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Orthopedics

Cite as: Archiv EuroMedica. 2026. 16; 4. DOI 10.35630/2026/16/Iss.4.26

Received 08 July 2026;
Accepted 11 August 2026;
Published 14 August 2026

3D PRINTING IN ORTHOPEDIC SURGERY: CURRENT APPLICATIONS AND FUTURE PERSPECTIVES

Agnieszka Sawina1 email orcid, Adam Iwanicki1 orcid,
Maciej Łabuś1 orcid, Aleksandra Skawińska1 orcid,
Tomasz Wołoszczuk1 orcid, Zofia Graca1 orcid,
Jakub Kołodziej1 orcid, Aleksandra Skowronek1 orcid,
Julia Jeziorna1 orcid, Elżbieta Siudmak1 orcid

1 Medical University of Silesia, Katowice, Poland

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  sawina.agnieszka13@gmail.com

ABSTRACT

Background

Three-dimensional (3D) printing technology is one of the fastest-developing innovations in contemporary orthopedic surgery, supporting the transition from conventional treatment approaches toward precision and personalized reconstructive medicine.

Aim

The aim of this narrative review was to summarize the current applications of 3D printing in orthopedic surgery, including preoperative planning, anatomical models, patient-specific surgical guides, customized implants, biomaterials, and bioprinting, and to identify the main limitations and future directions of these technologies.

Materials and Methods

This narrative review included 46 English-language publications published between January 2017 and March 2026. The literature search was performed using PubMed, Scopus, Web of Science, and Google Scholar, with the final search conducted on June 30, 2026. Original research articles, systematic reviews, meta-analyses, scoping reviews, and narrative reviews directly relevant to 3D printing in orthopedic surgery were included.

Results

The analyzed literature suggests that 3D printing may improve surgical precision and reduce operative time in selected orthopedic applications. Anatomical models generated from CT and MRI data support preoperative planning and surgical team preparation. Patient-specific surgical guides may improve the accuracy of planned osteotomies and implant positioning. Customized implants, particularly those manufactured from titanium alloys, offer favorable biomechanical properties and may support osseointegration. Bioprinting is a promising experimental approach for the regeneration of articular cartilage and bone tissue, although its clinical application remains limited.

Conclusions

Three-dimensional printing has considerable potential to support precision and personalized approaches in orthopedic surgery. Its most established applications include anatomical models and patient-specific surgical guides, whereas customized implants require further clinical validation and bioprinting remains largely investigational. Broader implementation is still limited by economic, technological, regulatory, and methodological challenges.

Keywords: 3D printing, Orthopedic surgery, Patient-specific implants, Surgical planning, Bioprinting

INTRODUCTION

Contemporary orthopedic surgery is undergoing a phase of dynamic technological transformation, with additive manufacturing commonly referred to as three-dimensional (3D) printing emerging as one of its key pillars [1,2]. Initially developed in the 1980s for industrial applications, this technology has, over the past decade, found widespread use in medicine, including orthopedics, where it enables the creation of highly complex and precise physical structures tailored to individual patient anatomy. The growing interest in 3D printing in orthopedics stems from its potential to fundamentally shift the treatment paradigm from standardized approaches toward fully personalized reconstructive medicine [2].

Current scientific evidence, including systematic reviews and meta-analyses of studies indexed in databases such as PubMed, Embase, and MEDLINE, indicates that the applications of this technology span a broad spectrum of clinical practice from preoperative planning and the fabrication of anatomical models to the development of patient-specific surgical guides, as well as the design and manufacture of customized implants and prostheses [1-3, 42]. In particular, the ability to reconstruct three-dimensional bone structures based on imaging data (CT, MRI) and convert them into physical models significantly improves the accuracy of surgical planning, facilitates communication within the surgical team and with patients, and may reduce operative time and the risk of intraoperative complications [1-3]. Furthermore, advances in additive manufacturing technologies, including powder bed fusion and vat photopolymerization, have enabled the production of sophisticated implants with biomechanical and biological properties closely resembling native bone tissue, thereby promoting osseointegration and improving clinical outcomes [2,3].

