connor PM. Conversion of anatomic total shoulder arthroplasty to reverse shoulder arthroplasty using a unique hybrid glenoid component: technique and preliminary results. JSES Reviews, Reports, and Techniques. (2021) 1-9. [48]. Connor PM. A Unique Convertible Hybrid Glenoid Component in Anatomic Shoulder Arthroplasty: 5-7 Year Outcome Data. In: Proceeding of 2024 American Shoulder and Elbow Surgeons (ASES) Annual Meeting, Oct 16-19, 2024, San Antonio, TX. [49]. Gao R, Isaksson F, Hasan A, Tan B, Chatindiara I, Poon PC. Good clinical and radiological outcomes of anatomic total shoulder arthroplasty with a novel convertible all polyethylene glenoid with hybrid fixation: minimum 2-year follow-up, Seminars in Arthroplasty: JSES, Volume 33, Issue 2, 2023. [50]. Lachance A, Shahsavarani S, Azam M, Giro ME, Choi JY. Short Term Comparative Outcomes of LIMA Hybrid, Metal-backed, and All Cemented Polyethylene Glenoids. Seminars in Arthroplasty: JSES, June 2024; 34(2); 482-489
SMR AUGMENTED 360 [51]. Verrall I, Chatindiara I, Stoneham ACS, Gao R, Poon PC. SMR TT Augmented 360 baseplates: how do they compare to standard baseplates in reverse shoulder arthroplasty? Minimum 2 years' clinical and radiographic follow-up. J Shoulder Elbow Surg. 2025 Mar 19: S1058-2746(25)00243-5.
SMR METAL BACK TT [52]. Castagna A, Randelli M, Garofalo R, Maradei L, Giardella A, Borroni M. Mid-term results of a metal-backed glenoid component in total shoulder replacement. J Bone Joint Surg Br. 2010 Oct;92(10):1410-5 [53]. Lachance A, Shahsavarani S, Azam M, Giro ME, Choi JY. Short Term Comparative Outcomes of LIMA Hybrid, Metal-backed, and All Cemented Polyethylene Glenoids. Seminars in Arthroplasty: JSES, June 2024; 34(2); 482-489 [54]. Ranieri R, Anzillotti G, Rose GD, Borroni M, Garofalo R, Castagna A. Anatomical total shoulder arthroplasty revision to reverse shoulder arthroplasty using convertible glenoid: a systematic review of clinical and radiological outcomes. Int Orthop. 2024 Sep;48(9):2411-2419.
SMR STEMLESS [55]. A’Court JJ, Chatindiara I, Fisher R, Poon PC. Stemless reverse arthroplasty: Does the stemless compare to a conventional stemmed implant? Clinical and radiographic evaluation 2 years minimum follow up. Journal of Shoulder and Elbow Surgery. February 2024 Feb. [56]. Albers CGM, Chatindiara I, Moreno G, Poon PC. Good clinical and radiologic outcomes with the SMR Stemless anatomic TSA after a minimum of 2 years’ followup. Seminars in Arthroplasty JSES. September 2021;31(3):563-570. [57]. Budge MD, Orvets N. Stemless total shoulder arthroplasty using a novel multiplanar osteotomy and elliptical humeral head results in both improved early range of motion and radiographic center of rotation compared with standard total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. February 2023;32(2):318-325. [58]. Churchill RS, Athwal GS. Stemless shoulder arthroplasty—current results and designs. Current Reviews in Musculoskeletal Medicine. March 2016;9(1):10-16. [59]. Comenda M, Quental C, Folgado J, Sarmento M, Monteiro J. Bone adaptation impact of stemless shoulder implants: a computational analysis. Journal of Shoulder and Elbow Surgery. October 2019;28(10):1886-1896. [60]. Monteiro HL, Antunes M, Sarmento M, Quental C, Folgado J. Influence of age-related