Overview of Emerging Technology in Orthopedic Surgery: What is the Value in 3D Modeling and Printing?

Abstract

Three-dimensional printing and modeling has evolved significantly since first introduced in the 1980s. In the last 5 years, this revolution in technology has become far more accessible and affordable, and is already mainstream in many areas of medicine. Nowhere is this more apparent than in orthopedics, and many surgeons already incorporate aspects of 3D modeling and virtual procedures in their routine clinical practice. However, this technology promises to become even more prevalent as creative applications continue to be developed, and further innovations are certain to come. There are important public policy aspects to consider, both economic and regulatory. Regulatory issues are currently still under development, but will need to take into account sterilization, quality assurance, and product liability. The mechanical integrity of 3D-printed implants is influenced by the unique characteristics of the print process, including the energy density of the laser, the resolution of the print, and the orientation of the print on the build platform. Introduction of expensive new technology should only be done after careful consideration of the costs associated, the potential benefits, and the value that can be derived. The value in 3D modeling and printing can be considered relative to the initial costs, the experience of a 3D modeling unit, the complexity of a particular case, and the clinical expertise of the surgeons involved. There is significant potential value derived from modeling most displaced intra-articular fractures, once a 3D modeling unit is established and proficient. However, the greatest value comes from modeling the most highly complex cases. When the pathology is most abnormal, 3D modeling/printing can be a valuable clinical adjunct for even the most expert and experienced surgeons. Although currently hospital-based 3D modeling/printing units are uncommon, they will soon become far more common. For surgeons in developing nations, 3D printing may currently be prohibitively expensive, but 3D modeling is relatively inexpensive and therefore far more accessible. As 3D printer prices continue to fall, the ability to rapidly manufacture prototypes and patient-specific models will inevitably spread through these regions as well. However, the future for 3D-printed medical models, devices, and implants will be limited unless we are able to document their clinical superiority and confirm their value with respect to patient outcomes. Level of Evidence: Level V—expert opinion.