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Review
. 2024 Oct 1;110(10):6748-6762.
doi: 10.1097/JS9.0000000000001842.

Innovations in three-dimensional-printed individualized bone prosthesis materials: revolutionizing orthopedic surgery: a review

Zhigang Qu  1 , Jiaji Yue  2 , Ning Song  3 , Shenglong Li  4   5   6
Affiliations
Review

Innovations in three-dimensional-printed individualized bone prosthesis materials: revolutionizing orthopedic surgery: a review

Zhigang Qu et al. Int J Surg. .

Abstract

The advent of personalized bone prosthesis materials and their integration into orthopedic surgery has made a profound impact, primarily as a result of the incorporation of three-dimensional (3D) printing technology. By leveraging digital models and additive manufacturing techniques, 3D printing enables the creation of customized, high-precision bone implants tailored to address complex anatomical variabilities and challenging bone defects. In this review, we highlight the significant progress in utilizing 3D-printed prostheses across a wide range of orthopedic procedures, including pelvis, hip, knee, foot, ankle, spine surgeries, and bone tumor resections. The integration of 3D printing in preoperative planning, surgical navigation, and postoperative rehabilitation not only enhances treatment outcomes but also reduces surgical risks, accelerates recovery, and optimizes cost-effectiveness. Emphasizing the potential for personalized care and improved patient outcomes, this review underscores the pivotal role of 3D-printed bone prosthesis materials in advancing orthopedic practice towards precision, efficiency, and patient-centric solutions. The evolving landscape of 3D printing in orthopedic surgery holds promise for revolutionizing treatment approaches, enhancing surgical outcomes, and ultimately improving the quality of care for orthopedic patients.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

None
Graphical abstract
Figure 1
Figure 1
Fundamental steps in the fabrication of bone prosthesis nanomaterials. (A) Biofabrication strategies for bone engineering materials were designed based on the hierarchical structure of natural bone; (B) Nanomaterials have the potential to become bone prosthesis materials; (C) Both organic and inorganic nanomaterials can be fabricated as bone prosthesis materials; (D) Nanomaterials are applied to bone tissue engineering.
Figure 2
Figure 2
Various types of 3D printing technologies. (A) Selective laser sintering is a three-dimensional printing technique utilized in additive manufacturing processes. The procedure involves applying a layer of powder material onto the upper surface of the previously molded part. Subsequently, the temperature is raised just below the sintering point of the powder. The control system then directs a laser beam to scan the powder layer according to the cross-sectional contour. This scanning process raises the temperature of the powder to its melting point, stimulating sintering and bonding with the underlying molded part. Once a layer is fully formed, the table undergoes a downward movement to decrease the layer’s thickness. Moreover, a spreading roller uniformly disperses a layer of densely-packed powder onto this reduced thickness for the sintering of subsequent layers. This procedure repeats until the entire model is complete. (B) Light-curing technology, also known as stereolithography, is a manufacturing process that utilizes liquid photosensitive resin as the primary material. The process starts by creating a three-dimensional digital model using computer-aided design software. This digital model is then sliced into individual layers using specialized software, which determines the scanning path for the subsequent steps. The liquid photosensitive resin is exposed to light according to the designed scanning path, causing it to solidify. The light exposure is done layer by layer until the desired three-dimensional workpiece prototype is formed. (C). Digital light processing (DLP): In the realm of light-curing 3D printers, the process of material solidification on the contact surface is facilitated through the projection of a cross-sectional image of the printed layer onto the photosensitive resin. (D) Fused deposition technology, utilizes thermoplastic materials including but not limited to wax, ABS, and nylon. Prior to the printing process, the digital three-dimensional model needs to be converted into two-dimensional graphics through a slicing procedure. Subsequently, a precise nozzle under computer numerical control is utilized to heat and melt the selected material. A computer program controls the movement of the nozzle as it follows the contour and filling trajectory along the cross-section. The molten material is then extruded as filaments from the nozzle and undergoes cooling, bonding, and curing mechanisms to form a thin layer of cross-section. By stacking these layers, the desired three-dimensional objects are ultimately fabricated.
Figure 3
Figure 3
Causes of bone defects and healing process after defects. (A) Bone defects caused by trauma, tumor resection, skeletal abnormalities, or infection are the most common causes; (B) Most bone defects can be successfully restored by self-repair of the bone; (C). Bone defects that are not self-repairable require outside intervention.
Figure 4
Figure 4
The potential applications of 3D printing technology in drug delivery. Three-dimensional (3D) printing technology can integrate cells, drugs, growth factors, and other biological materials to construct functional scaffold materials. 3D printing technology can print precise dosage pills by adjusting the size, shape, and other parameters of the pills, ensuring the accuracy of medication for special groups. The personalized pharmaceutical advantages of 3D printing technology also provide technical support for personalized healthcare. In addition, 3D printing technology has a high degree of flexibility and the advantages of integrated manufacturing, providing significant cost and efficiency advantages in the development and production of complex formulations.
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