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Roy M, Jeyaraman M, Jeyaraman N, Sahu A, Bharadwaj S, Jayan AK. Evaluating Effectiveness, Safety, and Patient Outcomes of 3D Printing in Orthopedic Implant Design and Customization: A PRISMA-Complaint Systematic Review. J Orthop Case Rep 2025; 15:213-222. [PMID: 40520756 PMCID: PMC12159611 DOI: 10.13107/jocr.2025.v15.i06.5720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2025] [Revised: 04/19/2025] [Indexed: 06/18/2025] Open
Abstract
Introduction The advent of 3D printing technology has revolutionized the field of orthopedics, particularly in the design and customization of implants. This study aims to evaluate the effectiveness, safety, and patient outcomes associated with the use of 3D-printed custom implants for various orthopedic conditions. Materials and Methods The systematic review was registered in PROSPERO (CRD42025648097). The literature search analyzed studies from multiple databases, focusing on parameters, such as implant fit, functionality, surgical outcomes, and patient satisfaction. Studies were selected based on their relevance to 3D-printed custom implants for various orthopedic conditions. Results The analysis included data from numerous studies, highlighting several key findings, such as (a) customization: 3D-printed implants provide a highly personalized fit that conforms precisely to individual anatomies, enhancing biomechanical performance and reducing complications, (b) surgical outcomes: The use of 3D-printed implants significantly reduces surgery time and intraoperative errors due to advanced imaging and meticulous pre-operative planning, (c) patient satisfaction: Patients reported higher satisfaction rates due to improved implant stability and functionality, leading to quicker recovery and a better quality of life post-surgery, and (d) challenges: The high costs of 3D printing technology and concerns about the long-term durability and performance of 3D-printed implants remain significant barriers to widespread adoption. Conclusion The integration of 3D printing technology into orthopedic implant design represents a transformative advancement, offering significant improvements in patient-specific outcomes and surgical precision. Despite financial and technical challenges, the potential benefits of delivering personalized, high-quality care are substantial. Future research should focus on long-term follow-up studies to provide comprehensive evidence on the safety and durability of 3D-printed implants, and efforts should be made to reduce production costs and streamline manufacturing processes to enhance accessibility. Level of Evidence Systematic review and meta-analysis, Level II.
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Affiliation(s)
- Mainak Roy
- Department of Orthopaedics, All India Institute of Medical Sciences-Central Armed Police Forces Institute of Medical Sciences, New Delhi, India
| | - Madhan Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, Tamil Nadu, India
| | - Naveen Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, Tamil Nadu, India
| | - Arpit Sahu
- Department of Orthopaedics, All India Institute of Medical Sciences-Central Armed Police Forces Institute of Medical Sciences, New Delhi, India
| | - Sanjeevi Bharadwaj
- Trauma and Orthopaedic Registrar, Wye Valley, National Health Service Trust, Hereford HR1 2ER, United Kingdom
| | - Abhijith K Jayan
- Department of Orthopaedics, All India Institute of Medical, Bhubaneswar, Odisha, India
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Chen T, Luo L, Li J, Li J, Lin T, Liu M, Sang H, Hong X, Pu J, Huang W. Advancements in 3D printing technologies for personalized treatment of osteonecrosis of the femoral head. Mater Today Bio 2025; 31:101531. [PMID: 40026627 PMCID: PMC11869124 DOI: 10.1016/j.mtbio.2025.101531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Revised: 01/25/2025] [Accepted: 01/28/2025] [Indexed: 03/05/2025] Open
Abstract
Three-dimensional (3D) printing technology has shown significant promise in the medical field, particularly in orthopedics, prosthetics, tissue engineering, and pharmaceutical preparations. This review focuses on the innovative application of 3D printing in addressing the challenges of osteonecrosis of the femoral head (ONFH). Unlike traditional hip replacement surgery, which is often suboptimal for younger patients, 3D printing offers precise localization of necrotic areas and the ability to create personalized implants. By integrating advanced biomaterials, this technology offers a promising strategy approach for early hip-preserving treatments. Additionally, 3D-printed bone tissue engineering scaffolds can mimic the natural bone environment, promoting bone regeneration and vascularization. In the future, the potential of 3D printing extends to combining with artificial intelligence for optimizing treatment plans, developing materials with enhanced bioactivity and compatibility, and translating these innovations from the laboratory to clinical practice. This review demonstrates how 3D printing technology uniquely addresses critical challenges in ONFH treatment, including insufficient vascularization, poor mechanical stability, and limited long-term success of conventional therapies. By introducing gradient porous scaffolds, bioactive material coatings, and AI-assisted design, this work outlines novel strategies to improve bone regeneration and personalized hip-preserving interventions. These advancements not only enhance treatment efficacy but also pave the way for translating laboratory findings into clinical applications.
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Affiliation(s)
- Tingting Chen
- School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian , 350108, China
| | - Lincong Luo
- Yue Bei People's Hospital Postdoctoral Innovation Practice Base, Southern Medical University, Guangzhou, 510515, China
| | - Jiaying Li
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong , 510515, China
| | - Jiamin Li
- School of Basic Medical Sciences, Guangdong Medical University, Dongguan, 523808, China
| | - Tao Lin
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong , 510515, China
| | - Mingrui Liu
- School of Basic Medicine, Dali University, Dali, Yunnan, 671003, China
| | - Hang Sang
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong , 510515, China
| | - Xinyu Hong
- School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian , 350108, China
| | - Jiahao Pu
- School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian , 350108, China
| | - Wenhua Huang
- School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian , 350108, China
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong , 510515, China
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Policicchio TJ, Konar K, Brameier DT, Sadoghi P, Suneja N, Stenquist D, Weaver MJ, von Keudell A. The use of three-dimensional printing and virtual reality technologies in orthopaedics-with a focus on orthopaedic trauma. J Clin Orthop Trauma 2025; 63:102930. [PMID: 40012847 PMCID: PMC11850734 DOI: 10.1016/j.jcot.2025.102930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Revised: 01/27/2025] [Accepted: 01/30/2025] [Indexed: 02/28/2025] Open
Abstract
Although the use of three-dimensional printing in orthopaedics is relatively new, many benefits of this technology to both patients and providers have already been observed. Printing models of fractured bone based upon segmented CT imaging allows for improved surgical planning as surgeons are able to view and physically manipulate accurate representations of fracture patterns prior to surgery, increasing both speed and accuracy of fixation in the operating room. The use of three-dimensional models by surgeons prior to surgery has been shown to reduce blood loss, intraoperative time, and fluoroscopy use. These models also have incredible potential in orthopaedic resident and patient education. Among residents, these models significantly improve recognition of fracture patterns, while patients benefit from the use of these models through increased trust and satisfaction with their surgeon's care, as well as decreased anxiety about their injury. Currently, the imaging segmentation and model generation process are prohibitively costly both in terms of time and money; however, in the future, three-dimensional printing may become a point-of-care technology in the orthopaedic field as technology improves and costs decrease. This article aims to illustrate the value of three-dimensional printing and virtual reality technologies in preoperative planning and intraoperative precision, resident education, and patient understanding and satisfaction. The benefits and challenges of the technologies are discussed, as well as current limitations.