Despite promising clinical results and a rapidly expanding body of literature, the implementation of 3D printing in routine orthopedic practice remains limited by several factors, including high production costs, the need for specialized equipment and technical expertise, regulatory requirements, and the limited availability of high-quality clinical evidence, particularly randomized controlled trials evaluating long-term outcomes [2,3]. Nevertheless, current evidence indicates that additive manufacturing represents one of the most promising directions in the evolution of orthopedic surgery and is increasingly being integrated with other advanced technologies, such as tissue engineering, regenerative medicine, and bioprinting [1,2].

Although numerous review articles have addressed the use of 3D printing in orthopedic surgery, most have focused on selected applications, such as patient-specific implants, anatomical models, surgical guides, or specific orthopedic subspecialties. Moreover, many previously published reviews do not comprehensively address the recent advances in additive manufacturing technologies, novel biomaterials, and bioprinting, nor do they provide an integrated discussion of the technological, economic, regulatory, and ethical challenges associated with the broader clinical implementation of these technologies. Therefore, an updated synthesis of the available evidence is warranted. The scientific novelty of this narrative review lies in its comprehensive and contemporary overview of 3D printing applications in orthopedic surgery, integrating current evidence on preoperative planning, patient-specific instrumentation, customized implant manufacturing, biomaterials, and musculoskeletal tissue regeneration while simultaneously discussing the challenges and future perspectives for the implementation of additive manufacturing in precision and personalized orthopedic care [1-3].

AIM

The aim of this narrative review is to summarize the current applications of 3D printing technology in orthopedic surgery and to describe its reported clinical applications and potential benefits in preoperative planning, patient-specific instrumentation, customized implant design and manufacturing, and musculoskeletal tissue regeneration.

Objectives

The objectives of this review are to:

  1. summarize the principal 3D printing technologies, materials, and current orthopedic applications;
  2. examine the use of anatomical models, patient-specific surgical guides, customized implants, and bioprinting in orthopedic surgery and musculoskeletal tissue regeneration;
  3. identify the main clinical, technological, economic, regulatory, and ethical limitations and outline future directions for the development of 3D printing in orthopedics.

MATERIALS AND METHODS

This study was conducted as a narrative review of the literature on the application of three-dimensional (3D) printing in orthopedic surgery. A literature search was performed using PubMed, Scopus, Web of Science, and Google Scholar. The review included English-language publications published between January 2017 and March 2026. The final literature search was conducted on June 30, 2026.

The search strategy included combinations of the following keywords and Medical Subject Headings (MeSH), where applicable: “3D printing”, “three-dimensional printing”, “additive manufacturing”, “orthopedic surgery”, “orthopaedics”, “patient-specific implants”, “customized implants”, “anatomical models”, “surgical guides”, “bioprinting”, “bone tissue engineering”, and “musculoskeletal regeneration”. Boolean operators “AND” and “OR” were used to combine the search terms. An example of the PubMed search query was:

(“3D printing” OR “three-dimensional printing” OR “additive manufacturing”) AND (“orthopedic surgery” OR orthopaedics) AND (“patient-specific implants” OR “surgical guides” OR “anatomical models” OR bioprinting).

The inclusion criteria were publications in English published between January 2017 and March 2026; original research articles, systematic reviews, meta-analyses, scoping reviews, and narrative reviews; full-text availability; and direct relevance to the use of 3D printing, patient-specific implants, anatomical models, surgical guides, biomaterials, or bioprinting in orthopedic surgery and musculoskeletal tissue regeneration.

The exclusion criteria were publications unrelated to orthopedic surgery; studies focused exclusively on non-medical engineering aspects without clinical relevance; veterinary studies; conference abstracts without full-text publication; editorials; letters to the editor; and duplicate publications.

Additional relevant publications were identified by screening the reference lists of the selected articles. Titles and abstracts were initially screened for eligibility, followed by full-text assessment of potentially relevant publications. A total of 46 publications met the inclusion criteria and were included in this narrative review.

RESULTS

Development of 3D printing technology in medicine

The origins of 3D printing technology date back to the 1980s, when Charles Hull developed the first stereolithography (SLA) method, enabling the layer-by-layer curing of photopolymers using ultraviolet (UV) light. In subsequent years, other additive manufacturing techniques were introduced, including selective laser sintering (SLS) and fused deposition modeling (FDM), which were initially applied primarily in engineering industries and rapid prototyping. A major breakthrough in medical applications occurred at the turn of the 20th and 21st centuries, driven by advancements in high-resolution medical imaging, particularly computed tomography (CT) and magnetic resonance imaging (MRI) [1,4,5]. The integration of imaging data with computer-aided design (CAD) software enabled the generation of precise three-dimensional reconstructions of patient-specific anatomical structures, which could subsequently be physically fabricated using 3D printing technologies. As a result, this technology has progressively evolved from an engineering tool into a sophisticated instrument supporting both diagnosis and treatment in modern medicine [4-6].

