Does 3D printing improve revision TJA planning and execution vs traditional methods?
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Not necessary for straightforward cases
For planning, occasionally we used 3D printing to better understand a complex situation. That said, in most hip revision situations planning and execution are relatively straightforward and advanced technologies are not required.
However, there are unique cases where holding a model in your hand can help you understand, anticipate and be prepared for what you’re going to see in the OR. For example, the pelvis has complex bony anatomy and sometimes, by seeing a model of it in your hands, you can be better prepared for the surgery. I think there are situations where that is helpful, but I don’t think it is necessary all the time, for every revision, especially in terms of preoperative planning. I think you need it in a minority of complicated cases where it is harder to understand what you are going to encounter. Three-dimensional printing also helps the surgeon decide when it’s best to refer a case to someone else as opposed to doing it their self because it is beyond their level of comfort and competency based on the available information.
From an implant perspective, the vast majority, for example, of hip revisions can be handled with standard implants, although 3D printing has no doubt allowed us to develop some implants for highly complex situations that we couldn’t have managed without the 3D printing technology. So again, I think that both from a planning and execution perspective, in terms of the implants themselves, for the majority of revisions I don’t think you need that technology. There are some complex cases where 3D printing can help you understand the problem better, and the 3D technology has allowed us to have implants that we could not have made without the 3D, printing technology.
Craig J. Della Valle, MD, is professor and chief of adult reconstruction at Rush University Medical Center in Chicago and an Orthopedics Today Editorial Board Member.
3D-printed models for all cases
The use of 3D printing is growing rapidly in orthopedic surgery. It is being used by implant companies to manufacture implants and by surgeons to assist with preoperative planning. The utility is growing as the technology becomes more affordable and widely available. In the realm of arthroplasty, 3D modeling is most commonly used for acetabular revision cases. Traditionally, we have relied on multiplanar X-rays and CT scans with 3D reconstruction to analyze bone loss and prepare for cases. Typically, a 3D-printed model would only be used if a custom implant was being made. Now that the technology is more widely available, models can be created for any case.
The advantage of a 3D-printed model is it allows the surgeon to fully assess the bony anatomy. It is often difficult to get a complete and accurate assessment of the bone stock from radiographs or even a 3D CT. With a model, the surgeon can determine implant placement and the need for and locations for any supplemental fixation. It may also help the surgeon to determine if a custom prosthesis is necessary.
A 3D model can also allow the surgeon to practice implantation prior to going into the OR. By knowing where and how the implants need to be positioned and inserted, one can potentially decrease the operative time. Of course, the bone models do not account for the potential challenges of the soft tissues.
A third and final potential advantage of using 3D-printed models is education. As previously noted, by educating the surgeon and OR team, the execution and efficiency of these complex cases can be improved. For trainees, a 3D model can enhance their understanding of anatomy and various surgical techniques. Finally, and equally important, a 3D model can be used to educate the patient and help them to understand the complexity of their situation.
In conclusion, 3D printing is a rapidly expanding area that can positively impact the planning and execution of revision total joint arthroplasties.
Melvyn A. Harrington Jr., MD, FAOA, is professor, residency program director, adult reconstruction fellowship director and vice chair for diversity and inclusion in the department of orthopedic surgery at Baylor College of Medicine in Houston.
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