bone density changes on primary stability in stemless shoulder arthroplasty: a multi-implant finite element study. J Shoulder Elbow Surg. 2025 Feb;34(2):557-566. doi: 10.1016/j.jse.2024.04.013. Epub 2024 Jun 6. [61]. Moreno G, Albers CGM, Chatindiara I, Donnelly K, Poon PC. Accuracy of reconstruction of proximal humerus anatomy: a comparison between stemless and stemmed shoulder modular replacement system. Seminars in Arthroplasty JSES. June 2023;33(2):291-296. [62]. Pokorný D, Fulín P, Heřt J, Walder J, Štefan J, Sosna A. Stemless Hemiarthroplasty of the Shoulder Using the SMR® System: Summary of Six-Year Experience and Surgical Technique. Chir Orthop Traumatol Cech. 2022;89(6):395-405. [63]. Rosso C, Kränzle J, Delaney R, Grezda K. Radiological, Clinical and Patient-reported Outcomes in Stemless Reverse Shoulder Arthroplasty at a Mean of 46 Months. Journal of Shoulder and Elbow Surgery. November 2023. [64]. Schoch C, Ambros L, Geyer M, Plath JE, Dittrich M. Clinical and radiological outcomes using the LIMA SMR stemless implant—A 2-year follow-up in 49 patients. Seminars in Arthroplasty JSES. June 2022;32(2):382-388. [65]. Schoch C, Dittrich M, Ambros L, Geyer M. Revision of a Stemless Anatomic Implant into a Stemless Reverse Implant. Case Reports in Orthopedics. January 2021; 2021:1-5. [66]. Schoch C, Plath JE, Ambros L, Geyer M, Dittrich M. Clinical and radiological outcomes of a stemless reverse shoulder implant: a two-year follow-up in 56 patients. JSES International. November 2021;5(6):1042-1048. [67]. Willems JIP, Achten G, Crowther MAA, Heikenfeld R, Karelse A, Van Noort A. Two-year follow-up of the SMR stemless platform shoulder system. A multicentre, prospective clinical study. JSES Int 2024 Apr 25;8(4):888-894.
PROMADE [68]. Akhtar A, Keightly A, Dhir R, Monga P. Scapular spine load-bearing strut in custom-made reverse shoulder arthroplasty - clinical and radiological follow-up of an index case. International Journal of Case Reports in Orthopaedics. July 2021;3(2):14-17. [69]. Aprato A, Giachino M, Bedino P, Mellano D, Piana R, Massè A. Management of Paprosky type three B acetabular defects by custom-made components: early results. International Orthopaedics. January 2019;43(1):117-122. [70]. Burton R, Adam J, Holland P, Rangan A. A review of custom implants for glenoid bone deficiency in reverse shoulder arthroplasty. Journal of Orthopaedics. February 2023; 36:65-71. [71]. De Biase C, Ziveri G, De Caro F, Roberts N, Delcogliano M. Reverse shoulder arthroplasty using a “L”shaped allograft for glenoid reconstruction in a patient with massive glenoid bone loss: case report. European Review for Medical and Pharmacological Sciences. 2014;18(Suppl.1):44- 49. [72]. Durand-Hill M, Henckel J, Di Laura A, Hart AJ. Can custom 3D printed implants successfully reconstruct massive acetabular defects? A 3D-CT assessment. Journal of Orthopaedic Research. December 2020;38(12):2640-2648. [73]. Fröschen FS, Randau TM, Hischebeth GTR, Gravius N, Gravius S, Walter SG. Mid-term results after revision total hip arthroplasty with custom-made acetabular implants in patients with Paprosky III acetabular bone loss. Arch Orthop Trauma Surg. 2020 Feb;140(2):263-273. [74]. Grossi S, Sacchetti F, Ceccoli M, Cosseddu F, Neri E, Colangeli S, Domenico Parchi