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Noori A, Persitz J, Khan S, Chan A, Paul R. Arthroscopic assisted versus open non-vascularized bone grafting in delayed union and nonunion of the scaphoid: a systematic review and meta-analysis. BMC Musculoskelet Disord 2024; 25:611. [PMID: 39090587 PMCID: PMC11293166 DOI: 10.1186/s12891-024-07723-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 07/22/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Delayed union and nonunion of the scaphoid is a common complication often requiring surgical reconstruction and bone grafting. Our goal was to systematically assess the healing time and clinical outcomes following arthroscopic-assisted versus open non-vascularized bone grafting of the scaphoid. METHODS A comprehensive search of the MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane Central databases was completed from inception to September 2023. We included randomized trials and observational studies that reported outcomes following scaphoid delayed union/nonunion comparing arthroscopic-assisted vs. open non-vascularized bone grafting. Two reviewers independently extracted data and assessed the risk of bias. One investigator assessed certainty of evidence and a senior investigator confirmed the assessment. We pooled effects using random-effects models, when possible, for all outcomes reported by more than 1 study. RESULTS Overall, 26 studies and 822 patients were included in the study. Very low certainty evidence demonstrated that arthroscopic-assisted surgery may decrease healing time compared to open surgery (weighted mean difference [WMD] -7.8 weeks; 95%CI -12.8 to -2.8). Arthroscopic bone grafting did not result in an improvement in union rate (relative risk 1.01; 95%CI 0.9 to 1.09). The pooled data in arthroscopic graft group showed mean time to union of 11.4 weeks (95%CI: 10.4 to 12.5) with union rate of 95% (95%CI 91-98%). A single comparative study reported very low certainty evidence that arthroscopy-assisted vs. open surgery may not have an effect on pain relief (MD 0 cm, 95%CI -0.4 to 0.5 on VAS 10 cm for pain) or improving function (MD -1.2, 95% CI -4.8 to 2.3 on 100 points DASH). CONCLUSION AND FUTURE DIRECTIONS Our results suggest that arthroscopic-assisted non-vascularized bone grafting may be associated with improved average weeks to heal in comparison with open surgery for scaphoid delayed union/nonunion reconstruction with overall comparable union rates. There is insufficient evidence to assess the effects of arthroscopic-assisted reconstruction on union rate, time to union, and patient-reported outcomes in patients with other important nonunion characteristics such as established humpback deformity.
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Affiliation(s)
- Atefeh Noori
- Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, University Health Network, Toronto Western Hospital, Affiliated with University of Toronto, East Wing, 2nd Floor, Rm. 400, Toronto, Canada
| | - Jonathan Persitz
- Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, University Health Network, Toronto Western Hospital, Affiliated with University of Toronto, East Wing, 2nd Floor, Rm. 400, Toronto, Canada
| | - Shawn Khan
- Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, University Health Network, Toronto Western Hospital, Affiliated with University of Toronto, East Wing, 2nd Floor, Rm. 400, Toronto, Canada
| | - Andrea Chan
- Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, University Health Network, Toronto Western Hospital, Affiliated with University of Toronto, East Wing, 2nd Floor, Rm. 400, Toronto, Canada.
- Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada.
| | - Ryan Paul
- Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, University Health Network, Toronto Western Hospital, Affiliated with University of Toronto, East Wing, 2nd Floor, Rm. 400, Toronto, Canada.
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Burnier M, Bouteille C, Cievet M. High Rates of Union Following Arthroscopic Treatment of Scaphoid Non-Union: Systematic Review. Arthroscopy 2024:S0749-8063(24)00072-0. [PMID: 38331367 DOI: 10.1016/j.arthro.2024.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To synthesize and analyze the existing literature and report on the outcomes of arthroscopic surgery for the treatment of scaphoid non-union (SNU). METHODS This systematic review conforms to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The authors conducted a search using Medline and Embase databases. Studies that reported outcomes on arthroscopic nonvascularized bone graft for SNU treatment, with no limits to follow-up, sample sizes or prevalence were included. RESULTS We found 17 eligible studies composed of 20 datasets, and all assessed nonvascularized arthroscopic treatment for SNU, with a mean follow-up that ranged from 6 to 38.5 months. Union rates ranged between 86% and 100%, and none of the studies reported any other complications than non-union following arthroscopic SNU. CONCLUSIONS The present systematic review found union rates ranging between 86% and 100%, with a time to union ranging from 2.3 to 7.8 months. Furthermore, the included studies reported satisfactory clinical scores, and the complication rate of non-union ranged between 0% and 14%. LEVEL OF EVIDENCE Level IV, systematic review of level II-IV studies.
