Patient-Specific Lattice Implants for Segmental Femoral and Tibial Reconstruction (Part 1): Defect Patterns, Fixation Strategies and Reconstruction Options-A Review.

Abstract

This first part of a two-part review examines how Computed Tomography(CT)-based, additively manufactured (AM) porous implants are used to reconstruct large segmental defects of the femur and tibia. We focus on lightweight patient-specific lattice implants, architected cages, and modular porous constructs that incorporate engineered porosity into the load-bearing structure and are deployed with plate-, nail-, or external-fixator-based stabilization. We show how defects are described and classified by size, morphology, and anatomical subsegment; how these descriptors influence fixation choice and the resulting mechanical environment; and where along the femur and tibia porous implants have been applied in clinical and preclinical settings. Across the literature, outcomes appear to depend most strongly on defect morphology and local biology, while fixation feasibility and construct behavior vary by subregional anatomy. Most reported constructs use Ti6Al4V porous architectures intended to share load with fixation, reduce stress shielding, and provide a regenerative space for graft and tissue ingrowth. Finite element analyses (FEA) and bench-top studies consistently indicate that lattice architecture, relative density (RD), and fixation concept jointly control stiffness, micromotion, and fatigue-sensitive regions, whereas early animal and human reports describe promising incorporation and functional recovery in selected cases. However, defect descriptors, fixation reporting, boundary conditions, and outcome metrics remain diverse, and explicit quantitative validation of simulations against mechanical or in vivo measurements is uncommon. Most published work relies on simulation and bench testing, with limited reporting of biological endpoints, leaving a validation gap that prevents direct translation. We emphasize the need for standardized defect and fixation descriptors, harmonized mechanical and modeling protocols, and defect-centered datasets that integrate anatomy, mechanics, and longitudinal outcomes. Across the 27 included studies (may be counted in more than one group), simulation and mechanical testing are reported in 19/27 (70%) and 15/27 (56%), respectively, while in vivo studies (preclinical or clinical) account for 9/27 (33%), highlighting a validation gap that limits translation. Part 2 (under review); of these two series review paper; Patient-Specific Lattice Implants for Segmental Femoral and Tibial Reconstruction (Part 2): CT-Based Personalization, Design Workflows, and Validation-A Review; extends this work by detailing CT-to-implant workflows, lattice design strategies, and methodological validation.