P, Andreani L, Capanna R. One-Step Reconstruction with Custom-Made 3D-printed Scapular Prosthesis After Partial or Total Scapulectomy. Surg Technol Int 2020 May 28:36:341-346. [75]. Hart A, Panagiotopoulou V, Henckel J. Personalised orthopaedics-using 3D printing for tailor- made technical teaching, pre-operative planning, bespoke implants and precise placement of implants. Orthop. Prod. News (OPN) Feature. May 2017;178: 21-24. [76]. Henckel J, Durand-Hill M, Noory S, Skinner J, Hart A, Radermacher K, Rodriguez F, Baena Y. Clinical and Radiological Results from Reconstruction of Massive Acetabular Defects Using 3D Printed Trabecular Titanium Implants for Computer Assisted Orthopaedic Surgery. 2017. [77]. Konarski AJ, Dupley L, Reddy NR, Trail IA, Walton MJ, Bale S, Monga P. Early clinical and radiological outcomes of a scapular spine load-bearing strut in custom glenoid implants for reverse total shoulder arthroplasty., Seminars in Arthroplasty: JSES (2025), doi: https://doi.org/10.1053/j.sart.2025.03.009. [78]. Malhas A, Rashid A, Copas D, Bale S, Trail I. Glenoid bone loss in primary and revision shoulder arthroplasty. Shoulder and Elbow. October 2016;8(4):229-240. [79]. Ortmaier R, Wierer G, Gruber MS. Functional and Radiological Outcomes after Treatment with Custom-Made Glenoid Components in Revision Reverse Shoulder Arthroplasty. Journal of Clinical Medicine. February 2022;11(3). [80]. Perticarini L, Rossi S, Benazzo F. Trabecular titanium tailored implants in complex acetabular revision surgeries: our experience at minimum 3 years follow-up. Journal of biological regulators & homeostatic agents. 2020;34(5(S1)):45-49. [81]. Petermann M, Verini L, Friedrich N, Pap G. Implantation accuracy of custom-made glenoid implants for treating severe glenoid bone deficiencies with reverse shoulder arthroplasty. Seminars in Arthroplasty JSES. June 2022;32(2):285-296. [82]. Porcellini G, Micheloni GM, Tarallo L, Paladini P, Merolla G, Catani F. Custom-made reverse shoulder arthroplasty for severe glenoid bone loss: review of the literature and our preliminary results. Journal of Orthopaedics and Traumatology. December 2021;22(1). [83]. Rashid MS, Cunningham L, Shields DW, Walton MJ, Monga P, Bale RS, Trail IA. Clinical and radiologic outcomes of Lima ProMade custom 3D-printed glenoid components in primary and revision reverse total shoulder arthroplasty with severe glenoid bone loss: a minimum 2-year follow-up. Journal of Shoulder and Elbow Surgery. October 2023;32(10):2017-2026. [84]. Romagnoli M, Zaffagnini M, Carillo E, Raggi F, Casali M, Leardini A, Marcheggiani Muccioli GM, Grassi A, Zaffagnini S. Custom-made implants for massive acetabular bone loss: accuracy with CT assessment. Journal of Orthopaedic Surgery and Research. September 2023;18(1):742. [85]. Romagnoli M, Casali M, Zaffagnini M, Cucurnia I, Raggi F, Reale D, Grassi A, Zaffagnini S. Tricalcium Phosphate as a Bone Substitute to Treat Massive Acetabular Bone Defects in Hip Revision Surgery: A Systematic Review and Initial Clinical Experience with 11 Cases. Journal of Clinical Medicine. March 2023;12(5). [86]. Zanasi S, Zmerly H. Customised three-dimensional printed revision acetabular implant for large defect after failed triflange revision cup. BMJ Case Reports. May 2020;13(5).