Initial applications of 3D printing in medicine were limited to the production of educational and demonstration models. However, with improvements in accuracy, reproducibility, and the availability of biocompatible materials, the technology has progressively found genuine clinical applications [4,6]. Currently, 3D printing plays a significant role in several areas of orthopedic practice, including preoperative planning using patient-specific anatomical models, the design and manufacture of custom-made implants, the production of patient-specific surgical instrumentation, and the reconstruction of complex bone defects with irregular geometry [5-9,46].

A key milestone in the clinical translation of this technology was the regulatory approval of the first additively manufactured implants, which confirmed their safety and feasibility for use in humans. In recent years, there has been a marked increase in both scientific publications and clinical implementations, particularly in reconstructive surgery and orthopedic oncology, where conventional solutions are often insufficient [8,9].

The main additive manufacturing technologies currently applied in medicine and tissue engineering differ in their working principles, available materials, accuracy, and clinical applications.

Table 1 summarizes the characteristics of selected 3D printing technologies used in orthopedic and biomedical applications. As shown in Table 1, techniques such as selective laser melting (SLM) and selective laser sintering (SLS) are predominantly used for manufacturing metallic implants due to their high mechanical strength and precision [43], whereas stereolithography (SLA) and fused deposition modeling (FDM) are frequently applied in the production of anatomical models, surgical guides, and polymer-based structures [9-11].

Table 1. Characteristics of selected 3D printing technologies used in medicine and tissue engineering [9-11]

TechniqueDescriptionApplications (particularly medical/orthopedic)
Stereolithography (SLA)Technology based on the photopolymerization of liquid resins using ultraviolet (UV) light. It is characterized by very high resolution and excellent accuracy in reproducing fine details.Production of anatomical models and structures requiring high precision, such as those used in surgical planning.
Selective Laser Sintering (SLS)A method based on laser sintering of powder materials (polymeric or metallic). It does not require the use of support structures.Manufacturing of durable and complex structures, including implants with porous architecture that promotes osseointegration.
Fused Deposition Modeling (FDM)A layer-by-layer deposition technology using melted thermoplastic material. It is relatively low-cost and widely accessible.Educational models and prototypes; limited precision and mechanical properties compared to other methods.
Powder Bed Fusion (PBF) - SLM and EBMAdvanced powder bed fusion techniques using metal powders (e.g., titanium alloys), employing either a laser beam (SLM - Selective Laser Melting) or an electron beam (EBM - Electron Beam Melting).Manufacturing of implants with high mechanical strength and controlled microstructure, particularly in orthopedics.

The development of these technologies, combined with advances in biomaterials and 3D modeling software, forms the foundation for the further expansion of 3D printing in medicine. In particular, orthopedics, due to its strong dependence on spatial structures and biomechanics, remains one of the main beneficiaries of this technological revolution [10,11].

Patient-specific orthopedic implants

One of the most groundbreaking applications of 3D printing technology in orthopedics is the ability to design and manufacture implants fully tailored to individual patient anatomy (patient-specific implants, PSI) [2,12]. The process begins with high-resolution imaging, most commonly computed tomography (CT), the data from which are subsequently segmented and reconstructed into a three-dimensional model using advanced CAD/CAE software [12]. Based on this, a digital implant model is created, taking into account both the geometry of the bone defect and the biomechanical conditions of the specific anatomical region. In contrast to standard implants available in a limited range of sizes, patient-specific solutions allow for precise replication of complex anatomical structures, which is particularly important in cases of post-traumatic deformities, oncological resections, or congenital abnormalities [1,5,13,14]. Importantly, implant design can be further supported by numerical analysis, such as finite element analysis (FEA), enabling optimization of stress distribution and minimization of the risk of mechanical failure [12-14].

A key aspect of the effectiveness of additively manufactured implants is the selection of appropriate materials, which must meet stringent biomechanical and biological requirements [1- 3].

