Three-dimensional printing in orthopaedic preoperative planning improves intraoperative metrics: a systematic review.

Abstract

Three-dimensional (3D) printing has seen increasing interest in surgery, where it improves the visualization of difficult anatomy in complex cases. This literature review investigates the benefits and limitations of 3D printed models in preoperative planning in the field of orthopaedic surgery. A literature search was performed using the Ovid platform on the Embase and MEDLINE databases using the terms '3D printing', 'Orthopaedics' and 'Surgical Planning'. Studies using 3D printed models as a part of preoperative planning were included. All others were excluded. Data regarding the metrics used to assess the benefit of the use of 3D models, surgical outcome, and surgeon or patient opinion on the technology were extracted. A total of 41 studies resulted. Eight (19.5%) were case-control studies, the remainder were case reports or case series. Assessment of benefit was mostly subjective, although the case-control studies included objective metrics such as operation time, intraoperative blood loss and intraoperative fluoroscopy time. The use of 3D printing technology showed subjective benefit for both patient and surgeon as well as indicating clinically significant improvements in intraoperative metrics. Despite the current absence of large scale trials, 3D printing has clear benefits in preoperative planning, particularly when utilized in complex cases. A streamlined workflow for case selection, in-house model creation and preoperative rehearsals is still required to be developed before the process is ready for routine use. Evidence supports an improvement in intraoperative metrics and patient engagement but data to support improved clinical outcome is lacking.