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Affiliation(s)
- Thomas J. Policicchio
- Brigham and Women's Hospital, Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Kishore Konar
- Brigham and Women's Hospital, Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Devon T. Brameier
- Brigham and Women's Hospital, Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Patrick Sadoghi
- Medical University of Graz, Department of Orthopedics and Trauma, Graz, Austria
| | - Nishant Suneja
- Brigham and Women's Hospital, Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Derek Stenquist
- Brigham and Women's Hospital, Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Michael J. Weaver
- Brigham and Women's Hospital, Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Arvind von Keudell
- Brigham and Women's Hospital, Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
- Bispebjerg Hospital, Department of Orthopaedic Surgery, University Hospital Copenhagen, Denmark
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Pérez-Mañanes R, Calvo-Haro JA. Digital orthopaedic surgery: Benefits and challenges of extended reality and spatial computing. Rev Esp Cir Ortop Traumatol (Engl Ed) 2025; 69:107-109. [PMID: 39612979 DOI: 10.1016/j.recot.2024.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2024] Open
Affiliation(s)
- R Pérez-Mañanes
- Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, España; CSUR de Sarcomas y Otros Tumores Músculo Esqueléticos del Adulto, Red europea EURACAN, Madrid, España; Universidad Complutense de Madrid, Madrid, España; Unidad de Planificación Avanzada y Manufactura 3D (UPAM3D), Madrid, España.
| | - J A Calvo-Haro
- Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, España; CSUR de Sarcomas y Otros Tumores Músculo Esqueléticos del Adulto, Red europea EURACAN, Madrid, España; Universidad Complutense de Madrid, Madrid, España; Unidad de Planificación Avanzada y Manufactura 3D (UPAM3D), Madrid, España
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5
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Pérez-Mañanes R, Calvo-Haro JA. [Translated article] Digital orthopaedic surgery: Benefits and challenges of extended reality and spatial computing. Rev Esp Cir Ortop Traumatol (Engl Ed) 2025; 69:T107-T109. [PMID: 39894392 DOI: 10.1016/j.recot.2025.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2025] Open
Affiliation(s)
- R Pérez-Mañanes
- Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; CSUR de Sarcomas y Otros Tumores Músculo Esqueléticos del Adulto, Red europea EURACAN, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain; Unidad de Planificación Avanzada y Manufactura 3D (UPAM3D), Madrid, Spain.
| | - J A Calvo-Haro
- Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; CSUR de Sarcomas y Otros Tumores Músculo Esqueléticos del Adulto, Red europea EURACAN, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain; Unidad de Planificación Avanzada y Manufactura 3D (UPAM3D), Madrid, Spain
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Fernández-Fernández T, Mediavilla-Santos L, Cuervo-Dehesa M, Gómez-Larrén E, Pérez-Mañanes R, Calvo-Haro J. [Translated article] Can 3D-printed patient-specific instruments improve local control and overall survival in pelvic sarcoma? A clinical validation study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2025; 69:T83-T90. [PMID: 39521125 DOI: 10.1016/j.recot.2024.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/24/2024] [Accepted: 07/01/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND AND OBJECTIVES 3D-printed patient-specific instruments (PSIs), also known as 3D guides, have been shown to improve accuracy in resection of pelvic tumors in cadaver studies and achieve better surgical margins in vivo. This study evaluates the clinical impact of 3D-printed guides on medium-term local and distant disease control, as well as disease-free and overall survival in patients. MATERIAL AND METHODS A cohort study included 25 patients with primary pelvic or sacral sarcomas: 10 in the 3D group and 15 in the control group, with a median follow-up of 47 months. Demographic and clinical data, including tumor histology, stage, resection technique, associated reconstruction, adjuvant therapies, and complications, were evaluated. Surgical margins (free, marginal, and contaminated) and relapse-free and overall survival curves were analyzed. RESULTS The 3D group achieved a higher rate of free margins (80% vs. 66.7%, p=.345). Local recurrence (50% vs. 60%, p=.244) and distant disease relapse (20% vs. 47%, p=.132) rates were lower in the 3D group. At the end of the follow-up, the 3D group had a higher overall survival rate (60% vs. 40%, p=.327). The complication rate was similar in both groups, with a deep infection rate of 40%. CONCLUSIONS The use of 3D guides in resecting primary pelvic tumors not only achieves a higher rate of free margins compared to conventional techniques but also shows a trend towards higher local, distant, and overall disease-free survival. Further studies with larger sample sizes and higher levels of evidence are necessary to validate these clinical trends.
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Affiliation(s)
- T Fernández-Fernández
- Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - L Mediavilla-Santos
- Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - M Cuervo-Dehesa
- Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - E Gómez-Larrén
- Unidad de Planificación Avanzada y Manufactura 3D, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - R Pérez-Mañanes
- Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Unidad de Planificación Avanzada y Manufactura 3D, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J Calvo-Haro
- Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Unidad de Planificación Avanzada y Manufactura 3D, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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7
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Fernández-Fernández T, Mediavilla-Santos L, Cuervo-Dehesa M, Gómez-Larrén E, Pérez-Mañanes R, Calvo-Haro J. Can 3D-printed patient-specific instruments improve local control and overall survival in pelvic sarcoma? A clinical validation study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2025; 69:83-90. [PMID: 39029899 DOI: 10.1016/j.recot.2024.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/24/2024] [Accepted: 07/01/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND AND OBJECTIVES 3D-printed patient-specific instruments (PSIs), also known as 3D guides, have been shown to improve accuracy in resection of pelvic tumors in cadaver studies and achieve better surgical margins in vivo. This study evaluates the clinical impact of 3D-printed guides on medium-term local and distant disease control, as well as disease-free and overall survival in patients. MATERIAL AND METHODS A cohort study included 25 patients with primary pelvic or sacral sarcomas: 10 in the 3D group and 15 in the control group, with a median follow-up of 47 months. Demographic and clinical data, including tumor histology, stage, resection technique, associated reconstruction, adjuvant therapies, and complications, were evaluated. Surgical margins (free, marginal, and contaminated) and relapse-free and overall survival curves were analyzed. RESULTS The 3D group achieved a higher rate of free margins (80% vs 66.7%, p = 0.345). Local recurrence (50% vs 60%, P=.244) and distant disease relapse (20% vs 47%, p = 0.132) rates were lower in the 3D group. At the end of the follow-up, the 3D group had a higher overall survival rate (60% vs 40%, p = 0.327). The complication rate was similar in both groups, with a deep infection rate of 40%. CONCLUSIONS The use of 3D guides in resecting primary pelvic tumors not only achieves a higher rate of free margins compared to conventional techniques but also shows a trend towards higher local, distant, and overall disease-free survival. Further studies with larger sample sizes and higher levels of evidence are necessary to validate these clinical trends.
