Literature Sharing | Advances in the Application of 3D Printing Technology in Personalized Orthopedic Surgery

【Introduction】

Over the past decade, 3D printing (also known as additive manufacturing) has revolutionized the medical field, particularly orthopedic surgery, thanks to its unique advantages in personalized customization.Unlike the traditional "one‑size‑fits‑all" standardized treatment, 3D printing can convert medical images such as CT and MRI into tangible, operable physical models, and even directly manufacture implants and surgical instruments that match the patient’s anatomical structure. This fundamentally improves surgical accuracy and enhances patient prognosis.

From simple prostheses to bionic trabecular bone implants, from preoperative planning models to patient-specific surgical guides, 3D printing is gradually penetrating every aspect of orthopedic surgery and has become a core carrier for the implementation of personalized medicine in orthopedics.Based on the latest research findings, this paper comprehensively interprets the applications, advantages, limitations and future directions of 3D printing in orthopedic surgery.

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Source：Prządka, M.; Pająk, W.; Kleinrok, J.; Pec, J.; Michno, K.; Karpiński, R.; Baj, J. Advances in 3D Printing Applications for Personalized Orthopedic Surgery: From Anatomical Modeling to Patient-Specific Implants. J. Clin. Med. 2025, 14, 3989. https://doi.org/10.3390/jcm14113989

【Overview of 3D Printing Technology】
The application of 3D printing in orthopedics is centered around the precise transformation from "digital modeling" to "physical printing". The entire process is divided into three key steps, and each step determines the accuracy and applicability of the final product:

1. Imaging Acquisition: High-precision 2D images of the patient’s bones are obtained via multi-detector computed tomography (MDCT, the first choice for orthopedics) or magnetic resonance imaging (MRI). With high resolution and the ability to generate thin axial images, MDCT serves as the core data source for orthopedic modeling, while MRI is mainly used to supplement soft tissue information.

2. Digital Reconstruction and Segmentation: The acquired images in DICOM format are processed using post-processing software for multi-planar reconstruction and volume rendering. Threshold segmentation is applied to separate regions of interest such as bone and lesion areas, generating a 3D digital model that is then converted to CAD (Computer-Aided Design) format.

3. 3D Printing Fabrication: The CAD model is exported in STL format. Anatomical models, implants or surgical instruments are printed layer by layer using technologies such as stereolithography, powder bed fusion and direct ink writing, with materials including titanium alloy, polylactic acid (PLA) and hydrogel.

【Core Clinical Application】
1. Patient-specific Implants and Prostheses

Traditional metal implants often cause stress shielding, bone loss, and even implant failure due to their mismatched stiffness with natural bone. Standard prostheses are difficult to fit perfectly in complex cases such as severe acetabular bone defects, pelvic tumors, and navicular necrosis of the wrist.

3D printing technology enables the fabrication of personalized implants that fully match the patient’s bone morphology and pathological conditions through precise modeling.Titanium alloy implants printed via Selective Laser Melting (SLM) can be designed with a bionic trabecular structure to promote osseointegration.For irreparable scaphoid injuries, individualized scaphoid prostheses can be customized based on the contralateral wrist CT data to restore carpal kinematics.In cranioplasty and pelvic tumor reconstruction, 3D-printed implants not only achieve better fit but also reduce surgical difficulty and shorten recovery time.

The more innovative "Lego‑style" stackable titanium scaffold can be flexibly assembled intraoperatively according to the shape of the bone defect, balancing biocompatibility and cost‑effectiveness. It is particularly suitable for complex reconstructive surgeries in resource‑limited regions.

