Meta-Analysis
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jan 18, 2020; 11(1): 57-67
Published online Jan 18, 2020. doi: 10.5312/wjo.v11.i1.57
Use of three-dimensional printing in preoperative planning in orthopaedic trauma surgery: A systematic review and meta-analysis
Catrin Morgan, Chetan Khatri, Sammy A Hanna, Hutan Ashrafian, Khaled M Sarraf
Catrin Morgan, Chetan Khatri, Khaled M Sarraf, Trauma and Orthopaedics, Imperial College NHS Trust, London W2 1NY, United Kingdom
Sammy A Hanna, The Royal London Hospital, Barts Health NHS Trust, London E1 1BB, United Kingdom
Hutan Ashrafian, Department of Surgery and Cancer, Imperial College London, London W2 1NY, United Kingdom
Author contributions: Morgan C, Khatri C, Ashrafian H and Sarraf K designed research; Morgan C, Khatri C and Ashrafian H performed research; Ashrafian H and Hanna SA contributed new reagents or analytic tools; Morgan C, Khatri C and Ashrafian H analyzed data; Morgan C, Khatri C, Hanna SA, Ashrafian H and Sarraf K wrote the paper.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest.
PRISMA 2009 Checklist statement: Manuscript meets requirements of PRISMA statement
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Catrin Morgan, BSc, MBBS, MRCS, Trauma and Orthopaedics, Imperial College NHS Trust, Praed Street, London W21NY, United Kingdom. catrin.morgan@nhs.net
Received: June 11, 2019
Peer-review started: June 11, 2019
First decision: September 21, 2019
Revised: September 25, 2019
Accepted: November 25, 2019
Article in press: November 25, 2019
Published online: January 18, 2020
Processing time: 212 Days and 5.3 Hours
Abstract
BACKGROUND

With the increasing complexity of surgical interventions performed in orthopaedic trauma surgery and the improving technologies used in three-dimensional (3D) printing, there has been an increased interest in the concept. It has been shown that 3D models allow surgeons to better visualise anatomy, aid in planning and performing complex surgery. It is however not clear how best to utilise the technique and whether this results in better outcomes.

AIM

To evaluate the effect of 3D printing used in pre-operative planning in orthopaedic trauma surgery on clinical outcomes.

METHODS

We performed a comprehensive systematic review of the literature and a meta-analysis. Medline, Ovid and Embase were searched from inception to February 8, 2018. Randomised controlled trials, case-control studies, cohort studies and case series of five patients or more were included across any area of orthopaedic trauma. The primary outcomes were operation time, intra-operative blood loss and fluoroscopy used.

RESULTS

Seventeen studies (922 patients) met our inclusion criteria and were reviewed. The use of 3D printing across all specialties in orthopaedic trauma surgery demonstrated an overall reduction in operation time of 19.85% [95% confidence intervals (CI): (-22.99, -16.71)], intra-operative blood loss of 25.73% [95%CI: (-31.07, -20.40)], and number of times fluoroscopy was used by 23.80% [95%CI: (-38.49, -9.10)].

CONCLUSION

Our results suggest that the use of 3D printing in pre-operative planning in orthopaedic trauma reduces operative time, intraoperative blood loss and the number of times fluoroscopy is used.

Keywords: Orthopaedic surgery; Trauma; Three-dimensional printing

Core tip: The use of three-dimensional (3D) printing in preoperative planning in orthopaedic trauma surgery is a relatively novel field. It has been shown that 3D models allow surgeons to better visualise anatomy, aid in planning and performing complex surgery. It is not clear how to utilise this technique and whether this results in better outcomes. This is the first systematic review and meta-analysis in this field to date. Our results suggest that the use of 3D printing in pre-operative planning in orthopaedic trauma reduces operative time, intraoperative blood loss and the number of times fluoroscopy is used.