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Affiliation(s)
- T Fernández-Fernández
- Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - L Mediavilla-Santos
- Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - M Cuervo-Dehesa
- Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - E Gómez-Larrén
- Unidad de Planificación Avanzada y Manufactura 3D, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - R Pérez-Mañanes
- Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, España; Unidad de Planificación Avanzada y Manufactura 3D, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J Calvo-Haro
- Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, España; Unidad de Planificación Avanzada y Manufactura 3D, Hospital General Universitario Gregorio Marañón, Madrid, España
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Żelechowski M, Zubizarreta‐Oteiza J, Karnam M, Faludi B, Zentai N, Gerig N, Rauter G, Thieringer FM, Cattin PC. Augmented reality navigation in orthognathic surgery: Comparative analysis and a paradigm shift. Healthc Technol Lett 2025; 12:e12109. [PMID: 39816699 PMCID: PMC11730987 DOI: 10.1049/htl2.12109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Accepted: 11/25/2024] [Indexed: 01/18/2025] Open
Abstract
The emergence of augmented reality (AR) in surgical procedures could significantly enhance accuracy and outcomes, particularly in the complex field of orthognathic surgery. This study compares the effectiveness and accuracy of traditional drilling guides with two AR-based navigation techniques: one utilizing ArUco markers and the other employing small-workspace infrared tracking cameras for a drilling task. Additionally, an alternative AR visualization paradigm for surgical navigation is proposed that eliminates the potential inaccuracies of image detection using headset cameras. Through a series of controlled experiments designed to assess the accuracy of hole placements in surgical scenarios, the performance of each method was evaluated both quantitatively and qualitatively. The findings reveal that the small-workspace infrared tracking camera system is on par with the accuracy of conventional drilling guides, hinting at a promising future where such guides could become obsolete. This technology demonstrates a substantial advantage by circumventing the common issues encountered with traditional tracking systems and surpassing the accuracy of ArUco marker-based navigation. These results underline the potential of this system for enabling more minimally invasive interventions, a crucial step towards enhancing surgical accuracy and, ultimately, patient outcomes. The study resulted in three relevant contributions: first, a new paradigm for AR visualization in the operating room, relying only on exact tracking information to navigate the surgeon is proposed. Second, the comparative analysis marks a critical step forward in the evolution of surgical navigation, paving the way for integrating more sophisticated AR solutions in orthognathic surgery and beyond. Finally, the system with a robotic arm is integrated and the inaccuracies present in a typical human-controlled system are evaluated.
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Affiliation(s)
- Marek Żelechowski
- Center for medical Image Analysis & Navigation, Department of Biomedical EngineeringUniversity of BaselBaselSwitzerland
- Present address:
Department of Biomedical EngineeringUniversity of BaselHegenheimermattweg 167CAllschwil4123Switzerland
| | - Jokin Zubizarreta‐Oteiza
- Medical Additive Manufacturing Research Group, Department of Biomedical EngineeringUniversity of BaselBaselSwitzerland
| | - Murali Karnam
- Bio‐Inspired RObots for MEDicine‐Laboratory (BIROMED‐lab), Department of Biomedical EngineeringUniversity of BaselBaselSwitzerland
| | - Balázs Faludi
- Center for medical Image Analysis & Navigation, Department of Biomedical EngineeringUniversity of BaselBaselSwitzerland
| | - Norbert Zentai
- Center for medical Image Analysis & Navigation, Department of Biomedical EngineeringUniversity of BaselBaselSwitzerland
| | - Nicolas Gerig
- Bio‐Inspired RObots for MEDicine‐Laboratory (BIROMED‐lab), Department of Biomedical EngineeringUniversity of BaselBaselSwitzerland
| | - Georg Rauter
- Bio‐Inspired RObots for MEDicine‐Laboratory (BIROMED‐lab), Department of Biomedical EngineeringUniversity of BaselBaselSwitzerland
| | - Florian M. Thieringer
- Medical Additive Manufacturing Research Group, Department of Biomedical EngineeringUniversity of BaselBaselSwitzerland
| | - Philippe C. Cattin
- Center for medical Image Analysis & Navigation, Department of Biomedical EngineeringUniversity of BaselBaselSwitzerland
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Mounsef PJ, Aita R, Skaik K, Addab S, Hamdy RC. Three-dimensional-printing-guided preoperative planning of upper and lower extremity pediatric orthopedic surgeries: A systematic review of surgical outcomes. J Child Orthop 2024; 18:360-371. [PMID: 39100975 PMCID: PMC11295370 DOI: 10.1177/18632521241264183] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 06/10/2024] [Indexed: 08/06/2024] Open
Abstract
Purpose Three-dimensional printing has evolved into a cost-effective and accessible tool. In orthopedic surgery, creating patient-specific anatomical models and instrumentation improves visualization and surgical accuracy. In pediatric orthopedics, three-dimensional printing reduces operating time, radiation exposure, and blood loss by enhancing surgical efficacy. This review compares outcomes of three-dimensional printing-assisted surgeries with conventional surgeries for upper and lower extremity pediatric surgeries. Methods A complete search of medical literature up to August 2023, using Ovid Medline, EMBASE, Scopus, Web of Science, and Cochrane Library was conducted in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Broad search terms included "pediatrics," "orthopedic," and "3D-printing." Eligible studies were assessed for intraoperative time, blood loss, and fluoroscopy exposure. Results Out of 3299 initially identified articles, 14 articles met inclusion criteria. These studies included 409 pediatric patients, with ages averaging 9.51 years. The majority were retrospective studies (nine), with four prospective and one experimental study. Studies primarily utilized three-dimensional printing for navigation templates and implants. Results showed significant reductions in operative time, blood loss, and radiation exposure with three-dimensional printing. Complication occurrences were generally lower in three-dimensional printing surgeries, but there was no statistical significance. Conclusions Three-dimensional printing is an emerging technology in the field of orthopedics, and it is primarily used for preoperative planning. For pediatric upper and lower extremity surgeries, three-dimensional printing leads to decreased operating room time, decreased intraoperative blood loss, and reduced radiation exposure. Other uses for three-dimensional printing include education, patient communication, the creation of patient-specific instrumentation and implants. Level of evidence Level III.