* Results from pre-clinical studies
DELTA TT [18]. Registro Regionale di Implantologia Protesica Ortopedica (R.I.P.O.) - Regional Register of Orthopaedic Prosthetic Implantology, Emilia Romagna Italy. Ad hoc report on Delta TT cup (Overall data 2007-2021), June 2024. [19]. Aiba H, Watanabe N, Inagaki T, Fukuoka M, Murakami H. Differences among the observers in the assessments of Japanese orthopedic association hip scores between surgeons and physical therapists and the correlations to patients’ reported outcomes after total hip arthroplasty. BMC Musculoskelet Disord. 2022 Jan 03; 23:27. [20]. Aleixo H, Camelo N, Carvalho L, Fernandes L, Castro D, Lino T, Araújo NS. Cementless total hip replacements without femoral osteotomies in severe dysplasia cases - valid option. Hip Int 2016;26(Suppl 2):S81. [21]. Arshad H, Malagelada F, Bates P, Culpan P. Acute fixation and total hip replacement for the management of acetabular fracture in patients over 55. Hip Int. 2015;25(Suppl 1): S50-S51. [22]. Bistolfi A, Cimino A, Lee GC, Ferracini R, Maina G, Berchialla P, Massazza G, Massè A. Does metal porosity affect metal ion release in blood and urine following total hip arthroplasty? A short-term study. Hip Int. 2018 Sep;28(5):522-530. [23]. Cha Y, Lee SY, Bae JH, Kang YJ, Baek JH, Kang JS, Park CH, Kim S, Yoo JI. Comparing Stability, Gait, and Functional Score after 40-mm Dual-Mobility Hip Arthroplasty to 36-mm Head Hip Arthroplasty in Elderly Hip Fracture Patients. Clin Orthop Surg. 2025 Feb;17(1):62-70. [24]. Grappiolo G, La Camera F, Della Rocca A, Mazziotta G, Santoro G, Loppini M. Total hip arthroplasty with a monoblock conical stem and subtrochanteric transverse shortening osteotomy in Crowe type IV dysplastic hips. Int Orthop. 2019 Jan;43(1):77-83. [25]. Innocenti M, Guido D, Cozzi Lepri A, Maritato E, Carulli C, Matassi F, Civinini R. Proximal femoral replacement: A salvage treatment of cephalomedullary nails' mechanical failures in the elderly population. Injury. 2021 Jul;52(7):1868-1874. [26]. Jannelli E, Boggio E, Castelli A, Pasta G, Grassi FA, Mosconi M. Trabecular titanium acetabular cup in patients with medial femoral neck fracture: Survivorship analysis and clinical and radiological outcomes. World J Orthop. 2025 Mar 18;16(3):100481. [27]. Klaassen AD, van Loon J, Willigenburg NW, Koster LA, Kaptein BL, van der Hulst VPM, Haverkamp D, Moojen DJF, Poolman RW. Comparison of 5-year cup and stem migration between ceramic-on-ceramic and ceramic-on-polyethylene bearing in press-fit total hip arthroplasty: a randomised controlled trial using radiostereometric analysis. Hip Int. 2024 Nov;34(6):701-716.