2. Preoperative Planning and Surgical Guides

The accuracy of orthopedic surgery directly determines patient prognosis. Traditional 2D imaging cannot fully display the complex structure of bones, which may lead to intraoperative decision-making errors. In contrast, 1:1 anatomical models produced by 3D printing allow surgeons to intuitively observe fracture patterns and tumor extent preoperatively, repeatedly simulate surgical procedures, and accurately determine osteotomy ranges and screw insertion positions.
On this basis, 3D‑printed patient‑specific surgical guides can accurately transfer preoperative planning to the operation, avoiding errors from freehand procedures.A prospective study in patients undergoing genioplasty showed that 3D‑printed guides limited surgical deviation to within 0.19 mm, with no postoperative complications at 6‑month follow‑up.A systematic review confirmed that 82% of relevant studies demonstrated that 3D‑printing‑assisted preoperative planning significantly improved surgical outcomes and shortened operation time.

3. Custom Orthoses and External Devices

Traditional orthoses rely on manual shaping, which is time-consuming, labor-intensive, and offers poor comfort, resulting in low patient compliance.3D printing technology, based on the patient’s anatomical scanning data, can rapidly produce lightweight, breathable, and ergonomically fitted personalized orthoses, including wrist splints, ankle-foot orthoses, scoliosis braces, and others.

3D-printed spinal braces are equivalent or superior to traditional braces in terms of Cobb angle correction, patient satisfaction, and clinical safety.Notably, studies included in this review also highlight the advantages of shorter delivery times and enhanced customization, making 3D-printed spinal orthoses increasingly popular in clinical practice.

4. Spine Surgery

Spine surgery has become one of the most active fields for the application of 3D printing technology in orthopedics. The most common clinical applications include patient‑specific drilling guides, anatomical models, and custom implants, designed to improve surgical accuracy and reduce complication rates.A large systematic review covering more than 100 studies and over 2,000 patients showed that 3D‑printed drilling guides significantly improved the accuracy of pedicle screw placement and shortened operation time in 88% of cases, although some procedures were prolonged due to technical complexity.

5. Orthopedic Oncology Surgery

3D printing has emerged as a transformative tool in orthopedic oncology, addressing major challenges in preoperative planning, tumor resection, and complex bone reconstruction.

In head and neck tumor surgery, CAD/CAM and 3D printing technologies have advanced the field of microvascular bone reconstruction, particularly for mandibular and maxillary reconstruction.Virtual planning, custom osteotomy guides, and pre-bent titanium plates significantly reduce ischemia time, improve surgical accuracy, and enable dental rehabilitation in the primary procedure.

【Advantages and Limitations】
Advantages：
1. Personalized Adaptation: Customized products can be tailored to the patient’s anatomical structure and pathological conditions, solving the fitting challenges of traditional standardized treatment.

2. Improved Surgical Accuracy: The application of preoperative planning and surgical guides reduces intraoperative errors and lowers the risk of complications such as nerve and blood vessel damage.

3. Optimized Therapeutic Outcomes: Shortens operation time, reduces intraoperative bleeding and fluoroscopy time, promotes osseointegration, and accelerates postoperative rehabilitation.
4. Empowering Medical Education: 3D-printed anatomical models can be used for surgeon training and case explanation, helping to improve clinical skills and teaching effectiveness.

Limitations：
1. Lengthy process: Modeling and printing can take several days, limiting its application in emergency trauma care.
2. High cost: Expensive equipment and biomaterials increase the economic burden of clinical application.
3. Insufficient regulation and standardization: The long-term safety of bioprinting and living cell-containing implants is not yet clear, and unified standards are lacking for printing processes, materials, and cell applications.
4. Infection risk and talent demand: The porous structure of 3D-printed implants may increase the risk of bacterial colonization. Meanwhile, a professional team (medicine + engineering + software) is required, leading to high personnel training costs.

【Conclusions】
The advent of 3D printing technology has revolutionized orthopedic surgery. It has broken through the limitations of traditional treatment and turned "personalization" from a concept into clinical practice. From anatomical modeling and customized implants to preoperative planning and postoperative rehabilitation, every application scenario delivers more precise, safer, and more efficient treatment for patients. Although challenges remain in terms of cost, regulation, and professional talent, continuous technological iteration and in‑depth research will make 3D printing an indispensable core technology in modern orthopedics. It will drive personalized orthopedic care into a new era and bring benefits to more patients with bone injuries, deformities, and tumors.

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