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Affiliation(s)
| | | | - Khaled Skaik
- Faculty of Medicine and Health Science, McGill University, Montreal, QC, Canada
| | - Sofia Addab
- Shriners Hospitals for Children – Canada, Montreal, QC, Canada
| | - Reggie Charles Hamdy
- Faculty of Medicine and Health Science, McGill University, Montreal, QC, Canada
- Shriners Hospitals for Children – Canada, Montreal, QC, Canada
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Hess S, Husarek J, Müller M, Eberlein SC, Klenke FM, Hecker A. Applications and accuracy of 3D-printed surgical guides in traumatology and orthopaedic surgery: A systematic review and meta-analysis. J Exp Orthop 2024; 11:e12096. [PMID: 39135870 PMCID: PMC11317891 DOI: 10.1002/jeo2.12096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 05/24/2024] [Accepted: 06/03/2024] [Indexed: 08/15/2024] Open
Abstract
Background Patient-Specific Surgical Guides (PSSGs) are advocated for reducing radiation exposure, operation time and enhancing precision in surgery. However, existing accuracy assessments are limited to specific surgeries, leaving uncertainties about variations in accuracy across different anatomical sites, three-dimensional (3D) printing technologies and manufacturers (traditional vs. printed at the point of care). This study aimed to evaluate PSSGs accuracy in traumatology and orthopaedic surgery, considering anatomical regions, printing methods and manufacturers. Methods A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Studies were eligible if they (1) assessed the accuracy of PSSGs by comparing preoperative planning and postoperative results in at least two different planes (2) used either computer tomography or magnetic resonance imaging (3) covered the field of orthopaedic surgery or traumatology and (4) were available in English or German language. The 'Quality Assessment Tool for Quantitative Studies' was used for methodological quality assessment. Descriptive statistics, including mean, standard deviation, and ranges, are presented. A random effects meta-analysis was performed to determine the pooled mean absolute deviation between preoperative plan and postoperative result for each anatomic region (shoulder, hip, spine, and knee). Results Of 4212 initially eligible studies, 33 were included in the final analysis (8 for shoulder, 5 for hip, 5 for spine, 14 for knee and 1 for trauma). Pooled mean deviation (95% confidence interval) for total knee arthroplasty (TKA), total shoulder arthroplasty (TSA), total hip arthroplasty (THA) and spine surgery (pedicle screw placement during spondylodesis) were 1.82° (1.48, 2.15), 2.52° (1.9, 3.13), 3.49° (3.04, 3.93) and 2.67° (1.64, 3.69), respectively. Accuracy varied between TKA and THA and between TKA and TSA. Conclusion Accuracy of PSSGs depends on the type of surgery but averages around 2-3° deviation from the plan. The use of PSSGs might be considered for selected complex cases. Level of Evidence Level 3 (meta-analysis including Level 3 studies).
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Affiliation(s)
- Silvan Hess
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Julius Husarek
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
- Faculty of MedicineUniversity of BernBernSwitzerland
- Faculty of MedicineMedical University of SofiaSofiaBulgaria
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Sophie C. Eberlein
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Frank M. Klenke
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Andreas Hecker
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
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Capek L, Schwarz D. 3D printing traceability in healthcare using 3Diamond software. Heliyon 2024; 10:e32664. [PMID: 38975088 PMCID: PMC11225769 DOI: 10.1016/j.heliyon.2024.e32664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 05/27/2024] [Accepted: 06/06/2024] [Indexed: 07/09/2024] Open
Abstract
Background 3D printing is one of the fastest-growing technologies in medicine, but it is essential to have a system for 3D printing documentation that is accessible for not only clinical engineers and surgeons, but also quality managers and data-privacy officers in hospitals. Dedicated software such as product lifecycle management (PLM) software could enable comprehensive management and traceability of all data relevant to 3D printing tasks in a hospital and would highly beneficial. Therefore, customizable software called 3Diamond was developed for 3D printing in medicine. Methods The software development process involved several stages, including setting specifications based on end-user requirements, design, implementation, and testing. In order to ensure the software's long-term success and smooth operation, critical phases were also considered, such as deployment and maintenance. Results The developed software provides immediate and complete traceability of all preparations and controls, as well as management of reports, orders, stock, and post-operative follow-up of tasks related to 3D printing in a hospital. Based on user requirements, software testing is provided automatically with each release. The software was implemented in a natural clinical environment with a developed 3D printing center. Conclusion Although 3D printing has potential for innovation in the medical profession, it is nevertheless subject to regulations. Even though there are exemptions for patient-specific products, the effects of their local legal implementations related to 3D printing cannot be fully overseen. To this end, 3Diamond provides a robust system for 3D printing documentation that is accessible to different personnel in hospitals.