DELTA REVISION TT [28]. Cacciola G, Giustra F, Bosco F, De Meo F, Bruschetta A, De Martino I, Risitano S, Sabatini L, Massè A, Cavaliere P. Trabecular titanium cups in hip revision surgery: A systematic review of the literature. Annals of Joint. October 2023;8. [29]. Cozzi Lepri A, Innocenti M, Galeotti A, Carulli C, Villano M, Civinini R. Trabecular titanium cups in acetabular revision arthroplasty: analysis of 10-year survivorship, restoration of center of rotation and osteointegration. Arch Orthop Trauma Surg. 2021 Oct 31; doi.org/10.1007/s00402- 021-04243-x. [30]. De Meo F, Cacciola G, Bellotti V, Bruschetta A, Cavaliere P. Trabecular Titanium acetabular cups in hip revision surgery: mid-term clinical and radiological outcomes. Hip Int. 2018 December;28(S2):61-5. [31]. Gallart X, Fernández-Valencia JA, Riba J, Bori G, García S, Tornero E, Combalía A. Trabecular TitaniumTM cups and augments in revision total hip arthroplasty: clinical results, radiology and survival outcomes. Hip Int. 2016 Sep 29;26(5):486-491. [32]. Munegato D, Bigoni M, Sotiri R, Bruschetta A, Omeljaniuk RJ, Turati M, Rossi A, Zatti G. Clinical and radiological outcomes of acetabular revision with the Delta Revision TT cup. Hip Int. 2018;28(S2):54-60. [33]. Patel A, Hayes T, Whittingham-Jones P, Davies N, Waters T. Early stability and ingrowth of 3D trabecular titanium in revision acetabular reconstruction. Hip Int. 2014;24(5):495. [34]. Perticarini L, Rossi SMP, Fioruzzi A, Jannelli E, Mosconi M, Benazzo F. Modular tapered conical revision stem in hip revision surgery: mid- term results. BMC Musculoskelet Disord. 2021 Jan 6;22(1):29. [35]. Perticarini L, Rossi SMP, Medetti M, Benazzo F. Clinical and radiological outcomes of acetabular revision surgery with trabecular titanium cups in Paprosky type II and III bone defects. J Orthop Traumatol. 2021 Mar 6;22(1):9. [36]. Steno B, Kokavec M, Necas L. Acetabular revision arthroplasty using trabecular titanium implants. Int Orthop. 2015 Mar;39(3):389-95 [37]. Waters T, Davies N, Whittingham-Jones P, Schaller G. Acetabular Revision with Trabecular Titanium - 120 cases with a 2-year minimum follow-up. Hip Int. 2015;25(Suppl 1): S104. [38]. Migaud H, Common H, Girard J, Huten D, Putman S. Acetabular reconstruction using porous metallic material in complex revision total hip arthroplasty: A systematic review. Orthop Traumatol Surg Res. 2019 Feb;105(1S):S53-S61.
TT ACETABULAR PLATES [39]. Ding H, Mao Y, Yu B, Zhu Z, Li H, Yu B, Huang J. The use of morselized allografts without impaction and cemented cage support in acetabular revision surgery: a 4- to 9-year follow-up. J Orthop Surg Res. 2015 May 23; 10:77. [40]. Di Laura A, Henckel J, Wescott R, Hothi H, Hart AJ. The effect of metal artefact on the design of custom 3D printed acetabular implants. 3D Printing in Medicine. December 2020;6(1).
SMR AXIOMA TT [41]. Lopiz Y, García-Fernández C, Arriaza A, Rizo B, Marcelo H, Marco F. Midterm outcomes of bone grafting in glenoid defects treated with reverse shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2017;26(9):1581-1588. [42]. Makki D, Balbisi B, Arshad MS, Monga P, Bale S, Trail I, Walton M. Assessing the required glenoid peg penetration in native scapula when bone graft is used during primary and revision shoulder arthroplasty. Shoulder and Elbow. 2022;14(3):269-277. [43]. Malhas A, Granville-Chapman J, Robinson P, Brookes-Fazakerley S, Walton M, Monga P, Bale S, Trail I. Reconstruction of the glenoid using autologous bone-graft and the SMR Axioma TT metal- backed prosthesis. Shoulder & Elbow. 2018;100(B):1609-17. [44]. Merolla G, Tartarone A, Sperling JW, Paladini P, Fabbri E, Porcellini G. Early clinical and radiological outcomes of reverse shoulder arthroplasty with an eccentric all-polyethylene glenosphere to treat failed hemiarthroplasty and the sequelae of proximal humeral fractures. International Orthopaedics. 2017;41(1):141-148. [45]. Seybold D, Schildhauer TA, Geßmann J. Shoulder prosthesis replacement options: New implants, treatment algorithms and clinical results. Orthopade. 2018;47(5):398-409. [46]. Singh J, Odak S, Neelakandan K, Walton MJ, Monga P, Bale S, Trail I. Survivorship of autologous structural bone graft at a minimum of 2 years when used to address significant glenoid bone loss in primary and revision shoulder arthroplasty: a computed tomographic and clinical review. Journal of Shoulder and Elbow Surgery. 2021;30(3):668-678.
