• 3D‐printed
• aseptic loosening
• distal femur
• revision
• uncemented stem

• Humans
• Printing, Three-Dimensional
• Middle Aged
• Male
• Female
• Prosthesis Design
• Reoperation/methods
• Retrospective Studies
• Aged
• Prosthesis Failure
• Femur/surgery
• Bone Cements

• Bone fractures
• Orthopedic surgery
• Patient-specific
• Three-dimensional printing
• Tumor

• Printing, Three-Dimensional
• Humans
• Prostheses and Implants
• Orthopedic Procedures/instrumentation
• Orthopedic Procedures/methods
• Prosthesis Design

• 3D‐printed
• Fenestration guide
• Multifunctional guide
• Proximal femur
• Screw drill guide

• Humans
• Printing, Three-Dimensional
• Bone Plates
• Female
• Male
• Bone Screws
• Adult
• Middle Aged
• Femoral Neoplasms/surgery
• Femoral Neoplasms/diagnostic imaging
• Young Adult
• Computer-Aided Design
• Adolescent

• ZR2021MH114 Natural Science Foundation of Shandong Province
• Natural Science Foundation of Shandong Province

• Accuracy
• Additive manufacturing
• Anatomical model
• Bone
• Surgery

• 858060 Österreichische Forschungsförderungsgesellschaft

• Orthopedic
• Printing
• Review
• Systematic
• Three dimensional

• 3D Printing
• biomaterials
• biomechanics
• bone
• reconstruction
• tissue engineering

• 3D CT
• 3D MRI
• 3D printing
• Bone tumour resection
• MR images
• Patient-specific resection guide
• Resection error
• anatomical structures
• bone resection
• bone tumour resections
• bone tumours
• metastatic bone tumours
• osteosarcoma
• soft-tissue

• Adolescent
• Humans
• Imaging, Three-Dimensional
• Lower Extremity/surgery
• Male
• Osteotomy/methods
• Printing, Three-Dimensional
• Retrospective Studies
• Surgery, Computer-Assisted
• Tibia/diagnostic imaging
• Tibia/surgery

With increasing requirements for medical effects, and huge differences among individuals, traditional surgical instruments are difficult to meet the patients' growing medical demands. 3D printing is increasingly mature, which connects to medical services critically as well. The patient specific surgical guide plate provides the condition for precision medicine in orthopaedics.

In this paper, a systematic review of the orthopedic guide template is presented, where the history of 3D-printing-guided technology, the process of guides, and basic clinical applications of orthopedic guide templates are described. Finally, the limitations of the template and possible future directions are discussed.

The technology of 3D printing surgical templates is increasingly mature, standard, and intelligent. With the help of guide templates, the surgeon can easily determine the direction and depth of the screw path, and choose the angle and range of osteotomy, increasing the precision, safety, and reliability of the procedure in various types of surgeries. It simplifies the difficult surgical steps and accelerates the growth of young and mid-career physicians. But some problems such as cost, materials, and equipment limit its development.

In different fields of orthopedics, the use of guide templates can significantly improve surgical accuracy, shorten the surgical time, and reduce intraoperative bleeding and radiation. With the development of 3D printing, the guide template will be standardized and simplified from design to production and use. 3D printing guides will be further sublimated in the application of orthopedics and better serve the patients.

Precision, intelligence, and individuation are the future development direction of orthopedics. It is more and more popular as the price of printers falls and materials are developed. In addition, the technology of meta-universe, digital twin, and artificial intelligence have made revolutionary effects on template guides. We aim to summarize recent developments and applications of 3D printing guide templates for engineers and surgeons to develop more accurate and efficient templates.

Patient-specific three-dimensional (3D) printed models have been increasingly used in many medical fields, including cardiac surgery for which they are used as planning and communication tools. To locate and plan the correct region of interest for the bypass placement during coronary artery bypass graft (CABG) surgery, cardiac surgeons can pre-operatively rely on different medical images. This article aims to present a workflow for the production of a patient-specific 3D-printed surgical guide, from data acquisition and image segmentation to final prototyping. The aim of this surgical guide is to help visualize the region of interest for bypass placement during the operation, through the use of dedicated surgical holes. The results showed the feasibility of this surgical guide in terms of design and fitting to the phantom. Further studies are needed to assess material biocompatibility and technical properties.

Since osteosarcoma (OS) is an aggressive bone cancer with unknown molecular pathways of etiology and pathophysiology, improving patient survival has long been a challenge. The conventional therapy is a complex multidisciplinary management that include radiotherapy, chemotherapy which followed by surgery and then post-operative adjuvant chemotherapy. However, they have severe side effects because the majority of the medicines used have just a minor selectivity for malignant tissue. As a result, treating tumor cells specifically without damaging healthy tissue is currently a primary goal in OS therapy. The coupling of chemotherapeutic drugs with targeting ligands is a unique therapy method for OS that, by active targeting, can overcome the aforementioned hurdles. This review focuses on advances in ligands and chemotherapeutic agents employed in targeted delivery to improve the capacity of active targeting and provide some insight into future therapeutic research for OS.