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Affiliation(s)
- Lukas Capek
- Dept. of Clinical Biomechanics, Regional Hospital in Liberec, Husova 10, 46001, Liberec, Czech Republic
| | - Daniel Schwarz
- Institute of Biostatistics and Analyses Ltd., Postovska 3, 60200, Brno, Czech Republic
- Department of Simulation Medicine, Kamenice 5, 62500, Brno, Czech Republic
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12
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Maintz M, Tourbier C, de Wild M, Cattin PC, Beyer M, Seiler D, Honigmann P, Sharma N, Thieringer FM. Patient-specific implants made of 3D printed bioresorbable polymers at the point-of-care: material, technology, and scope of surgical application. 3D Print Med 2024; 10:13. [PMID: 38639834 PMCID: PMC11031859 DOI: 10.1186/s41205-024-00207-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/04/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Bioresorbable patient-specific additive-manufactured bone grafts, meshes, and plates are emerging as a promising alternative that can overcome the challenges associated with conventional off-the-shelf implants. The fabrication of patient-specific implants (PSIs) directly at the point-of-care (POC), such as hospitals, clinics, and surgical centers, allows for more flexible, faster, and more efficient processes, reducing the need for outsourcing to external manufacturers. We want to emphasize the potential advantages of producing bioresorbable polymer implants for cranio-maxillofacial surgery at the POC by highlighting its surgical applications, benefits, and limitations. METHODS This study describes the workflow of designing and fabricating degradable polymeric PSIs using three-dimensional (3D) printing technology. The cortical bone was segmented from the patient's computed tomography data using Materialise Mimics software, and the PSIs were designed created using Geomagic Freeform and nTopology software. The implants were finally printed via Arburg Plastic Freeforming (APF) of medical-grade poly (L-lactide-co-D, L-lactide) with 30% β-tricalcium phosphate and evaluated for fit. RESULTS 3D printed implants using APF technology showed surfaces with highly uniform and well-connected droplets with minimal gap formation between the printed paths. For the plates and meshes, a wall thickness down to 0.8 mm could be achieved. In this study, we successfully printed plates for osteosynthesis, implants for orbital floor fractures, meshes for alveolar bone regeneration, and bone scaffolds with interconnected channels. CONCLUSIONS This study shows the feasibility of using 3D printing to create degradable polymeric PSIs seamlessly integrated into virtual surgical planning workflows. Implementing POC 3D printing of biodegradable PSI can potentially improve therapeutic outcomes, but regulatory compliance must be addressed.
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Affiliation(s)
- Michaela Maintz
- Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, Basel, Switzerland
- Department of Biomedical Engineering, Medical Additive Manufacturing Research Group (Swiss MAM), University of Basel, Hegenheimermattweg 167C, Allschwil, Switzerland
- Institute for Medical Engineering and Medical Informatics IM², University of Applied Sciences and Arts Northwestern Switzerland FHNW, Hofackerstrasse 30, Muttenz, Switzerland
| | - Céline Tourbier
- Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, Basel, Switzerland.
- Department of Biomedical Engineering, Medical Additive Manufacturing Research Group (Swiss MAM), University of Basel, Hegenheimermattweg 167C, Allschwil, Switzerland.
| | - Michael de Wild
- Institute for Medical Engineering and Medical Informatics IM², University of Applied Sciences and Arts Northwestern Switzerland FHNW, Hofackerstrasse 30, Muttenz, Switzerland
| | - Philippe C Cattin
- Department of Biomedical Engineering, Center of Medical Image Analysis and Navigation (CIAN), University of Basel, Hegenheimermattweg 167C, Allschwil, Basel, Switzerland
| | - Michel Beyer
- Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, Basel, Switzerland
- Department of Biomedical Engineering, Medical Additive Manufacturing Research Group (Swiss MAM), University of Basel, Hegenheimermattweg 167C, Allschwil, Switzerland
| | - Daniel Seiler
- Institute for Medical Engineering and Medical Informatics IM², University of Applied Sciences and Arts Northwestern Switzerland FHNW, Hofackerstrasse 30, Muttenz, Switzerland
| | - Philipp Honigmann
- Department of Biomedical Engineering, Medical Additive Manufacturing Research Group (Swiss MAM), University of Basel, Hegenheimermattweg 167C, Allschwil, Switzerland
- Department of Orthopaedic Surgery and Traumatology, Hand- and peripheral Nerve Surgery, Kantonsspital Baselland, Bruderholz| Liestal| Laufen, Switzerland
- Biomedical Engineering and Physics, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Neha Sharma
- Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, Basel, Switzerland
- Department of Biomedical Engineering, Medical Additive Manufacturing Research Group (Swiss MAM), University of Basel, Hegenheimermattweg 167C, Allschwil, Switzerland
| | - Florian M Thieringer
- Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, Basel, Switzerland
- Department of Biomedical Engineering, Medical Additive Manufacturing Research Group (Swiss MAM), University of Basel, Hegenheimermattweg 167C, Allschwil, Switzerland
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Aiba H, Spazzoli B, Tsukamoto S, Mavrogenis AF, Hermann T, Kimura H, Murakami H, Donati DM, Errani C. Current Concepts in the Resection of Bone Tumors Using a Patient-Specific Three-Dimensional Printed Cutting Guide. Curr Oncol 2023; 30:3859-3870. [PMID: 37185405 PMCID: PMC10136997 DOI: 10.3390/curroncol30040292] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/25/2023] [Accepted: 03/29/2023] [Indexed: 04/01/2023] Open
Abstract
Orthopedic oncology has begun to use three-dimensional-printing technology, which is expected to improve the accuracy of osteotomies, ensure a safe margin, and facilitate precise surgery. However, several difficulties should be considered. Cadaver and clinical studies have reported more accurate osteotomies for bone-tumor resection using patient-specific cutting guides, especially in challenging areas such as the sacrum and pelvis, compared to manual osteotomies. Patient-specific cutting guides can help surgeons achieve resection with negative margins and reduce blood loss and operating time. Furthermore, this patient-specific cutting guide could be combined with more precise reconstruction using patient-specific implants or massive bone allografts. This review provides an overview of the basic technologies used in the production of patient-specific cutting guides and discusses their current status, advantages, and limitations. Moreover, we summarize cadaveric and clinical studies on the use of these guides in orthopedic oncology.
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Affiliation(s)
- Hisaki Aiba
- Department of Orthopedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
- Department of Orthopedic Surgery, Nagoya City University, Nagoya 467-8601, Aichi, Japan
| | - Benedetta Spazzoli
- Department of Orthopedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Shinji Tsukamoto
- Department of Orthopedic Surgery, Nara Medical University, Kashihara 634-8521, Nara, Japan
| | - Andreas F Mavrogenis
- First Department of Orthopedics, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Tomas Hermann
- Department of Orthopedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
- Department of Tumors, HTC Hospital, Traumagologico Concepcion, 1580 San Martin, Concepcion 4030000, Chile
| | - Hiroaki Kimura
- Department of Orthopedic Surgery, Nagoya City University, Nagoya 467-8601, Aichi, Japan
| | - Hideki Murakami
- Department of Orthopedic Surgery, Nagoya City University, Nagoya 467-8601, Aichi, Japan
| | - Davide Maria Donati
- Department of Orthopedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Costantino Errani
- Department of Orthopedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
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Zamri MF, Ng BW, Jamil K, Abd Rashid AH, Abd Rasid AF. Office Three-Dimensional Printed Osteotomy Guide for Corrective Osteotomy in Fibrous Dysplasia. Cureus 2023; 15:e36384. [PMID: 37090315 PMCID: PMC10115740 DOI: 10.7759/cureus.36384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 03/22/2023] Open
Abstract
Fibrous dysplasia is a benign condition but can lead to severe long-bone deformities. Three-dimensional (3D) printing technology is a rapidly developing field that has now been popularized to aid surgeons in preoperative planning. We report a case of hip deformity in a 21-year-old woman who suffered from fibrous dysplasia and underwent a corrective osteotomy. We utilized open-source 3D computing software for preoperative planning before producing an osteotomy guide to aid in the operation.