SMR HYBRID TT [47]. Bitzer A, Rondinelli S, Hurwit DJ, Sonnenfeld JJ, Hong IS, Connor PM. Conversion of anatomic total shoulder arthroplasty to reverse shoulder arthroplasty using a unique hybrid glenoid component: technique and preliminary results. JSES Reviews, Reports, and Techniques. (2021) 1-9. [48]. Connor PM. A Unique Convertible Hybrid Glenoid Component in Anatomic Shoulder Arthroplasty: 5-7 Year Outcome Data. In: Proceeding of 2024 American Shoulder and Elbow Surgeons (ASES) Annual Meeting, Oct 16-19, 2024, San Antonio, TX. [49]. Gao R, Isaksson F, Hasan A, Tan B, Chatindiara I, Poon PC. Good clinical and radiological outcomes of anatomic total shoulder arthroplasty with a novel convertible all polyethylene glenoid with hybrid fixation: minimum 2-year follow-up, Seminars in Arthroplasty: JSES, Volume 33, Issue 2, 2023. [50]. Lachance A, Shahsavarani S, Azam M, Giro ME, Choi JY. Short Term Comparative Outcomes of LIMA Hybrid, Metal-backed, and All Cemented Polyethylene Glenoids. Seminars in Arthroplasty: JSES, June 2024; 34(2); 482-489
SMR AUGMENTED 360 [51]. Verrall I, Chatindiara I, Stoneham ACS, Gao R, Poon PC. SMR TT Augmented 360 baseplates: how do they compare to standard baseplates in reverse shoulder arthroplasty? Minimum 2 years' clinical and radiographic follow-up. J Shoulder Elbow Surg. 2025 Mar 19: S1058-2746(25)00243-5.
SMR METAL BACK TT [52]. Castagna A, Randelli M, Garofalo R, Maradei L, Giardella A, Borroni M. Mid-term results of a metal-backed glenoid component in total shoulder replacement. J Bone Joint Surg Br. 2010 Oct;92(10):1410-5 [53]. Lachance A, Shahsavarani S, Azam M, Giro ME, Choi JY. Short Term Comparative Outcomes of LIMA Hybrid, Metal-backed, and All Cemented Polyethylene Glenoids. Seminars in Arthroplasty: JSES, June 2024; 34(2); 482-489 [54]. Ranieri R, Anzillotti G, Rose GD, Borroni M, Garofalo R, Castagna A. Anatomical total shoulder arthroplasty revision to reverse shoulder arthroplasty using convertible glenoid: a systematic review of clinical and radiological outcomes. Int Orthop. 2024 Sep;48(9):2411-2419.