Table 2 summarizes the most commonly used materials in additive manufacturing of orthopedic implants and their key biological and mechanical properties. As presented in Table 2, titanium and its alloys remain the most frequently used materials for load-bearing orthopedic implants due to their favorable strength-to-weight ratio, excellent biocompatibility, and proven capacity for bone integration. In contrast, polymer-based materials are primarily applied in less mechanically demanding structures, while bioactive composites represent a promising direction for future applications in bone regeneration and tissue engineering.

Table 2. Key materials used in additive manufacturing of medical implants and their properties [15-17]

MaterialCharacteristicsApplications and clinical significance
Titanium alloys (e.g., Ti-6Al-4V)High mechanical strength, corrosion resistance, and excellent biocompatibility. Additive manufacturing (e.g., powder bed fusion, PBF) enables the production of porous structures that mimic trabecular bone architecture.Considered the gold standard in orthopedics and implantology; promotes osseointegration and implant stability.
Biocompatible polymers (e.g., PEEK)Elasticity close to bone tissue, radiolucency, and a favorable elastic modulus that reduces the stress shielding effect.Implants requiring lower stiffness; applications in spinal surgery and reconstructive procedures. However, limited osseointegration often necessitates surface modification.
Composites and bioactive materialsHybrid materials containing bioactive additives, such as hydroxyapatite, promoting cell adhesion and mineralization.Supporting bone regeneration and improving biological integration of the implant; a key direction in modern implantology.

The use of patient-specific orthopedic implants is associated with a range of significant clinical benefits that are increasingly supported by the scientific literature. First and foremost, they enable improved anatomical fit, which allows optimal contact between the implant and bone tissue, enhanced primary stability, and more physiological load transfer. As a result, this translates into better functional outcomes and improved long-term durability of the reconstruction. In addition, precise implant customization, combined with the possibility of preoperative planning, contributes to reduced surgical trauma and shorter operative time, which in turn facilitates earlier patient mobilization and a reduced length of hospital stay. Implant personalization also minimizes the need for intraoperative modifications and reduces the risk of mismatch, which could otherwise lead to loosening, instability, or the need for revision surgery. Furthermore, improved osseointegration contributes to a reduced risk of infection and treatment failure [6,18,19].

Patient-specific implants manufactured using 3D printing technology represent an important step toward precision medicine in orthopedics [18]. Their growing clinical use reflects not only technological progress but also a paradigm shift in treatment philosophy - from a universal approach to one that is individually tailored, based on the specific anatomical and biomechanical characteristics of each patient [6,19].

Anatomical models for surgical planning

The application of 3D printing in the creation of anatomical models is based on the integration of high-resolution imaging data, primarily from computed tomography (CT) and magnetic resonance imaging (MRI), with advanced software for segmentation and three-dimensional reconstruction [20]. Current scientific reports emphasize that a critical step in this process is the precise segmentation of anatomical structures, including the separation of bone, cartilage, and soft tissues, which directly influences the accuracy of the final model [20,21]. In recent years, semi-automated and artificial intelligence-based algorithms have gained particular importance, improving reproducibility and reducing the time required for model generation. The resulting data are then converted into the STL (Standard Tessellation Language) format and fabricated using additive manufacturing technologies such as stereolithography (SLA) or material jetting, which ensure high geometric resolution [20-23]. Contemporary studies indicate that the accuracy of such models can reach deviations of less than 1 mm compared to patient anatomy, making them a highly reliable clinical tool [22,23].

According to recent meta-analyses and prospective studies, the use of 3D-printed anatomical models in preoperative planning significantly improves surgical precision. In particular, studies have demonstrated a reduction in operative time, often by 10–20%, decreased intraoperative blood loss, reduced intraoperative radiation exposure (fluoroscopy), and improved accuracy of fracture reduction as well as implant positioning [21-24,45].

Physical models allow surgeons to “rehearse” the procedure prior to surgery, which is particularly important in cases involving complex anatomy. They also facilitate appropriate implant selection, assessment of screw trajectories, and optimization of the surgical approach. As a result, the number of unexpected intraoperative events is reduced, and overall patient safety is improved [22].

The greatest benefits of using anatomical models are observed in cases of high complexity, where standard planning based solely on 2D images or digital reconstructions may be insufficient [20-22].