• Allografts
• Bone Neoplasms/diagnostic imaging
• Bone Neoplasms/surgery
• Humans
• Limb Salvage
• Printing, Three-Dimensional
• Plastic Surgery Procedures
• Retrospective Studies
• Sarcoma/surgery
• Treatment Outcome

• Guiding
• Intraoperative
• Orthopaedic surgery
• Paediatric
• Patient-specific instrumentation
• Three-dimensional printing

• 3-D printing
• Additive manufacturing
• Biomaterial
• Biomedical
• Lithography (deposition)
• Polymer

The combination of 3D printing and navigation promises improvements in surgical procedures and outcomes for complex bone tumor resection of the trunk, but its features have rarely been described in the literature. Five patients with trunk tumors were surgically treated in our institution using a combination of 3D printing and navigation. The main process includes segmentation, virtual modeling and build preparation, as well as quality assessment. Tumor resection was performed with navigated instruments. Preoperative planning supported clear margin multiplanar resections with intraoperatively adaptable real-time visualization of navigated instruments. The follow-up ranged from 2–15 months with a good functional result. The present results and the review of the current literature reflect the trend and the diverse applications of 3D printing in the medical field. 3D printing at hospital sites is often not standardized, but regulatory aspects may serve as disincentives. However, 3D printing has an increasing impact on precision medicine, and we are convinced that our process represents a valuable contribution in the context of patient-centered individual care.

• 3D printing
• bone defects
• navigation-assisted surgery
• oncologic orthopedics
• patient specific
• tumor orthopedics
• tumor surgery

• 3D guide plate
• Bone resection
• Devitalization
• Hemicortical resection
• Metaphysis of the distal femur
• Reconstruction

Osteosarcoma (OS) is the most common bone cancer in children. OS most commonly arises in the legs, but can arise in any bone, including the spine, head or neck. Along with chemotherapy, surgery is a mainstay of OS treatment and in the 1990s, surgeons began to shift from amputation to limb-preserving surgery. Since then, improvements in imaging, surgical techniques and implant design have led to improvements in functional outcomes without compromising on the cancer outcomes for these patients. This paper summarises these advances, along with a brief discussion of future technologies currently in development.

Osteosarcoma (OS) is the most common primary bone cancer in children and, unfortunately, is associated with poor survival rates. OS most commonly arises around the knee joint, and was traditionally treated with amputation until surgeons began to favour limb-preserving surgery in the 1990s. Whilst improving functional outcomes, this was not without problems, such as implant failure and limb length discrepancies. OS can also arise in areas such as the pelvis, spine, head, and neck, which creates additional technical difficulty given the anatomical complexity of the areas. We reviewed the literature and summarised the recent advances in OS surgery. Improvements have been made in many areas; developments in pre-operative imaging technology have allowed improved planning, whilst the ongoing development of intraoperative imaging techniques, such as fluorescent dyes, offer the possibility of improved surgical margins. Technological developments, such as computer navigation, patient specific instruments, and improved implant design similarly provide the opportunity to improve patient outcomes. Going forward, there are a number of promising avenues currently being pursued, such as targeted fluorescent dyes, robotics, and augmented reality, which bring the prospect of improving these outcomes further.

• osteosarcoma
• sarcoma
• surgery

The long-term outcomes of osteosarcoma have improved; however, patients with metastases, recurrence or axial disease continue to have a poor prognosis. Computer navigation in surgery is becoming ever more commonplace, and the proposed advantages, including precision during surgery, is particularly applicable to the field of orthopaedic oncology and challenging areas such as the axial skeleton. Within this article, we provide an overview of the field of computer navigation and computer-assisted tumour surgery (CATS), in particular its relevance to the surgical management of osteosarcoma.