SMR STEMLESS [55]. A’Court JJ, Chatindiara I, Fisher R, Poon PC. Stemless reverse arthroplasty: Does the stemless compare to a conventional stemmed implant? Clinical and radiographic evaluation 2 years minimum follow up. Journal of Shoulder and Elbow Surgery. February 2024 Feb. [56]. Albers CGM, Chatindiara I, Moreno G, Poon PC. Good clinical and radiologic outcomes with the SMR Stemless anatomic TSA after a minimum of 2 years’ followup. Seminars in Arthroplasty JSES. September 2021;31(3):563-570. [57]. Budge MD, Orvets N. Stemless total shoulder arthroplasty using a novel multiplanar osteotomy and elliptical humeral head results in both improved early range of motion and radiographic center of rotation compared with standard total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. February 2023;32(2):318-325. [58]. Churchill RS, Athwal GS. Stemless shoulder arthroplasty—current results and designs. Current Reviews in Musculoskeletal Medicine. March 2016;9(1):10-16. [59]. Comenda M, Quental C, Folgado J, Sarmento M, Monteiro J. Bone adaptation impact of stemless shoulder implants: a computational analysis. Journal of Shoulder and Elbow Surgery. October 2019;28(10):1886-1896. [60]. Monteiro HL, Antunes M, Sarmento M, Quental C, Folgado J. Influence of age-related bone density changes on primary stability in stemless shoulder arthroplasty: a multi-implant finite element study. J Shoulder Elbow Surg. 2025 Feb;34(2):557-566. doi: 10.1016/j.jse.2024.04.013. Epub 2024 Jun 6. [61]. Moreno G, Albers CGM, Chatindiara I, Donnelly K, Poon PC. Accuracy of reconstruction of proximal humerus anatomy: a comparison between stemless and stemmed shoulder modular replacement system. Seminars in Arthroplasty JSES. June 2023;33(2):291-296. [62]. Pokorný D, Fulín P, Heřt J, Walder J, Štefan J, Sosna A. Stemless Hemiarthroplasty of the Shoulder Using the SMR® System: Summary of Six-Year Experience and Surgical Technique. Chir Orthop Traumatol Cech. 2022;89(6):395-405. [63]. Rosso C, Kränzle J, Delaney R, Grezda K. Radiological, Clinical and Patient-reported Outcomes in Stemless Reverse Shoulder Arthroplasty at a Mean of 46 Months. Journal of Shoulder and Elbow Surgery. November 2023. [64]. Schoch C, Ambros L, Geyer M, Plath JE, Dittrich M. Clinical and radiological outcomes using the LIMA SMR stemless implant—A 2-year follow-up in 49 patients. Seminars in Arthroplasty JSES. June 2022;32(2):382-388. [65]. Schoch C, Dittrich M, Ambros L, Geyer M. Revision of a Stemless Anatomic Implant into a Stemless Reverse Implant. Case Reports in Orthopedics. January 2021; 2021:1-5. [66]. Schoch C, Plath JE, Ambros L, Geyer M, Dittrich M. Clinical and radiological outcomes of a stemless reverse shoulder implant: a two-year follow-up in 56 patients. JSES International. November 2021;5(6):1042-1048. [67]. Willems JIP, Achten G, Crowther MAA, Heikenfeld R, Karelse A, Van Noort A. Two-year follow-up of the SMR stemless platform shoulder system. A multicentre, prospective clinical study. JSES Int 2024 Apr 25;8(4):888-894.
PROMADE [68]. Akhtar A, Keightly A, Dhir R, Monga P. Scapular spine load-bearing strut in custom-made reverse shoulder arthroplasty - clinical and radiological follow-up of an index case. International Journal of Case Reports in Orthopaedics. July 2021;3(2):14-17. [69]. Aprato A, Giachino M, Bedino P, Mellano D, Piana R, Massè A. Management of Paprosky type three B acetabular defects by custom-made components: early results. International Orthopaedics. January 2019;43(1):117-122. [70]. Burton R, Adam J, Holland P, Rangan A. A review of custom implants for glenoid bone deficiency in reverse shoulder arthroplasty. Journal of Orthopaedics. February 2023; 36:65-71. [71]. De Biase C, Ziveri G, De Caro F, Roberts N, Delcogliano M. Reverse shoulder arthroplasty using a “L”shaped allograft for glenoid reconstruction in a patient with massive glenoid bone loss: case report. European Review for Medical and Pharmacological Sciences. 