Table 3 presents selected applications of 3D-printed anatomical models in different areas of orthopedic surgery. As summarized in Table 3, these models have been successfully implemented in trauma surgery, orthopedic oncology, reconstructive procedures, and surgical education, demonstrating their versatility as tools for improving preoperative decision-making and surgical accuracy.

Table 3. Applications of 3D-printed anatomical models in selected areas of orthopedic surgery [19-24]

Application areaSignificance of 3D models
Complex intra-articular fracturesIn comminuted fractures, such as acetabular fractures or tibial plateau injuries, 3D models enable precise analysis of fragment configuration and planning of their anatomical reduction, which translates into improved restoration of articular surfaces.
Bone deformities (congenital and acquired)In corrective surgery, 3D models enable precise planning of osteotomies, including determination of the cutting angle and level. They are often integrated with patient-specific surgical guides, which further increases the accuracy of the correction.
Orthopedic oncologyAnatomical models enable precise determination of bone tumor resection margins and planning of defect reconstruction, often in combination with patient-specific implants.
Spine surgeryThey are used for planning pedicle screw trajectories, particularly in scoliotic deformities and revision cases, where the anatomy is significantly altered.

The use of 3D-printed anatomical models is currently one of the best-documented and most clinically established applications of 3D printing in orthopedics. Recent evidence indicates that this technology not only enhances surgical precision but also contributes to improved treatment outcomes and patient safety, particularly in the most challenging clinical cases [21-24].

3D-printed surgical instruments and operative guides

One of the most rapidly developing applications of 3D printing technology in orthopedics is the design and manufacture of patient-specific surgical guides (PSG) [25,26]. These are instruments tailored to the unique anatomy of the patient, whose primary function is the precise execution of preoperatively planned trajectories for cutting, drilling, and implant placement. Their development process is closely integrated with digital surgical planning [26,27]. Based on computed tomography (CT) data, bone structures are segmented, and a guide is subsequently designed to fit precisely onto anatomical surfaces (e.g., femoral condyles, tibial plateau, or vertebral arches). This allows for unambiguous positioning of the instrument within the surgical field without the need for additional intraoperative verification [24-28]. Current studies indicate that the use of PSG is particularly valuable in procedures requiring high geometric precision, such as joint arthroplasty, corrective osteotomies, and spinal stabilization procedures [25,26].

One of the best-documented effects of the use of 3D-printed surgical guides is a significant improvement in procedural accuracy. Recent clinical analyses and meta-analyses indicate that patient-specific guides (PSG) reduce axial and rotational deviations in prosthetic implant positioning, enable more precise reproduction of planned osteotomy angles, improve the accuracy of screw placement (e.g., in spinal surgery), and reduce the number of technical errors resulting from the surgeon’s subjective assessment [26-28]. In total knee arthroplasty, the use of patient-specific guides has been shown to improve the rate of correct component alignment within the mechanical axis of the limb. Similarly, in spinal surgery, a higher rate of accurately placed pedicle screws has been observed, along with a reduced risk of injury to neural structures [27,28].

Another important benefit of using 3D-printed surgical instruments is the reduction in operative time. This is primarily attributed to the elimination of certain intraoperative planning steps, a reduced need for real-time measurements, decreased reliance on fluoroscopy, and a simplified instrumentation process [25,27]. According to current reports, the reduction in surgical time may range from several to several dozen minutes, depending on the type of procedure. This has a direct impact not only on operating room efficiency but also on patient safety, including shorter duration of general anesthesia and reduced exposure to intraoperative risk factors [27,28]. 3D-printed surgical guides represent a significant step toward increased standardization and precision in orthopedic procedures. Their use aligns with the broader trend of digitalization in medicine and the integration of preoperative planning with intraoperative execution, ultimately leading to improved clinical outcomes and reduced operator-dependent variability [25-28].

Bioprinting and the future of tissue regeneration

Bioprinting represents an advanced branch of additive manufacturing in which, instead of synthetic materials, so-called bioinks are used - compositions containing living cells, biomaterials (e.g., hydrogels), and growth factors. The aim of this technology is to create three-dimensional, functional biological structures capable of replicating the properties of human tissues [29,30]. In the context of orthopedics, bioprinting is primarily focused on tissues with limited regenerative capacity, such as articular cartilage and bone tissue. This process is based on the precise spatial deposition of cells (e.g., chondrocytes, osteoblasts, or stem cells) within a three-dimensional construct, according to a predesigned biomimetic architecture [29,30]. A key challenge remains maintaining cell viability and ensuring appropriate microenvironmental conditions that support cellular differentiation and maturation [31].

