Background

In recent years, the use of 3-dimensional (3D) printing in orthopedic surgery has greatly expanded, including the application of 3D-printed implants following bone tumor excision. After complete bone tumor excision, bone defects are typically reconstructed and implanted with a prosthetic. Historically, commercially produced implants have been used, but recent research explores the benefit of individualized 3D-printed prostheses (3DPs). These custom implants more accurately match the complex shapes of orthopedic defects and are especially useful in areas where unusual implants are necessary. The purpose of this review is to compile the available literature surrounding 3D-printed bone tumor prostheses and use patient outcomes to evaluate the efficacy of 3DPs compared to conventional prostheses. This review aims to assess the benefits and limitations of 3DPs and determine if they are a viable alternative to traditional implants.

Methods: A systematic review was conducted, and the literature search was limited to studies with a comparable non-3DP control. A variety of bone tumor types and locations were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was applied. Outcome measures of 3DPs and conventional implants were compared in the context of the tumor location and procedure type. The selected outcome measures include operative duration, intraoperative blood loss, hospital stay, cost, complication rate, implant dislocation, and Musculoskeletal Tumor Society Scoring System (MSTS) score.

Results

Operative duration was decreased with 3DP use in 4 studies of pelvic and periacetabular tumors, with a reduction of 125, 70, 63, and 41 minutes respectively. Conversely, thoracolumbar 3DPs showed an average increased operative duration of 54 minutes. Compared to control, reduced intraoperative blood loss was seen in pelvic, periacetabular, and thoracolumbar 3DP procedures. MSTS score, a quality of life measure, was improved in the 3DP group compared to control in all four studies of pelvic and periacetabular tumors. In two cases of pelvic tumors, the 3DP group demonstrated an average decreased risk of implant dislocation by 11.22%. In thoracolumbar tumors, the risk decreased by 7.2%.

Conclusion

Compared to conventional controls, our review demonstrates the benefits of 3DPs in improving patient outcomes and the efficiency of surgical procedures. Intraoperative blood loss, complication rate, and implant dislocation occurrence were all shown to be reduced with the use of 3DPs. 3DP use also revealed an improvement in MSTS score and tumor resection accuracy. Additional studies with comparable controls are necessary to further evaluate the benefits of 3DPs and assess their long-term efficacy.