2014;18(Suppl.1):44- 49. [72]. Durand-Hill M, Henckel J, Di Laura A, Hart AJ. Can custom 3D printed implants successfully reconstruct massive acetabular defects? A 3D-CT assessment. Journal of Orthopaedic Research. December 2020;38(12):2640-2648. [73]. Fröschen FS, Randau TM, Hischebeth GTR, Gravius N, Gravius S, Walter SG. Mid-term results after revision total hip arthroplasty with custom-made acetabular implants in patients with Paprosky III acetabular bone loss. Arch Orthop Trauma Surg. 2020 Feb;140(2):263-273. [74]. Grossi S, Sacchetti F, Ceccoli M, Cosseddu F, Neri E, Colangeli S, Domenico Parchi P, Andreani L, Capanna R. One-Step Reconstruction with Custom-Made 3D-printed Scapular Prosthesis After Partial or Total Scapulectomy. Surg Technol Int 2020 May 28:36:341-346. [75]. Hart A, Panagiotopoulou V, Henckel J. Personalised orthopaedics-using 3D printing for tailor- made technical teaching, pre-operative planning, bespoke implants and precise placement of implants. Orthop. Prod. News (OPN) Feature. May 2017;178: 21-24. [76]. Henckel J, Durand-Hill M, Noory S, Skinner J, Hart A, Radermacher K, Rodriguez F, Baena Y. Clinical and Radiological Results from Reconstruction of Massive Acetabular Defects Using 3D Printed Trabecular Titanium Implants for Computer Assisted Orthopaedic Surgery. 2017. [77]. Konarski AJ, Dupley L, Reddy NR, Trail IA, Walton MJ, Bale S, Monga P. Early clinical and radiological outcomes of a scapular spine load-bearing strut in custom glenoid implants for reverse total shoulder arthroplasty., Seminars in Arthroplasty: JSES (2025), doi: https://doi.org/10.1053/j.sart.2025.03.009. [78]. Malhas A, Rashid A, Copas D, Bale S, Trail I. Glenoid bone loss in primary and revision shoulder arthroplasty. Shoulder and Elbow. October 2016;8(4):229-240. [79]. Ortmaier R, Wierer G, Gruber MS. Functional and Radiological Outcomes after Treatment with Custom-Made Glenoid Components in Revision Reverse Shoulder Arthroplasty. Journal of Clinical Medicine. February 2022;11(3). [80]. Perticarini L, Rossi S, Benazzo F. Trabecular titanium tailored implants in complex acetabular revision surgeries: our experience at minimum 3 years follow-up. Journal of biological regulators & homeostatic agents. 2020;34(5(S1)):45-49. [81]. Petermann M, Verini L, Friedrich N, Pap G. Implantation accuracy of custom-made glenoid implants for treating severe glenoid bone deficiencies with reverse shoulder arthroplasty. Seminars in Arthroplasty JSES. June 2022;32(2):285-296. [82]. Porcellini G, Micheloni GM, Tarallo L, Paladini P, Merolla G, Catani F. Custom-made reverse shoulder arthroplasty for severe glenoid bone loss: review of the literature and our preliminary results. Journal of Orthopaedics and Traumatology. December 2021;22(1). [83]. Rashid MS, Cunningham L, Shields DW, Walton MJ, Monga P, Bale RS, Trail IA. Clinical and radiologic outcomes of Lima ProMade custom 3D-printed glenoid components in primary and revision reverse total shoulder arthroplasty with severe glenoid bone loss: a minimum 2-year follow-up. Journal of Shoulder and Elbow Surgery. October 2023;32(10):2017-2026. [84]. Romagnoli M, Zaffagnini M, Carillo E, Raggi F, Casali M, Leardini A, Marcheggiani Muccioli GM, Grassi A, Zaffagnini S. Custom-made implants for massive acetabular bone loss: accuracy with CT assessment. Journal of Orthopaedic Surgery and Research. September 2023;18(1):742. [85]. Romagnoli M, Casali M, Zaffagnini M, Cucurnia I, Raggi F, Reale D, Grassi A, Zaffagnini S. Tricalcium Phosphate as a Bone Substitute to Treat Massive Acetabular Bone Defects in Hip Revision Surgery: A Systematic Review and Initial Clinical Experience with 11 Cases. Journal of Clinical Medicine. March 2023;12(5). [86]. Zanasi S, Zmerly H. Customised three-dimensional printed revision acetabular implant for large defect after failed triflange revision cup. BMJ Case Reports. May 2020;13(5).
* Results from pre-clinical studies