The use of Three-Dimensional Printing in Orthopaedics: a Systematic Review and Meta-analysis

Document Type : SYSTEMATIC REVIEW

Authors

1 Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom- School of Clinical Medicine, University Of Cambridge, Cambridge, United Kingdom

2 Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom

3 Department of Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom

4 Kellogg College, University of Oxford, Oxford, United Kingdom - Medical Sciences Division, Oxford University Hospitals, University of Oxford, Oxford, United Kingdom

Abstract

Objectives: 3D-printing is a rapidly developing technology with applications in orthopaedics including 
pre-operative planning, intraoperative guides, design of patient specific instruments and prosthetics, 
and education. Existing literature demonstrates that in the surgical trea tment of a wide range of 
orthopaedic pathology, using 3D printing shows favourable outcomes. Despite this evidence 3D printing 
is not routinely used in orthopaedic practice. We aim to evaluate the advantages of 3D printing in 
orthopaedic surgery to demonstrate its widespread applications throughout the field.
Methods: We performed a comprehensive systematic review and meta-analysis. AMED, EMBASE, EMCARE, 
HMIC, PsycINFO, PubMed, BNI, CINAHL and Medline databases were searched using Healthcare Databases 
Advanced Search (HDAS) platform. The search was conducted to include papers published before 8th November 
2020. Clinical trials, journal articles, Randomised Control Trials and Case Series were included across any area of 
orthopaedic surgery. The primary outcomes measured were operation time, blood loss, fluoroscopy time, bone 
fusion time and length of hospital stay.
Results: A total of 65 studies met the inclusion criteria and were reviewed, and 15 were suitable for the metaanalysis, producing a data set of 609 patients. The use of 3D printing in any of its recognised applications across 
orthopaedic surgery showed an overall reduction in operative time (SMD = -1.30; 95%CI: -1.73, -0.87), reduction in 
intraoperative blood loss (SMD = -1.58; 95%CI: -2.16, -1.00) and reduction in intraoperative fluoroscopy time (SMD 
= -1.86; 95%CI: -2.60, -1.12). There was no significant difference in length of hospital stay or in bone fusion time 
post-operatively.
Conclusion: The use of 3D printing in orthopaedics leads to an improvement in primary outcome measures showing 
reduced operative time, intraoperative blood loss and number of times fluoroscopy is used. With its wide-reaching 
applications and as the technology improves, 3D printing could become a valuable addition to an orthopaedic 
surgeon’s toolbox.
 Level of evidence: I

Keywords

Main Subjects

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The Archives of Bone and Joint Surgery
Volume 12, Issue 7
July 2024
Pages 441-456

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History

  • Receive Date: 26 October 2023
  • Revise Date: 03 December 2023
  • Accept Date: 13 March 2024

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