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Yi Z, Lim RQR, Chen W, Zhu J, Chen S, Liu B. Arthroscopic Bone Grafting and Robot-assisted Fixation for Scaphoid Nonunion. Orthop Surg 2024; 16:254-262. [PMID: 37963816 PMCID: PMC10782245 DOI: 10.1111/os.13930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/03/2023] [Accepted: 09/29/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVES Scaphoid nonunion remains a challenging problem to manage with no general consensus on its treatment recommendations. We propose a novel minimally invasive (MIS) technique of arthroscopic bone grafting (ABG) with robot-assisted fixation for the treatment of scaphoid nonunions. METHODS Patients with radiographically proven scaphoid nonunion treated by this novel surgical technique were included. Following arthroscopic debridement and iliac crest bone grafting, the scaphoid was fixed percutaneously using either multiple Kirschner (K)-wires or a headless compression screw using a robotic navigation system. RESULTS Six male patients with an average age of 29.2 years were enrolled. Four patients had scaphoid waist fractures, and the other two were proximal pole fractures. During wrist arthroscopy, punctate bleeding of the proximal scaphoid fragment was observed in four out of the six patients. Half of the patients were fixed using a headless compression screw and the other half using multiple K-wires. All the guidewires were placed with a single-attempt using the robotic navigation system. Postoperatively, all the scaphoid fractures had complete radiographic union by 16 weeks. At a mean follow-up of 18.3 months, there were significant improvements in wrist range of motion, grip strength, and patient-rated outcomes. No intraoperative or early postoperative complications were encountered in any of our patients. CONCLUSION Arthroscopic bone grafting with robot-assisted fixation is a feasible and promising therapeutic option for scaphoid nonunions, regardless of the vascularity of the proximal pole fragment. This novel technique allows for anatomic restoration of the scaphoid alignment and accurate, targeted placement of implants into the scaphoid nonunion site within a single-attempt using a robotic navigation system.
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Affiliation(s)
- Zhe Yi
- Department of Hand Surgery, Beijing Jishuitan HospitalCapital Medical UniversityBeijingChina
- Peking University Fourth School of Clinical MedicineBeijingChina
| | - Rebecca Qian Ru Lim
- Department of Hand & Reconstructive MicrosurgerySingapore General HospitalSingaporeSingapore
| | - Wei Chen
- Department of Hand Surgery, Beijing Jishuitan HospitalCapital Medical UniversityBeijingChina
| | - Jin Zhu
- Department of Hand Surgery, Beijing Jishuitan HospitalCapital Medical UniversityBeijingChina
| | - Shanlin Chen
- Department of Hand Surgery, Beijing Jishuitan HospitalCapital Medical UniversityBeijingChina
- Peking University Fourth School of Clinical MedicineBeijingChina
| | - Bo Liu
- Department of Hand Surgery, Beijing Jishuitan HospitalCapital Medical UniversityBeijingChina
- Peking University Fourth School of Clinical MedicineBeijingChina
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O'Connor O, Patel R, Thahir A, Sy J, Jou E. The use of Three-Dimensional Printing in Orthopaedics: a Systematic Review and Meta-analysis. THE ARCHIVES OF BONE AND JOINT SURGERY 2024; 12:441-456. [PMID: 39070875 PMCID: PMC11283294 DOI: 10.22038/abjs.2024.74117.3465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 03/13/2024] [Indexed: 07/30/2024]
Abstract
