Title : Three-Dimensional printing in orthopaedic surgery: A scoping review of technological innovations, clinical applications, cost-effectiveness, and regulatory challenges (2015-2025)
Abstract:
Three-Dimensional (3D) printing, or additive manufacturing, has emerged over the past decade as a transformative technology in orthopaedic surgery, offering personalised, anatomically accurate, and biologically integrated solutions across multiple subspecialties. This scoping review aimed to map significant technological innovations from 2015 to 2025, consolidate clinical applications, critically appraise cost and feasibility data, and identify regulatory and operational challenges that continue to limit widespread adoption. A comprehensive search of PubMed/MEDLINE, Scopus, Cochrane, Web of Science, and Google Scholar was performed using terms related to 3D printing, additive manufacturing, rapid prototyping, and orthopaedics.
Eligible peer-reviewed English-language studies published between January 2015 and 2025 - including randomised controlled trials, cohort and feasibility studies, scoping and systematic reviews, technical reports, and bibliometric analyses - were screened in duplicate, yielding 34 included studies from an initial 11,300 records. A descriptive synthesis was conducted, with data organised across four domains.
Major technological advances include the introduction of biodegradable metals (magnesium, calcium, zinc, and iron), metal-matrix composites, highly porous titanium scaffolds promoting osseointegration, and the deployment of point-of-care workflows enabling in-house production of patient-specific implants and bioresorbable devices. Clinical applications span trauma, paediatric orthopaedics, complex arthroplasty, oncology, external fixation, prosthetics, and orthotics, with consistent evidence of reduced operating time, intraoperative blood loss, and fluoroscopy exposure.
Reported costs vary widely, from under US$10 to over US$20,000, with economic modelling suggesting net savings when operative-time reductions are accounted for. However, persistent barriers include the absence of harmonised regulatory and quality-control frameworks, high upfront infrastructure and training costs, limited long-term outcome data, and underexplored environmental considerations. Future progress will depend on coordinated efforts between clinicians, engineers, and policymakers to standardise practice, advance multicentre trials, and ensure equitable, sustainable adoption.