• computer navigation
• computer-assisted surgery
• osteosarcoma
• patient-specific instrumentation

• Computer-assisted surgery
• Femoral head reduction osteotomy
• Patient-specific instruments
• Three-dimensional preoperative planning

• Acetabulum/diagnostic imaging
• Acetabulum/surgery
• Child
• Computer Simulation
• Femur Head/diagnostic imaging
• Femur Head/surgery
• Hip Joint/diagnostic imaging
• Hip Joint/surgery
• Humans
• Legg-Calve-Perthes Disease/diagnostic imaging
• Legg-Calve-Perthes Disease/surgery
• Osteotomy
• Pilot Projects
• Radiography
• Retrospective Studies
• Treatment Outcome

• Promedica Stiftung
• Deutsche Arthrose Stiftung

• Breast
• Lymphedema
• Microsurgery

• 3D printing technology
• Bone reconstruction
• Bone tumour surgery
• Limb salvation
• Patient-specific orthopaedics

• 3D resection
• bone tumor
• limb salvage surgery
• patient-specific instruments
• surgical guide

• 3D Printing
• Arthroplasty
• Patientspecific instrumentation
• Shoulder Instability
• Trauma surgery

Additive manufacturing has allowed for the creation of a patient-specific custom solution that can resolve many of the limitations previously reported for canine cranioplasty. The purpose of this pilot study was to determine the schedule feasibility and workflow in manufacturing patient-specific titanium implants for canines undergoing cranioplasty immediately following craniectomy.

Computed tomography scans from patients with tumors of the skull were considered and 3 cases were selected. Images were imported into a DICOM image processing software and tumor margins were determined based on agreement between a board-certified veterinary radiologist and veterinary surgical oncologist. Virtual surgical planning was performed and a bone safety margin was selected. A defect was created to simulate the planned intraoperative defect. Stereolithography format files of the skulls were then imported into a plate design software. In collaboration with a medical solution centre, a custom titanium plate was designed with the input of an applications engineer and veterinary surgery oncologist. Plates were printed in titanium and post-processed at the solution centre. Total planning time was approximately 2 h with a manufacturing time of 2 weeks.

Based on the findings of this study, with access to an advanced 3D metal printing medical solution centre that can provide advanced software and printing, patient-specific additive manufactured titanium implants can be planned, created, processed, shipped and sterilized for patient use within a 3-week turnaround.

• 3d print
• Additive manufacturing
• Cancer
• Cranioplasty
• Dog
• Implant
• Oncology

• 3D printing technology
• Developmental dysplasia of the hip
• Navigation template
• Total hip arthroplasty

Cubitus varus deformity is a common sequela of elbow fractures in children. Cubitus varus deformity treatment is tending toward 3D correction, which is challenging for orthopedic surgeons. This study aims to explore whether individualized 3D-printed navigation templates can assist with accurate and effective corrective treatment of children with cubitus varus deformity.

Thirty-five patients were treated for cubitus varus deformity from June 2015 to April 2017, including 21 boys and 14 girls, aged 4.6–13.2 years (average, 7.5 years). Of these cases, 17 deformities were on the left side and 18 were on the right side. All were treated with wedge osteotomy of the lateral distal humerus. 3D-printed navigation templates were used in 16 cases, while traditional surgery was used in 19 cases. All patients underwent computed tomography scans before surgery. Computer software was used to analyze the measurements and design and print individualized navigation templates. The navigation templates were matched, and surgery was initially simulated. Intraoperative individualized navigation templates were used to assist with accurate osteotomy and Kirschner wire fixation. Operation times were recorded in all cases, the carrying angles before and after surgery were assessed by computer, and postoperative elbow joint function was evaluated using Bellemore criteria. All measurement data were presented as means ± SD, and Student’s t test was used to examine differences between groups. All count data between both groups were compared using the chi-square test or Fisher’s exact test analysis.

All individualized navigation templates matched well with the corresponding anatomical markers and were consistent with preoperative planning, simulated surgery, and intraoperative procedures. Average operation times from clear exposure to fixed Kirschner wire were 11.69 min (9.6–13.5 min) for the individualized navigation template group and 22.89 min (17.7–26.8 min) for the traditional operation group (p < 0.001). Average differences in postoperation carrying angles between affected and healthy sides were 1.13° (0–2.0°) and 4.21° (0–7.5°), respectively (p < 0.001). Follow-up 6–12 months postoperation showed that elbow function did not differ significantly between groups using the Bellemore criteria (p > 0.05).

Individualized navigation templates simplify procedures, reduce operation time, and improve accuracy when used in orthopedic surgery to treat children with cubitus varus deformity.

• 3D-printing technology
• Children
• Cubitus varus deformity
• Individualized navigation template

With the increasing complexity of surgical interventions performed in orthopaedic trauma surgery and the improving technologies used in three-dimensional (3D) printing, there has been an increased interest in the concept. It has been shown that 3D models allow surgeons to better visualise anatomy, aid in planning and performing complex surgery. It is however not clear how best to utilise the technique and whether this results in better outcomes.

To evaluate the effect of 3D printing used in pre-operative planning in orthopaedic trauma surgery on clinical outcomes.