According to recent scientific literature, bioprinting remains at the stage of intensive preclinical research and early clinical studies. Significant progress has been made in several areas, including the development of bioinks with properties resembling the extracellular matrix (ECM), the use of mesenchymal stem cells (MSCs) as a cellular source for regeneration, multi-material 3D printing technologies enabling the fabrication of constructs with layered and heterogeneous architecture, and the application of growth factors (e.g., TGF-β, BMP) to support cellular differentiation [29-32]. In vivo studies have demonstrated that bioprinted cartilage constructs may exhibit the ability to integrate with host tissue and partially restore the biomechanical properties of cartilage. In bone tissue engineering, hybrid scaffolds are being developed that combine the mechanical properties of synthetic materials with the bioactivity of biological components. Despite significant progress, major limitations remain, including the lack of vascularization in larger constructs, challenges in scaling the technology, and the absence of long-term clinical data confirming the durability of the achieved outcomes [31,32,44]. Potential applications of bioprinting primarily include articular cartilage regeneration, which, due to its limited intrinsic healing capacity, remains one of the major challenges in contemporary orthopedics [31]. Recent studies indicate that it is possible to fabricate constructs containing chondrocytes or stem cells differentiating toward the chondrogenic lineage, which are capable of producing cartilage extracellular matrix components, including type II collagen and proteoglycans [28,29]. Compared with currently used treatment methods, such as microfracture techniques or autologous chondrocyte implantation, bioprinting provides substantially greater control over tissue architecture and biomechanical properties, potentially leading to more predictable and durable therapeutic outcomes. Another important area of bioprinting application is bone tissue regeneration [28-32]. In this context, bioprinted scaffolds are being developed that can be seeded with osteoblasts or progenitor cells supporting osteogenesis [32,33]. Of particular importance are constructs with precisely controlled porosity, which enables both cell migration and angiogenesis - critical processes for proper healing and integration with host tissue [33,34]. Experimental models have demonstrated that such structures may effectively support the regeneration of critically sized bone defects, which is particularly relevant in trauma and oncological surgery [32-34]. Bioprinting represents one of the most promising directions in orthopedic regenerative medicine. Although its clinical application remains currently limited, the rapid development of 3D printing technologies, biomaterials, and tissue engineering suggests that in the coming decades it may play a key role in the treatment of tissue defects, significantly exceeding the capabilities of conventional therapeutic approaches [34].

Systemic benefits, limitations, clinical experience, and the future of 3D printing-based orthopedic surgery

The dynamic development of 3D printing technology in orthopedics not only redefines approaches to surgical treatment but also has a significant impact on the functioning of entire healthcare systems [35]. Analysis of recent scientific reports indicates that the implementation of additive manufacturing solutions is associated with measurable economic and organizational benefits, although it also faces important technological, regulatory, and ethical barriers. From a systemic perspective, one of the most important aspects is the reduction of long-term costs. Despite the high initial expenses related to infrastructure implementation (equipment, software, training), numerous analyses have shown that the use of anatomical models, surgical guides, and patient-specific implants leads to a reduction in complication rates, reoperations, and operative time [35-37]. Consequently, this translates into lower overall treatment costs in the long term. Particularly important is also the reduction in hospital length of stay, resulting from less invasive procedures and faster patient recovery [38,39].

An important element is also the optimization of medical team workflows. The integration of preoperative planning using 3D models and digital tools enables improved coordination between surgeons, radiologists, and biomedical engineers [38]. As a result, procedural predictability increases and variability in outcomes dependent on operator experience is reduced. In many centers, improved operating room efficiency has also been observed [36-40]. Despite these advantages, the widespread implementation of 3D printing technology faces significant challenges and limitations. One of the main issues remains the high initial costs, including the purchase of advanced printers, materials, and software, as well as the need for staff training [40,41]. In addition, regulatory and certification processes represent a substantial barrier, as patient-specific implants are subject to more complex approval pathways than standard medical devices. There is also a lack of standardized guidelines for quality control and validation of manufacturing processes. Further limitations include technological and material constraints, particularly the limited availability of materials with optimal biomechanical and biological properties and difficulties in ensuring their reproducibility [39-41]. In the context of bioprinting, an additional challenge is the inability to fabricate fully functional, vascularized tissues. Ethical considerations are also important, including issues related to the use of stem cells, therapy personalization, and responsibility for the design and manufacturing of implants [40,41].

