A Systematic Review of the Uses and Benefits of 3-D Printing in Orthopaedic Surgery

Introduction: The objective of this systematic review was to analyse 3-D printing in orthopaedic surgery, focussing on pre-operative planning, patient specific implants, instruments, and orthoses. Method: The PRISMA methodology was followed and literature searches were conducted on Medline, Embase and the Cochrane library. MeSH search terms and Boolean operators included `3-D printing', `orthopaedic', `pre-operative plan', `implants', `patient specific instruments' AND `orthosis'. Results: Searches resulted in 36 studies included in the review. The increasing interest in 3-D printing in orthopaedics is reflected in the rise in publications between 2015 and 2020. The most common application, reported by 75% of the studies was the use of 3-D printed anatomical models to aid in pre-operative planning. The models were also utilized for surgical simulation (31%), intraoperative navigation (8%), and patient/family and surgical education (8%). The use of 3-D printing to manufacture patient specific orthoses, implants and instruments was reported in 14%, 11% and 8% of the studies respectively. The advantage of 3-D printing reported most (56%) was the educational and training opportunities the models provided for junior surgeons. Doctor-patient communication and improved consenting was a reported benefit in 28% of the studies. Objective benefits of 3-D printing included reduced operating time (42%), instrumentation time (11%), fluoroscopy time (31%) and intraoperative blood loss (33%). Conclusion: The literature shows 3-D printing has improved pre-operative planning, allowed for surgical simulation, training and education. These benefits have led to improved operating metrics. There are currently no studies which demonstrate these reported benefits led to improved patient outcomes.