In vitro comparative study of deformation of 3D-printed models using different polylactic acids treated by steam sterilization

Introduction: 3D printing, which is becoming ever more widespread in orthopedic surgery, requires specific materials. Polylactic acid (PLA) is the most widely used in general-purpose 3D printing, but its thermosensitivity can be incompatible with sterilization. Even so, it is easy to use, inexpensive, non-toxic and biodegradable. Controversy surrounds its use. 3D printing of directly sterilizable PLA parts according to surgeons' needs would be highly advantageous, but doubts remain. We therefore performed an in vitro study to determine which PLAs resist steam sterilization regarding deformation. Hypothesis: The study hypothesis was that, depending on make and shape, 3D-printed PLA parts can retain their properties after steam sterilization. Material and methods: We selected 4 makes of PLA and used each to print 4 simple cubes and 4 complex shapes corresponding to cuboid bones. They were subjected to steam sterilization under normal French hospital conditions. The size of the cubes was measured before and after sterilization, using a digital caliper. Results: Cuboid parts in HT-PLA and PLA-WANAO showed mean deformation of -0.02 mm and -0.4 mm, respectively after sterilization, the differences being non-significant (p = 0.679 and p = 0.241, respectively). Cuboid parts in PLA-SUNLU and PLA-G3D showed significant mean deformation: respectively, -1.37 mm (p = 0.026) and -35.03 mm (p > 0.001). Cubes in all types of PLA showed significant mean deformation: HT-PLA, -0.61 mm (p = 0.004); PLA-SUNLU, -2.70 mm (p = 0.002); PLA-G3D, -28.64 mm (p > 0.001); and PLA-WANAO, -1.33 mm (p = 0.010). Discussion: The study confirmed recent findings that steam sterilization is feasible with certain PLA-printed parts, with deformations less than 1 mm, and that choice of PLA is crucial for success. Computer-designed objects (here, cubes) did not resist sterilization without significant deformation. Analysis of resistance to various stresses was not performed, and therefore it cannot be claimed that the process could be used other than for printing anatomic parts. Use of 3D printing in French hospitals is probably a real source of innovation and improvement in care quality; however, a legal framework needs establishing for the use of 3D-printed parts, to ensure patient safety and promote research in this field. Level of evidence: III; prospective in vitro study. (c) 2024 Elsevier Masson SAS. All rights reserved.