Despite these limitations, an increasing number of clinical examples and case studies confirm the high practical value of 3D printing technology in orthopedics. The literature describes numerous successful applications of patient-specific implants in reconstructions following tumor resections, treatment of extensive bone defects, and complex deformities [34,37,38]. Likewise, the use of anatomical models and surgical guides has demonstrated significant improvements in treatment outcomes in cases of complex fractures and reconstructive procedures. Findings from clinical practice indicate increased surgical precision, reduced complication rates, and improved functional outcomes in patients [37,39].

Looking ahead, the development of orthopedic surgery will be increasingly driven by the integration of 3D printing technology with other advanced digital tools. Of particular importance is its integration with artificial intelligence (AI) algorithms, which can automate medical image segmentation, implant design, and surgical planning processes [36-39]. In the coming years, the development of systems enabling automated implant design based on imaging data is also expected, which will significantly shorten preoperative preparation time [37-41]. Over a 10–20-year horizon, further dissemination of bioprinting technology, the development of bioactive materials, and the integration of 3D printing with robotic systems and intraoperative navigation are anticipated [38,39]. This may ultimately lead to fully integrated digital treatment pathways covering the entire clinical process - from diagnosis and planning to surgical execution and outcome monitoring. 3D printing technology therefore represents not only a tool supporting orthopedic surgery but also a component of a broader systemic transformation toward personalized, precision, and data-driven medicine [40,41].

DISCUSSION

Three-dimensional printing has become an important adjunct in orthopaedic surgery, but the strength of evidence varies by application. The best-supported uses remain patient-specific anatomical models and surgical guides, which consistently improve preoperative planning, spatial understanding, and communication in complex cases [1-6]. These technologies are relatively easy to integrate into clinical workflows because they rely on standard imaging and established printing platforms [1,2,5]. By contrast, the literature on patient-specific implants and especially bioprinted scaffolds is less consistent. Most studies in these areas are small, single-centre, and heterogeneous, making direct comparison difficult [8-11]. Reported benefits often focus on surrogate outcomes such as operative time, blood loss, or planning confidence, while robust data on complications, long-term function, and cost-effectiveness remain limited [6,10,12]. This discrepancy explains why some reviews report highly encouraging results, whereas others emphasize the need for further comparative studies before widespread clinical implementation can be recommended [3,6,9]. In terms of readiness for orthopaedic practice, anatomical models and guides are closest to routine use, patient-specific implants are promising but still require further validation, and scaffolds/bioprinting remain largely investigational [8,10,16-19]. Future progress will depend on standardisation, prospective trials, and clearer regulatory and economic frameworks [9,15,20]. Overall, 3D printing is already clinically useful in selected orthopaedic settings, but the level of maturity differs substantially across technologies.

Although the available evidence supports the clinical value of selected 3D-printing applications, these findings should be interpreted cautiously. Most published studies consist of single-center observational investigations with relatively small sample sizes, heterogeneous patient populations, variable outcome measures, and limited follow-up, reducing the overall certainty of the available evidence [3,20,28,40]. Consequently, while improvements in preoperative planning, surgical accuracy, and procedural efficiency appear consistent across the literature, convincing evidence demonstrating reductions in complications, superior long-term functional outcomes, and cost-effectiveness remains limited [6,20,28,41]. Therefore, despite encouraging results, 3D printing cannot yet be regarded as a universally established standard of care across orthopedic surgery.

Overall, 3D printing has substantial potential to enhance selected areas of orthopaedic practice but cannot yet be regarded as a universally established standard of care [3,6,20,26]. Its integration into clinical workflows may improve surgical predictability and support more individualized treatment strategies through improved preoperative planning and patient-specific solutions [3,20,25,26]. Nevertheless, important barriers continue to limit broader implementation, including high production costs, regulatory requirements, workflow integration, technical standardization, and the limited availability of high-quality comparative evidence [35,39–41]. Ethical considerations also remain important, particularly regarding the clinical application of living cells in bioprinting, responsibility for the design and manufacture of patient-specific implants, and equitable access to advanced and potentially costly technologies [29,32,40,41].