Objectives 3D-printing is a rapidly developing technology with applications in orthopaedics including pre-operative planning, intraoperative guides, design of patient specific instruments and prosthetics, and education. Existing literature demonstrates that in the surgical treatment of a wide range of orthopaedic pathology, using 3D printing shows favourable outcomes. Despite this evidence 3D printing is not routinely used in orthopaedic practice. We aim to evaluate the advantages of 3D printing in orthopaedic surgery to demonstrate its widespread applications throughout the field. Methods We performed a comprehensive systematic review and meta-analysis. AMED, EMBASE, EMCARE, HMIC, PsycINFO, PubMed, BNI, CINAHL and Medline databases were searched using Healthcare Databases Advanced Search (HDAS) platform. The search was conducted to include papers published before 8th November 2020. Clinical trials, journal articles, Randomised Control Trials and Case Series were included across any area of orthopaedic surgery. The primary outcomes measured were operation time, blood loss, fluoroscopy time, bone fusion time and length of hospital stay. Results A total of 65 studies met the inclusion criteria and were reviewed, and 15 were suitable for the meta-analysis, producing a data set of 609 patients. The use of 3D printing in any of its recognised applications across orthopaedic surgery showed an overall reduction in operative time (SMD = -1.30; 95%CI: -1.73, -0.87), reduction in intraoperative blood loss (SMD = -1.58; 95%CI: -2.16, -1.00) and reduction in intraoperative fluoroscopy time (SMD = -1.86; 95%CI: -2.60, -1.12). There was no significant difference in length of hospital stay or in bone fusion time post-operatively. Conclusion The use of 3D printing in orthopaedics leads to an improvement in primary outcome measures showing reduced operative time, intraoperative blood loss and number of times fluoroscopy is used. With its wide-reaching applications and as the technology improves, 3D printing could become a valuable addition to an orthopaedic surgeon's toolbox.
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Affiliation(s)
- Olivia O'Connor
- Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom
- School of Clinical Medicine, University Of Cambridge, Cambridge, United Kingdom
- Contributed equally to this article as first authors
| | - Reece Patel
- Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom
- School of Clinical Medicine, University Of Cambridge, Cambridge, United Kingdom
- Contributed equally to this article as first authors
| | - Azeem Thahir
- Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom
| | - Jamie Sy
- Department of Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Eric Jou
- Kellogg College, University of Oxford, Oxford, United Kingdom
- Medical Sciences Division, Oxford University Hospitals, University of Oxford, Oxford, United Kingdom
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Brosner P, Hohlmann B, Welle K, Radermacher K. Ultrasound-Based Registration for the Computer-Assisted Navigated Percutaneous Scaphoid Fixation. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2023; 70:1064-1072. [PMID: 37399161 DOI: 10.1109/tuffc.2023.3291387] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
An ultrasound (US)-based computer-assisted approach has the potential to improve the accuracy and precision of screw placement for the percutaneous fixation of scaphoid fractures and also reduce the radiation dose for patient and clinical staff. Therefore, a surgical plan based on preoperative diagnostic computed tomography (CT) is registered with intraoperative US images, enabling a navigated percutaneous fracture fixation. However, approaches published so far rely on semimanual methods for intraoperative registration and are limited by long computation times. To address these challenges, we propose the employment of deep learning-based methods for US segmentation and registration in order to achieve a fast and fully automated yet robust registration process. For validation of the proposed US-based approach, we first provide a comparison of methods for segmentation and registration, assess their contribution to the overall error throughout our pipeline, and, finally, evaluate navigated screw placement in an in vitro study on 3-D printed carpal phantoms. Successful screw placement has been achieved for all ten screws, with deviations from the planned axis of 1.0 ± 0.6 and 0.7 ± 0.3 mm at the distal and proximal pole, respectively. The complete automation and total duration of about 12 s also allow seamless integration of our approach into the surgical workflow.
