4 Applications of 3D Printing in Orthopedics

3D printing in orthopedic surgery has unlimited potential.

Also called additive manufacturing, 3D printing is exciting, cutting-edge technology — but that doesn’t mean it’s out of reach for orthopedic surgeons. 

A digital file is used to create a physical object by fusing a material together, usually layer by layer, in three-dimensional printing. Traditional printing process manufacturing methods require a mold or a block of material to create something, whereas 3D printing doesn’t, meaning you can make minor adjustments quickly.

Research shows that the benefits of using 3D printing include reduced operative time and estimated blood loss. This technology has changed how orthopedic surgeons approach many aspects of their field, including the design and creation of implants and prostheses, surgical planning, and instruments designed specifically to fit each patient’s needs and anatomy.

3D printing is versatile. That means there are many medical applications of the technology for orthopedic surgeons to capitalize on, providing an advantage in the field and improving patient outcomes.

Preoperative planning

Surgeons rely on medical imaging like CT scans, X-rays, and MRIs to show them what they’ll face on the surgical table — bone defects, injuries, broken bones, tumors, and more. 3D printing takes traditional imaging a step further with life-size, accurate depictions of the patient’s actual anatomy and trauma.

At the preoperative stage, 3D-printed anatomical models allow physicians to simulate surgical procedures and determine the best approach. The models can also help surgeons identify potential issues that may arise in surgery — like an improperly fitted implant — before opening their patient, leading to a more successful procedure.

The benefit of having a clearer picture before surgery not only means more successful surgeries but also quicker recovery for patients and better outcomes overall. Surgeons can also use 3D-printed models to explain to patients what the surgery will entail, easing patient fears by deepening their understanding of the surgery.

In a 2019 study, radiological images were compared with life-size 3D-printed models when selecting anatomically contoured plates for distal tibial fracture surgery. The 3D-printed models allowed surgeons to check the fit of the plate with the fracture. For complex fractures, more than half of the surgeons ended up choosing a different plate after using the 3D-printed models than they did with only the CT and MRI images.

Surgical guides and instruments

3D-printed patient-specific instruments (PSIs), like customized surgical guides and other medical devices, improve surgeons’ precision during complex orthopedic surgery. Tools are designed specifically for the patient’s anatomy, leading to faster, more accurate surgeries.

A systematic review in 2016 found that 73% of papers that focused on the use of 3D-printed patient-specific instruments reported better patient outcomes than when using instruments not custom-designed for patient anatomy.

3D-printed surgical guides serve as templates for total knee arthroplasties (TKA) and have led to increased alignment, less of a learning curve for surgeons, and simplified techniques.

Studies that compared osteotomies of the femur and pelvis found that 3D-printed PSIs led to better precision and less time on the operating table, which is always preferred for the patient’s sake. Since 3D-printed PSIs also potentially reduce operative times, operating room costs are thus also reduced.

One study links 3D-printed PSIs to improved accuracy of bone cutting in surgery. A 3D model of a pelvic bone with a simulated tumor was created from a CT image. Twenty-four orthopedic surgeons used 3D-printed patient-specific instruments created with rapid prototyping technology for bone cutting. As a result, the PSIs “clearly” demonstrated better value in bone-cutting margins than standard navigational tools. 

Personalized implants

3D-printed custom implants result in fewer bad outcomes than standard implants, including less blood loss during surgery and patients being less likely to be discharged to an acute care facility post-surgery because the PSIs are made of stronger materials and are custom-fitted to the patient. 

Some 3D printers use titanium, and research shows that 3D-printed titanium orthopedic implants have favorable clinical results. These patient-specific implants allow for better function and have the advantage of a stronger structure compared to their traditional steel or cobalt counterparts.

3D-printed foot and ankle implants, for instance, have more porosity, serving as an alternative to traditional screws and plates. The porous nature of the 3D-printed implants is better for support and incorporation into the patient’s body.

Because patient-specific implants are custom fit, they require less adaptation before and during surgery, making them stronger in the long term. Designing traditional implants is a lengthy process, but 3D printing is faster, allowing for changes to be made quickly when necessary. 

In one case study, a 12-year-old boy with a sarcoma on his spine underwent surgery to remove the affected vertebrae. After the tumor resection, another procedure was done to insert a customized, 3D-printed titanium implant in the vertebrae’s place. The implant’s structure was “optimized for better biomechanical stability and enhanced bone healing.” The patient’s recovery was uneventful, and he was up and moving around within a week. He was still tumor-free a year later. 

Customized prostheses and orthoses

Typical prosthetics and orthotics come in standard sizes, but 3D-printed, customized designs are made of biomaterials better suited for patients and simpler to manufacture.

Traditional prostheses and orthoses can lead to issues stemming from poor patient-design fit, but 3D-printed designs can solve some of those problems. In one study, patients needing pelvic reconstruction and prostheses experienced reduced trauma and improved recovery time with 3D-printed, custom prostheses and orthoses compared to standard-sized ones.

3D-printed, custom-made orthoses present many other patient advantages, including affordability, faster manufacturing after design, and increased comfort.

A good example is the exciting updates to the design and production of ankle-foot orthoses (AFOs) thanks to 3D printing. Traditional ankle-foot orthoses are made from plaster castings, which takes a lot of time, labor, and money. Traditional ankle-foot orthoses can also lead to issues with fitting and comfort. In addition to simplifying production, 3D printing has also improved the design and comfort of ankle-foot orthoses compared to traditional AFOs that are made of plaster castings.

What’s next in orthopedics?

Like other healthcare fields, orthopedics is constantly evolving and improving. And 3D printing in orthopedics is just one of the exciting technological advancements in the field with limitless potential.

Want to know what’s on the horizon in orthopedic surgery? Dive into the world of cutting-edge tech by reading more about emerging trends in the field here.