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Pérez-Mañanes R, Calvo-Haro J. [Translated article] PERSONALISED MEDICINE: HOSPITAL-BASED ACADEMIC MANUFACTURING OF CUSTOMISED MEDICAL DEVICES IN ORTHOPAEDIC SURGERY AND TRAUMATOLOGY. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:T81-T82. [PMID: 36868739 DOI: 10.1016/j.recot.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Affiliation(s)
- R Pérez-Mañanes
- Servicio de Cirugía Ortopédica y Traumatología. Hospital General Universitario Gregorio Marañón, Spain; CSUR de Sarcomas y Otros Tumores Músculo Esqueléticos del Adulto. Red europea EURACAN, Spain; Universidad Complutense de Madrid, Spain; Unidad de Planificación Avanzada y Manufactura 3D (UPAM3D), Spain.
| | - J Calvo-Haro
- Servicio de Cirugía Ortopédica y Traumatología. Hospital General Universitario Gregorio Marañón, Spain; CSUR de Sarcomas y Otros Tumores Músculo Esqueléticos del Adulto. Red europea EURACAN, Spain; Universidad Complutense de Madrid, Spain; Unidad de Planificación Avanzada y Manufactura 3D (UPAM3D), Spain
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16
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Pérez-Mañanes R, Calvo-Haro J. PERSONALISED MEDICINE: HOSPITAL-BASED ACADEMIC MANUFACTURING OF CUSTOMISED MEDICAL DEVICES IN ORTHOPAEDIC SURGERY AND TRAUMATOLOGY. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:81-82. [PMID: 36868738 DOI: 10.1016/j.recot.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Affiliation(s)
- R Pérez-Mañanes
- Servicio de Cirugía Ortopédica y Traumatología. Hospital General Universitario Gregorio Marañón; CSUR de Sarcomas y Otros Tumores Músculo Esqueléticos del Adulto. Red europea EURACAN; Universidad Complutense de Madrid; Unidad de Planificación Avanzada y Manufactura 3D (UPAM3D).
| | - J Calvo-Haro
- Servicio de Cirugía Ortopédica y Traumatología. Hospital General Universitario Gregorio Marañón; CSUR de Sarcomas y Otros Tumores Músculo Esqueléticos del Adulto. Red europea EURACAN; Universidad Complutense de Madrid; Unidad de Planificación Avanzada y Manufactura 3D (UPAM3D)
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Mendonça CJA, Guimarães RMDR, Pontim CE, Gasoto SC, Setti JAP, Soni JF, Schneider B. An Overview of 3D Anatomical Model Printing in Orthopedic Trauma Surgery. J Multidiscip Healthc 2023; 16:875-887. [PMID: 37038452 PMCID: PMC10082616 DOI: 10.2147/jmdh.s386406] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/09/2022] [Indexed: 04/12/2023] Open
Abstract
Introduction 3D object printing technology is a resource increasingly used in medicine in recent years, mainly incorporated in surgical areas like orthopedics. The models made by 3D printing technology provide surgeons with an accurate analysis of complex anatomical structures, allowing the planning, training, and surgery simulation. In orthopedic surgery, this technique is especially applied in oncological surgeries, bone, and joint reconstructions, and orthopedic trauma surgeries. In these cases, it is possible to prototype anatomical models for surgical planning, simulating, and training, besides printing of instruments and implants. Purpose The purpose of this paper is to describe the acquisition and processing from computed tomography images for 3D printing, to describe modeling and the 3D printing process of the biomodels in real size. This paper highlights 3D printing with the applicability of the 3D biomodels in orthopedic surgeries and shows some examples of surgical planning in orthopedic trauma surgery. Patients and Methods Four examples were selected to demonstrate the workflow and rationale throughout the process of planning and printing 3D models to be used in a variety of situations in orthopedic trauma surgeries. In all cases, the use of 3D modeling has impacted and improved the final treatment strategy. Conclusion The use of the virtual anatomical model and the 3D printed anatomical model with the additive manufacturing technology proved to be effective and useful in planning and performing the surgical treatment of complex articular fractures, allowing surgical planning both virtual and with the 3D printed anatomical model, besides being useful during the surgical time as a navigation instrument.