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McWilliam RH, Chang W, Liu Z, Wang J, Han F, Black RA, Wu J, Luo X, Li B, Shu W. Three-dimensional biofabrication of nanosecond laser micromachined nanofibre meshes for tissue engineered scaffolds. BIOMATERIALS TRANSLATIONAL 2023; 4:104-114. [PMID: 38283921 PMCID: PMC10817787 DOI: 10.12336/biomatertransl.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/19/2023] [Accepted: 06/20/2023] [Indexed: 01/30/2024]
Abstract
There is a high demand for bespoke grafts to replace damaged or malformed bone and cartilage tissue. Three-dimensional (3D) printing offers a method of fabricating complex anatomical features of clinically relevant sizes. However, the construction of a scaffold to replicate the complex hierarchical structure of natural tissues remains challenging. This paper reports a novel biofabrication method that is capable of creating intricately designed structures of anatomically relevant dimensions. The beneficial properties of the electrospun fibre meshes can finally be realised in 3D rather than the current promising breakthroughs in two-dimensional (2D). The 3D model was created from commercially available computer-aided design software packages in order to slice the model down into many layers of slices, which were arrayed. These 2D slices with each layer of a defined pattern were laser cut, and then successfully assembled with varying thicknesses of 100 μm or 200 μm. It is demonstrated in this study that this new biofabrication technique can be used to reproduce very complex computer-aided design models into hierarchical constructs with micro and nano resolutions, where the clinically relevant sizes ranging from a simple cube of 20 mm dimension, to a more complex, 50 mm-tall human ears were created. In-vitro cell-contact studies were also carried out to investigate the biocompatibility of this hierarchal structure. The cell viability on a micromachined electrospun polylactic-co-glycolic acid fibre mesh slice, where a range of hole diameters from 200 μm to 500 μm were laser cut in an array where cell confluence values of at least 85% were found at three weeks. Cells were also seeded onto a simpler stacked construct, albeit made with micromachined poly fibre mesh, where cells can be found to migrate through the stack better with collagen as bioadhesives. This new method for biofabricating hierarchical constructs can be further developed for tissue repair applications such as maxillofacial bone injury or nose/ear cartilage replacement in the future.
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Affiliation(s)
- Ross H. McWilliam
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Wenlong Chang
- Centre for Precision Manufacturing, Design, Manufacturing & Engineering Management, University of Strathclyde, Glasgow, UK
| | - Zhao Liu
- Orthopaedic Institute, Department of Orthopaedic Surgery, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu Province, China
| | - Jiayuan Wang
- Orthopaedic Institute, Department of Orthopaedic Surgery, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu Province, China
| | - Fengxuan Han
- Orthopaedic Institute, Department of Orthopaedic Surgery, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu Province, China
| | - Richard A. Black
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Junxi Wu
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Xichun Luo
- Centre for Precision Manufacturing, Design, Manufacturing & Engineering Management, University of Strathclyde, Glasgow, UK
| | - Bin Li
- Orthopaedic Institute, Department of Orthopaedic Surgery, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu Province, China
| | - Wenmiao Shu
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
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Bodansky DMS, Sandow MJ, Volk I, Luria S, Verstreken F, Horwitz MD. Insights and trends review: the role of three-dimensional technology in upper extremity surgery. J Hand Surg Eur Vol 2023; 48:383-395. [PMID: 36748271 DOI: 10.1177/17531934221150498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The use of three-dimensional (3-D) technology in upper extremity surgery has the potential to revolutionize the way that hand and upper limb procedures are planned and performed. 3-D technology can assist in the diagnosis and treatment of conditions, allowing virtual preoperative planning and surgical templating. 3-D printing can allow the production of patient-specific jigs, instruments and implants, allowing surgeons to plan and perform complex procedures with greater precision and accuracy. Previously, cost has been a barrier to the use of 3-D technology, which is now falling rapidly. This review article will discuss the current status of 3-D technology and printing, including its applications, ethics and challenges in hand and upper limb surgery. We have provided case examples to outline how clinicians can incorporate 3-D technology in their clinical practice for congenital deformities, management of acute fracture and malunion and arthroplasty.
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Affiliation(s)
- David M S Bodansky
- Department of Plastic Surgery, Chelsea and Westminster NHS Foundation Trust, London, UK
| | | | - Ido Volk
- Hadassah Medical Organisation, Jerusalem, Israel
| | - Shai Luria
- Hadassah Medical Organisation, Jerusalem, Israel
| | | | - Maxim D Horwitz
- Department of Plastic Surgery, Chelsea and Westminster NHS Foundation Trust, London, UK
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Dittman LE, Kakar S. CMC Mimickers: Differential Diagnosis and Work-Up for Radial-Sided Wrist Pain. Hand Clin 2022; 38:149-160. [PMID: 35465933 DOI: 10.1016/j.hcl.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In patients with radial-sided wrist pain, a myriad of possible etiologies exists and as such, a detailed history, examination, and, where indicated, imaging is obtained to try and aid with its diagnosis. The purpose of this article is to provide an overview of radial-sided wrist pain, diagnostic modalities and discuss current treatment options. More detailed information is out-of-scope for this article and if needed, we would guide the reader to seek out other selected texts, as indicated.
