April 15, 2016
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Challenges, risks of using 3-D printing in orthopaedics must be considered

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The Cover Story in this issue of Orthopaedics Today Europe includes comments from worldwide orthopaedic experts about 3-D printing in musculoskeletal medicine, some of whom use 3-D printing in their daily practice. It is evident this technology is here to stay in medicine and no doubt will soon be sought out by many surgeons as a tool for the development of custom guides and implants unique to their patients, as well as for providing a better understanding of patients with complex deformities and anatomies.

At the same time, 3-D printing technology has potential drawbacks that must be discussed.

Since 3-D printing technology is currently based on digital information from CT and MRI scans, it is slow to use. The 3-D fabrication process takes a long time and this, of course, will increase the costs related to its use.

Per Kjaersgaard-Andersen, MD
Per Kjaersgaard-Andersen

Cost is a concern

My concern is whether governmental and hospital systems have the financial capability to support the use of 3-D printing in the regular practice of medicine. I do not think most health care systems today can support the costs associated with this technology. There is no doubt 3-D printing has an obvious benefit for unique orthopaedic cases, such as for surgery to correct severe deformities. However, patients who require these treatments are seen at select institutions with high-level expertise, not general hospitals.

In my country, Denmark, which has a population of less than 6 million people, I expect the regulatory governmental body will allow only one surgical department, one with considerable expertise, to use the technique at the beginning.

Analyze now before full adoption

We should learn from the past regarding the introduction of new technology like 3-D printing. Although it has shown promise in its applications to date, 3-D printing and fabrication is still a new tool and should be viewed as such. Therefore, we should carefully analyze this technology scientifically to ensure it is safe, particularly because implants created by 3-D printing are currently classified as custom-made. Even though these implants may provide a better, or maybe the best solution, for certain special cases in orthopaedics, it is essential to still study and report the long-term outcomes and failure rates of 3-D printed implants.

Orthopaedic manufacturers and other companies that use 3-D printing also can play a role in the evaluation of possible risks. A good way to start doing this is by making it a priority to use radiostereometric analysis to evaluate the stability and possible micromotion of the 3-D printed implants they sell or produce, just as they would do to evaluate any other new product.

Only when orthopaedic surgeons, government and hospital systems and orthopaedic manufacturers do their part to evaluate the risks of 3-D printing in orthopaedics will this technology stand a good chance of being the innovative technique it was designed to be.

Disclosure: Kjaersgaard-Andersen reports no relevant financial disclosures.