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Affiliation(s)
- Celso Junio Aguiar Mendonça
- Musculoskeletal System Unit, Hospital of Federal University of Paraná, Curitiba, Paraná, Brazil
- Postgraduate Program in Electrical Engineering and Industrial Informatics, Hospital of the Federal University of Paraná, Curitiba, Paraná, Brazil
- Correspondence: Celso Junio Aguiar Mendonça, Postgraduate Program in Electrical Engineering and Industrial Informatics – CPGEI, Federal Technological University of Paraná – UTFPR, Av. Sete de Setembro, 3165 – Rebouças, Curitiba, Paraná, 80230-901, Brazil, Tel +55 41 999973900, Email
| | - Ricardo Munhoz da Rocha Guimarães
- Cajuru University Hospital, Pontifical Catholic University of Paraná, Curitiba, Paraná, Brazil
- Postgraduate Program in Biomedical Engineering, Hospital of the Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Carlos Eduardo Pontim
- Postgraduate Program in Biomedical Engineering, Hospital of the Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Sidney Carlos Gasoto
- Postgraduate Program in Electrical Engineering and Industrial Informatics, Hospital of the Federal University of Paraná, Curitiba, Paraná, Brazil
| | - João Antonio Palma Setti
- Postgraduate Program in Biomedical Engineering, Hospital of the Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Jamil Faissal Soni
- Musculoskeletal System Unit, Hospital of Federal University of Paraná, Curitiba, Paraná, Brazil
- Cajuru University Hospital, Pontifical Catholic University of Paraná, Curitiba, Paraná, Brazil
| | - Bertoldo Schneider
- Postgraduate Program in Electrical Engineering and Industrial Informatics, Hospital of the Federal University of Paraná, Curitiba, Paraná, Brazil
- Postgraduate Program in Biomedical Engineering, Hospital of the Federal University of Paraná, Curitiba, Paraná, Brazil
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Park JW, Kang HG. Application of 3-dimensional printing implants for bone tumors. Clin Exp Pediatr 2022; 65:476-482. [PMID: 34942688 PMCID: PMC9561186 DOI: 10.3345/cep.2021.01326] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/03/2021] [Indexed: 11/27/2022] Open
Abstract
Three-dimensional (3D) additive manufacturing has recently been used in various medical fields. Among them, orthopedic oncology is one that utilizes it most actively. Bone and tumor modeling for surgical planning, personalized surgical instrument fabrication, and implant fabrication are typical applications. The 3D-printed metal implants using titanium alloy powder have created a revolutionary change in bone reconstruction that can be customized to all body areas; however, bioprinting remains experimental and under active study. This review explores the practical applications of 3D printing in orthopedic oncology and presents a representative case. The 3D-printed implant can replace the conventional tumor prosthesis and auto/allobone graft, thereby personalizing bone reconstruction. Biologic bone reconstruction using biodegradable or bioprinted materials beyond metal may be possible in the future.
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Affiliation(s)
- Jong Woong Park
- Orthopaedic Oncology Clinic, National Cancer Center, Goyang, Korea.,Division of Convergence Technology, National Cancer Center, Goyang, Korea
| | - Hyun Guy Kang
- Orthopaedic Oncology Clinic, National Cancer Center, Goyang, Korea.,Division of Convergence Technology, National Cancer Center, Goyang, Korea
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Habib A, Jovanovich N, Muthiah N, Alattar A, Alan N, Agarwal N, Ozpinar A, Hamilton DK. 3D printing applications in spine surgery: an evidence-based assessment toward personalized patient care. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:1682-1690. [PMID: 35590016 DOI: 10.1007/s00586-022-07250-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Spine surgery entails a wide spectrum of complicated pathologies. Over the years, numerous assistive tools have been introduced to the modern neurosurgeon's armamentarium including neuronavigation and visualization technologies. In this review, we aimed to summarize the available data on 3D printing applications in spine surgery as well as an assessment of the future implications of 3D printing. METHODS We performed a comprehensive review of the literature on 3D printing applications in spine surgery. RESULTS Over the past decade, 3D printing and additive manufacturing applications, which allow for increased precision and customizability, have gained significant traction, particularly spine surgery. 3D printing applications in spine surgery were initially limited to preoperative visualization, as 3D printing had been primarily used to produce preoperative models of patient-specific deformities or spinal tumors. More recently, 3D printing has been used intraoperatively in the form of 3D customizable implants and personalized screw guides. CONCLUSIONS Despite promising preliminary results, the applications of 3D printing are so recent that the available data regarding these new technologies in spine surgery remains scarce, especially data related to long-term outcomes.
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Affiliation(s)
- Ahmed Habib
- Department of Neurosurgery, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA, USA.,Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Nicolina Jovanovich
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Nallammai Muthiah
- Department of Neurosurgery, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA, USA
| | - Ali Alattar
- Department of Neurosurgery, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA, USA
| | - Nima Alan
- Department of Neurosurgery, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA, USA
| | - Nitin Agarwal
- Department of Neurosurgery, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA, USA
| | - Alp Ozpinar
- Department of Neurosurgery, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA, USA.
| | - David Kojo Hamilton
- Department of Neurosurgery, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA, USA
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Additive Manufacturing Strategies for Personalized Drug Delivery Systems and Medical Devices: Fused Filament Fabrication and Semi Solid Extrusion. MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27092784. [PMID: 35566146 PMCID: PMC9100145 DOI: 10.3390/molecules27092784] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/15/2022] [Accepted: 04/22/2022] [Indexed: 12/26/2022]
Abstract
Novel additive manufacturing (AM) techniques and particularly 3D printing (3DP) have achieved a decade of success in pharmaceutical and biomedical fields. Highly innovative personalized therapeutical solutions may be designed and manufactured through a layer-by-layer approach starting from a digital model realized according to the needs of a specific patient or a patient group. The combination of patient-tailored drug dose, dosage, or diagnostic form (shape and size) and drug release adjustment has the potential to ensure the optimal patient therapy. Among the different 3D printing techniques, extrusion-based technologies, such as fused filament fabrication (FFF) and semi solid extrusion (SSE), are the most investigated for their high versatility, precision, feasibility, and cheapness. This review provides an overview on different 3DP techniques to produce personalized drug delivery systems and medical devices, highlighting, for each method, the critical printing process parameters, the main starting materials, as well as advantages and limitations. Furthermore, the recent developments of fused filament fabrication and semi solid extrusion 3DP are discussed. In this regard, the current state of the art, based on a detailed literature survey of the different 3D products printed via extrusion-based techniques, envisioning future directions in the clinical applications and diffusion of such systems, is summarized.
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Willemsen K, Magré J, Mol J, Noordmans HJ, Weinans H, Hekman EEG, Kruyt MC. Vital Role of In-House 3D Lab to Create Unprecedented Solutions for Challenges in Spinal Surgery, Practical Guidelines and Clinical Case Series. J Pers Med 2022; 12:395. [PMID: 35330395 PMCID: PMC8951204 DOI: 10.3390/jpm12030395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/17/2022] Open
Abstract
For decades, the advantages of rapid prototyping for clinical use have been recognized. However, demonstrations of potential solutions to treat spinal problems that cannot be solved otherwise are scarce. In this paper, we describe the development, regulatory process, and clinical application of two types of patient specific 3D-printed devices that were developed at an in-house 3D point-of-care facility. This 3D lab made it possible to elegantly treat patients with spinal problems that could not have been treated in a conventional manner. The first device, applied in three patients, is a printed nylon drill guide, with such accuracy that it can be used for insertion of cervical pedicle screws in very young children, which has been applied even in semi-acute settings. The other is a 3D-printed titanium spinal column prosthesis that was used to treat progressive and severe deformities due to lysis of the anterior column in three patients. The unique opportunity to control size, shape, and material characteristics allowed a relatively easy solution for these patients, who were developing paraplegia. In this paper, we discuss the pathway toward the design and final application, including technical file creation for dossier building and challenges within a point-of-care lab.