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Affiliation(s)
| | - Sanjeev Kakar
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Catena N, Arrigoni C, Origo C. Use of a 3D Model for the Correction of a Complex Madelung Deformity in a Teenager: A Case Report. JBJS Case Connect 2022; 12:01709767-202206000-00008. [PMID: 36099456 DOI: 10.2106/jbjs.cc.21.00622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE The aim of the article is to report on a case of a teenager affected by Madelung deformity treated with a double osteotomy, planned by means of a 3D model. Using a custom-made cutting guide, the radial osteotomy was performed, and after the reorientation, a shortening ulnar osteotomy completed the procedure. Postoperative clinical assessment showed a normal alignment of the ulna with increased range of motion wrist motion. CONCLUSIONS Using a 3D model when planning a multidirectional correction of a Madelung deformity may be advantageous to achieve a more accurate and precise realignment of the carpus and distal radioulnar joint.
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Affiliation(s)
- Nunzio Catena
- Reconstructive Surgery and Hand Surgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Chiara Arrigoni
- Pediatric Orthopaedic and Traumatology Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Carlo Origo
- Pediatric Orthopaedic and Traumatology Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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Wong RMY, Wong PY, Liu C, Chung YL, Wong KC, Tso CY, Chow SKH, Cheung WH, Yung PSH, Chui CS, Law SW. 3D printing in orthopaedic surgery: a scoping review of randomized controlled trials. Bone Joint Res 2021; 10:807-819. [PMID: 34923849 PMCID: PMC8696518 DOI: 10.1302/2046-3758.1012.bjr-2021-0288.r2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Aims The use of 3D printing has become increasingly popular and has been widely used in orthopaedic surgery. There has been a trend towards an increasing number of publications in this field, but existing literature incorporates limited high-quality studies, and there is a lack of reports on outcomes. The aim of this study was to perform a scoping review with Level I evidence on the application and effectiveness of 3D printing. Methods A literature search was performed in PubMed, Embase, and Web of Science databases. The keywords used for the search criteria were ((3d print*) OR (rapid prototyp*) OR (additive manufactur*)) AND (orthopaedic). The inclusion criteria were: 1) use of 3D printing in orthopaedics, 2) randomized controlled trials, and 3) studies with participants/patients. Risk of bias was assessed with Cochrane Collaboration Tool and PEDro Score. Pooled analysis was performed. Results Overall, 21 studies were included in our study with a pooled total of 932 participants. Pooled analysis showed that operating time (p < 0.001), blood loss (p < 0.001), fluoroscopy times (p < 0.001), bone union time (p < 0.001), pain (p = 0.040), accuracy (p < 0.001), and functional scores (p < 0.001) were significantly improved with 3D printing compared to the control group. There were no significant differences in complications. Conclusion 3D printing is a rapidly developing field in orthopaedics. Our findings show that 3D printing is advantageous in terms of operating time, blood loss, fluoroscopy times, bone union time, pain, accuracy, and function. The use of 3D printing did not increase the risk of complications. Cite this article: Bone Joint Res 2021;10(12):807–819.
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Affiliation(s)
- Ronald Man Yeung Wong
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Pui Yan Wong
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Chaoran Liu
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Yik Lok Chung
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Kwok Chuen Wong
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Chi Yin Tso
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Simon Kwoon-Ho Chow
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Wing-Hoi Cheung
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Chun Sing Chui
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Sheung Wai Law
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hong Kong, Hong Kong
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Affiliation(s)
- Chelsea Hopkins
- The Chinese University of Hong Kong, Prince of Wales Hospital, Department of Orthopaedics & Traumatology, Shatin, N.T, Hong Kong, China
| | - Ling Qin
- The Chinese University of Hong Kong, Prince of Wales Hospital, Department of Orthopaedics & Traumatology, Shatin, N.T, Hong Kong, China
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