Future progress will depend on well-designed prospective comparative studies, longer clinical follow-up, standardized methodological frameworks, and continued advances in digital planning, additive manufacturing technologies, biomaterials, artificial intelligence-assisted design, and bioprinting [6,20,29,32,40]. Collectively, these developments may facilitate the transition of additive manufacturing from selected specialized indications toward broader implementation within precision orthopaedic surgery.

Limitations

This narrative review has several limitations that should be acknowledged. First, although a comprehensive literature search was performed using multiple scientific databases, the search strategy may not have identified all relevant publications. The possibility of publication bias and the exclusion of studies published in languages other than English may have influenced the scope of the analyzed evidence. Second, due to the narrative nature of this review, no formal methodological quality assessment or risk-of-bias evaluation of the included studies was performed. Therefore, the conclusions presented should be interpreted considering the varying methodological quality, study designs, and levels of evidence of the available literature. Third, this review included a heterogeneous range of publications, including clinical studies, experimental investigations, systematic reviews, meta-analyses, and narrative reviews. The inclusion of different types of evidence allowed a broad overview of current applications and future directions of 3D printing in orthopedic surgery; however, it also limits direct comparison between studies and may introduce variability in the interpretation of reported outcomes. Finally, the rapidly evolving nature of additive manufacturing technologies represents an additional limitation. Continuous advances in printing techniques, biomaterials, artificial intelligence-based design systems, and regulatory frameworks may influence the applicability of currently available evidence and require ongoing evaluation in future studies.

CONCLUSIONS

Three-dimensional printing is an increasingly important technology in contemporary orthopaedic surgery, supporting the transition toward more personalized approaches based on individual patient anatomy and biomechanical requirements. The current evidence indicates that its most established clinical applications include preoperative planning using anatomical models and patient-specific surgical guides, both of which may improve surgical precision and procedural preparation. Patient-specific implants also represent a promising development, particularly for complex reconstructive procedures, although additional high-quality clinical studies are required to confirm their long-term effectiveness and safety. In contrast, bioprinting remains largely experimental despite its considerable potential for musculoskeletal tissue regeneration.

Among the available additive manufacturing technologies, metal 3D printing, particularly using titanium alloys, currently provides the strongest evidence for load-bearing orthopaedic implants, whereas polymer-based printing is primarily used for anatomical models and surgical guides.

Overall, three-dimensional printing has become a valuable adjunct to selected areas of orthopaedic practice, with its future clinical impact likely to depend on continued technological advances, improvements in biomaterials, and the generation of higher-quality comparative clinical evidence.

DISCLOSURE

Author contributions

Conceptualization: Agnieszka Sawina, Adam Iwanicki, Maciej Łabuś, Aleksandra Skawińska, Tomasz Wołoszczuk, Zofia Graca, Jakub Kołodziej, Aleksandra Skowronek, Julia Jeziorna, Elżbieta Siudmak. Methodology: Agnieszka Sawina, Adam Iwanicki, Maciej Łabuś, Aleksandra Skawińska, Tomasz Wołoszczuk, Zofia Graca, Jakub Kołodziej, Aleksandra Skowronek, Julia Jeziorna, Elżbieta Siudmak. Formal analysis: Julia Jeziorna, Adam Iwanicki, Agnieszka Sawina, Aleksandra Skawińska, Maciej Łabuś. Investigation: Elżbieta Siudmak, Julia Jeziorna, Adam Iwanicki. Writing – original draft: Agnieszka Sawina, Zofia Graca, Jakub Kołodziej. Writing – review and editing: Zofia Graca, Tomasz Wołoszczuk, Aleksandra Skowronek. Supervision: Agnieszka Sawina, Aleksandra Skawińska, Maciej Łabuś.

All authors have read and approved the final version of the manuscript.

Funding

The article received no external funding.

Conflict of Interest

The authors declare no conflicts of interest.

Use of AI

The authors used ChatGPT (OpenAI) solely for language editing, grammar correction, and refinement of scientific terminology. Artificial intelligence tools were not used for data collection, data analysis, interpretation of the results, or preparation of the scientific content of the manuscript. All AI-assisted content was critically reviewed, edited, and verified by the authors, who take full responsibility for the final version of the manuscript.

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