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Affiliation(s)
- Koen Willemsen
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (J.M.); (J.M.); (H.W.); (M.C.K.)
- 3D Lab, Division of Surgical Specialties, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Joëll Magré
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (J.M.); (J.M.); (H.W.); (M.C.K.)
- 3D Lab, Division of Surgical Specialties, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Jeroen Mol
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (J.M.); (J.M.); (H.W.); (M.C.K.)
| | - Herke Jan Noordmans
- Department of Medical Technology and Clinical Physics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Harrie Weinans
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (J.M.); (J.M.); (H.W.); (M.C.K.)
- Department Biomechanical Engineering, Delft University of Technology, 2628 CD Delft, The Netherlands
| | - Edsko E. G. Hekman
- Department of Biomechanical Engineering, Twente University, 7522 NB Enschede, The Netherlands;
| | - Moyo C. Kruyt
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (J.M.); (J.M.); (H.W.); (M.C.K.)
- Department of Biomechanical Engineering, Twente University, 7522 NB Enschede, The Netherlands;
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22
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Addressing the Needs of the Rapidly Aging Society through the Development of Multifunctional Bioactive Coatings for Orthopedic Applications. Int J Mol Sci 2022; 23:ijms23052786. [PMID: 35269928 PMCID: PMC8911303 DOI: 10.3390/ijms23052786] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 02/27/2022] [Accepted: 02/28/2022] [Indexed: 12/15/2022] Open
Abstract
The unprecedented aging of the world's population will boost the need for orthopedic implants and expose their current limitations to a greater extent due to the medical complexity of elderly patients and longer indwelling times of the implanted materials. Biocompatible metals with multifunctional bioactive coatings promise to provide the means for the controlled and tailorable release of different medications for patient-specific treatment while prolonging the material's lifespan and thus improving the surgical outcome. The objective of this work is to provide a review of several groups of biocompatible materials that might be utilized as constituents for the development of multifunctional bioactive coatings on metal materials with a focus on antimicrobial, pain-relieving, and anticoagulant properties. Moreover, the review presents a summary of medications used in clinical settings, the disadvantages of the commercially available products, and insight into the latest development strategies. For a more successful translation of such research into clinical practice, extensive knowledge of the chemical interactions between the components and a detailed understanding of the properties and mechanisms of biological matter are required. Moreover, the cost-efficiency of the surface treatment should be considered in the development process.
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Gandapur HK, Amin MS. Orthopaedics and Additive Manufacturing: The Start of a New Era. Pak J Med Sci 2022; 38:751-756. [PMID: 35480542 PMCID: PMC9002451 DOI: 10.12669/pjms.38.3.5182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 10/20/2021] [Indexed: 11/28/2022] Open
Abstract
The aim of this article is to report the recent surge in use of additive manufacturing (AM) or three-dimensional printing (3DP) services in healthcare, especially the field of orthopaedics. Pakistan's healthcare infrastructure has been slow in adapting and implementing this new technology which is an integral part of the industry 4.0. Various sources including Pubmed, ScienceDirect, Google Scholar and Google were utilised from June to august 2021 to extract articles and information on advantages of AM in orthopaedics. Furthermore, its possible acquisition by a hospital, educational or an industrial setup is also highlighted in this review.
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Affiliation(s)
| | - M. Suhail Amin
- Prof. Maj. Gen. M. Suhail Amin, MRCS (Ed), MCPS (HPE), FCPS (Surg), FCPS (Ortho). Dean, Armed Forces Postgraduate Medical Institute, Professor, Army Medical College, Rawalpindi, Combined Military Hospital, Rawalpindi, Pakistan
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Huang XW, Hong GQ, Zuo Q, Chen Q. Intracortical screw insertion plus limited open reduction in treating type 31A3 irreducible intertrochanteric fractures in the elderly. World J Clin Cases 2021; 9:9752-9761. [PMID: 34877314 PMCID: PMC8610916 DOI: 10.12998/wjcc.v9.i32.9752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/28/2021] [Accepted: 08/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In most elderly patients with intertrochanteric fractures, satisfactory fracture reduction can be achieved by closed reduction using a traction table. However, intertrochanteric fractures cannot achieve satisfactory reduction in a few patients, which is called irreducible intertrochanteric fractures. Especially for type 31A3 irreducible intertrochanteric fractures, limited open reduction of the broken end with different intraoperative reduction methods is required to achieve satisfactory reduction and fixation.
AIM To discuss clinical efficacy of intracortical screw insertion plus limited open reduction in type 31A3 irreducible intertrochanteric fractures in the elderly.
METHODS A retrospective analysis was performed on 23 elderly patients with type 31A3 irreducible intertrochanteric fractures (12 males and 11 females, aged 65-89-years-old) who received treatment at the orthopedics department. After type 31A3 irreducible intertrochanteric fractures were confirmed by intraoperative C-arm, all of these cases received intracortical screw insertion plus limited open reduction in the broken end with intramedullary screw internal fixation. The basic information of surgery, reduction effects, and functional recovery scores of the hip joint were assessed.
RESULTS All patients were followed up for 13.8 mo on average. The operation time was 53.8 ± 13.6 min (40-95 min). The intraoperative blood loss was 218.5 ± 28.6 mL (170-320 mL). The average number of intraoperative X-rays was 22.8 ± 4.6 (18-33). The average time to fracture union was 4.8 ± 0.7 mo. The reduction effect was assessed using Kim’s fracture reduction evaluation. Twenty cases achieved grade I fracture reduction and three cases grade II fracture reduction. All of them achieved excellent or good fracture reduction. Upon the last follow-up, the functional recovery scores score was 83.6 ± 9.8, which was not significantly different from the functional recovery scores score (84.8 ± 10.7) before the fracture (t = 0.397, P = 0.694).
CONCLUSION With careful preoperative preparation, intracortical screw insertion plus limited open reduction contributed to high-quality fracture reduction and fixation. Good clinical outcomes were achieved without increasing operation time and intraoperative blood loss.
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Affiliation(s)
- Xiao-Wen Huang
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing 210029, Jiangsu Province, China
| | - Gu-Qi Hong
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing 210029, Jiangsu Province, China
| | - Qiang Zuo
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing 210029, Jiangsu Province, China
| | - Qun Chen
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing 210029, Jiangsu Province, China
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