We performed a comprehensive systematic review of the literature and a meta-analysis. Medline, Ovid and Embase were searched from inception to February 8, 2018. Randomised controlled trials, case-control studies, cohort studies and case series of five patients or more were included across any area of orthopaedic trauma. The primary outcomes were operation time, intra-operative blood loss and fluoroscopy used.

Seventeen studies (922 patients) met our inclusion criteria and were reviewed. The use of 3D printing across all specialties in orthopaedic trauma surgery demonstrated an overall reduction in operation time of 19.85% [95% confidence intervals (CI): (-22.99, -16.71)], intra-operative blood loss of 25.73% [95%CI: (-31.07, -20.40)], and number of times fluoroscopy was used by 23.80% [95%CI: (-38.49, -9.10)].

Our results suggest that the use of 3D printing in pre-operative planning in orthopaedic trauma reduces operative time, intraoperative blood loss and the number of times fluoroscopy is used.

• Orthopaedic surgery
• Trauma
• Three-dimensional printing

• 3D printing
• Augmented reality
• Virtual reality

• P41 EB017183 NIBIB NIH HHS
• In-kind Research Support Stratasys
• NIH P41 EB017183 NIBIB NIH HHS
• National Institute of Biomedical Imaging and Bioengineering

The goal of periacetabular osteotomy (PAO) is to reorient the acetabulum in a more physiological position. Its realization remains challenging regarding the final position of the acetabulum. Assistance with custom cutting- and reorientation-guides would thus be very helpful. Our purpose is to present a pilot study on such guides. Eight cadaveric hemipelvis were scanned using CT. After segmentation, 3D models of each specimen were created, a PAO was virtually performed and reorientation of the acetabula were defined. A specific guide was designed aiming to assist in iliac, posterior column and superior pubic ramus cuts as well as in acetabulum reorientation. Furthermore, the acetabular position was planned. Three-dimensional printed guides were used to perform PAO using the modified Smith-Peterson approach. The post-operative CT images and virtually planned acetabulum reorientation were compared in terms of acetabular index (AC), lateral centre edge angle (LCE), acetabular anteversion angle (AcetAV). There was no intra-articular or posterior column fracture seen. Two cadavers showed very low bone quality with insufficient stability of fixation and were excluded from further analysis. Correlation between the post-operative result and planning of the six included cadavers revealed the following mean deviations: 5° (SD ±3°) for AC angle, 6° (SD ±4°) for LCE angle and 15° (SD ±11°) for AcetAV angle. The use of 3D cutting and reorientation blocks for PAO was possible through a modified Smith-Peterson approach and revealed accurate fit to bone, accurate positioning of the osteotomies and acceptable planned corrections in cadavers with good bone quality.

• 3D printed osteotomy guide plate-assisted total knee arthroplasty
• Clinical operation
• Valgus knee deformity

• Aged
• Arthroplasty, Replacement, Knee/methods
• Bone Plates
• Female
• Humans
• Knee Joint/abnormalities
• Knee Joint/diagnostic imaging
• Knee Joint/surgery
• Male
• Middle Aged
• Osteotomy/methods
• Printing, Three-Dimensional
• Treatment Outcome

• end of life decisions (palliative care)
• orthopaedic and trauma surgery
• orthopaedics
• palliative care
• palliative procedures

• 3d print
• customized protheses
• osteotomy guide
• pelvic tumor

• Female
• Humans
• Middle Aged
• Neoplasm Metastasis
• Pelvic Neoplasms/pathology
• Pelvic Neoplasms/surgery
• Printing, Three-Dimensional
• Prosthesis Design/methods
• Prosthesis Implantation
• Plastic Surgery Procedures/methods

• 3D printing
• pediatric MRI

• 3D-multimodality image
• patient-specific instruments
• pelvic tumor
• surgical margin
• surgical planning

• 3D printing
• Osteochondral allograft transplantation
• Osteochondritis dissecans
• Preoperative planning

• 3D printing
• Additive manufacturing
• Anatomic model
• Appropriateness
• Guideline
• Quality
• Radiology

• P41 EB017183 NIBIB NIH HHS
• T32 EB021955 NIBIB NIH HHS

• Femur
• Humans
• Neoplasms
• Pelvic Bones

• computer-assisted
• craniofacial
• implants
• reconstructive surgical procedures
• stereolithography
• three-dimensional printing

• 3D printing
• Musculoskeletal oncology
• Navigation
• Patient-specific instrument
• Three-dimensional printing

• biomedical engineering
• image-guided surgery
• orthopedic surgery

• Humans
• Image Processing, Computer-Assisted
• Imaging, Three-Dimensional
• Models, Anatomic
• Models, Theoretical
• Orthopedic Procedures
• Orthopedics/methods
• Printing, Three-Dimensional
• Prostheses and Implants
• Reproducibility of Results
• Treatment Outcome