P. Andrés-Canoa,∗, J.A. Calvo-Haro b,c, F. Fillat-Gomà d, I. Andrés-Cano e, R. Perez-Ma˜nanes b,c

a Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen del Rocío, Sevilla, Spain

b Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Mara˜nón, Madrid, Spain

c Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain

d Unidad de Planificación Quirúrgica 3D, Departamento de Cirugía Ortopédica y Traumatología, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain

e Departamento de Radiodiagnóstico Hospital Universitario Puerta del Mar, Cádiz, Spain

Abstract

      3D printing (I3D) is an additive manufacturing technology with a growing interest in medicine and especially in the specialty of Orthopaedic Surgery and Traumatology. There are numerous applications that add value to the personalised treatment of patients: advanced preoperative planning, surgeries with specific tools for each patient, customised orthotic treatments, personalised implants or prostheses and innovative development in the field of bone and cartilage tissue engineering.

      This paper provides an update on the role that the orthopaedic surgeon and traumatologist plays as a user and prescriber of this technology and a review of the stages required for the correct integration of I3D into the hospital care flow, from the necessary resources to the current legal recommendations.

KEYWORDS

Additive manufacturing; Patient-specific  surgical guide; Custom implants; Bioprinting; Medical 3d printing

PALABRAS CLAVE

Fabricación de aditivos; Guía quirúrgica específica para el paciente; Implantes personalizados; Bioimpresión; Impresión médica en 3D

Resumen

      La impresión 3D (I3D) es una tecnología de fabricación aditiva con un creciente interés en medicina y sobre todo en la especialidad de Cirugía Ortopédica y Traumatología. Hay numerosas aplicaciones que aportan un valor a ˜ nadido al tratamiento personalizado de los pacientes: planificación preoperatoria avanzada, cirugías con herramientas específicas para cada paciente, tratamientos ortésicos a medida, implantes o prótesis personalizadas y un desarrollo innovador en el campo de la ingeniería de tejidos óseos y cartilaginosos.

      En el presente trabajo se realiza una actualización sobre el papel que el cirujano ortopédico y traumatólogo desempe˜ na como usuario y como médico prescriptor de esta tecnología y un repaso a las etapas necesarias para una correcta integración de la I3D en el flujo asistencial hospitalario, desde los recursos necesarios hasta las recomendaciones legales actuales. © 2020 SECOT. Publicado por Elsevier Espa˜na, S.L.U. Este es un art´ıculo Open Access bajo la licencia CC BY-NC-ND (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Hitesh Lal, Mohit Kumar Patralekh*

Central Institute of Orthopaedics, Safdarjung Hospital and VMMC, New Delhi, 110029, India

abstract

Background: With rapid emergence of 3D printing technology, surgeons have recently started to apply this for nearly all areas of orthopaedic trauma surgery. Computed tomography or magnetic resonance images of trauma patients can be utilized for making graspable objects from 3D reconstructed images. Patient specifific anatomical models can thereby be created. They enhance surgeon's knowledge of their patients' precise patho-anatomy, regarding both traumatized bones and soft tissue as well as normal areas, and therefore help in accurate preoperative planning. 3D printed patient specifific instrumentation can help to achieve precise implant placement, and better surgical results. Most importantly, customized implants, casts, orthoses and prosthetics can be manufactured to match an individual's anatomy. Three dimensional (3D) printing, also called as ‘additive manufacturing’ and ‘rapid prototyping’ is considered as the “second industrial revolution”, and this appears to be especially true for orthopaedic trauma surgery.

Methods: A literature search was performed for extracting all papers related to 3D Printing applications in orthopaedics and allied sciences on the Pubmed, and SCOPUS; using suitable key terms and Boolean operators (“3D Printing” OR “3 dimensional printing” OR “3D printed” OR “additive manufacturing” OR “rapid prototyping”) AND (‘‘Orthopaedics” OR “Orthopaedics’’) AND (“Trauma” OR “Injury”)in June 2018. Search was also performed in Web of Science, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews. No limits were set on the time period or evidence level, as 3D printing in orthopaedics is relatively recent and mainly low level evidence is available. Titles and abstracts were screened and all duplicate and unrelated papers were excluded. Papers related to orthopaedic trauma were manually selected for this review.

Results: The search on Pubmed retrieved 144 Papers and similar search on SCOPUS retrieved 94 papers. Additional searches did not reveal more relevant papers. After excluding duplicates and unrelated papers, and on screening of titles and abstracts, 59 papers were considered for review. Papers related to spine fractures only were not included, as they have been covered in another paper in this journal issue.

Conclusion: All over the world, orthopaedic Surgeon's and allied professionals and scientists are enthusiastically using 3D printing technology for designing patient specifific models, instrumentation, implants, orthosis and prosthesis, besides 3D bioprinting of bone and cartilage scaffolding, and the same has been applied for nearly all areas of orthopaedic trauma surgery, from head to foot.

article info

Article history: Received 19 July 2018 Accepted 31 July 2018 Available online 3 August 2018

Keywords: 3D Printing  Rapid prototyping  Additive manufacturing  Orthopaedics Trauma