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Orthopaedic surgery has often benefitted from innovation in biomedical engineering, with additive manufacturing (AM) and 3-dimensional printing (3DP) being some of the most recent advances. AM refers to the process that builds 3D geometries by successive addition of material, with 3DP being one of the employed production techniques.1,2 New technologies are often expensive and technically inaccessible, progressively becoming more affordable and user friendly as refinements and developments occur.3 In the field of AM, this process has been accelerated by foundational patents having lapsed in the 2000s, drastically reducing costs.4 Improved accessibility and the intuitive knowledge that having a3D model of the patient’s anatomy will aid the understanding of the pathology has resulted in many orthopaedic surgeons exploring 3DP.5-7 Clinical applications have included anatomical models for preoperative planning and surgery rehearsal, production of patient specific instrumentation, manufacture of patient-specific implants and bio printing.8,9 In their 2015 review of 3DP in medicine, Tacket al. reported on 227 papers that included 270 cases. In 45% of these cases, 3DP was used to produce patient-specific implants and anatomical models for planning orthopaedic surgeries. Mostarticles (72%) reported improved clinical outcomes, although quantitative data supported only 10% of these reports. Interestingly,33% of studies mentioned an increased associated cost, while 64% of studies did not report cost at all, reiterating that cost is stillan essential factor to consider. 10In 2018 we founded an in-house orthopaedic 3DP laboratory in collaboration with the Institute of Biomedical Engineering (IBE) at Stellenbosch University (SU) to explore the place for this emergent technology in orthopaedic practice and training. Since inception,we have identified several ways that 3DP could improve the planning of surgical procedures, the way we evaluate orthopaedicpathology and how we train future orthopaedic surgeons by adding haptic perception to traditional visual-only planning techniques.This retrospective, descriptive case series aims to illustrate the clinical use of 3D-printed anatomical models and investigate the time and cost involved in their manufacture.
Segmentation process (left) using Rhino3D Medical (Mirrakoi SA, Switzerland) to create an initial surface mesh based on CT data. Finishedsurface mesh (right) modelled in Meshmixer (Autodesk Inc., San Rafael, Calif).
The final model manufactured in PETG (black) with water-soluble support material (white) shown immediately after manufacturing
