Current Concepts and Advances of Three-Dimensional Printing in Reconstructive Musculoskeletal Oncology: A Systematic Review.

Three-dimensional printing has the potential to advance current surgical practice, by way of anatomical and pathological structure analysis and customized implant manufacturing. Applications for this technology include pre-operative planning, prosthesis customization, and bioprinting. A comprehensive literature review of PubMed, Embase, Cochrane Library, Scopus, and Web of Science databases was conducted to extract all studies adopting three-dimensional printing in the operative management of primary and metastatic musculoskeletal tumors. A total of 73 articles reporting on 449 patients were deemed eligible for analysis. Indications of three-dimensional printing use consisted mainly of challenging tumor locations and proximity to neighboring neurovascular structures (232 [51.7%] patients) or anticipated high complication rates (142 [31.6%] patients). Operative time and follow-up averaged 240 minutes (4 hours) and 25.8 months, respectively. The majority of patients (327 [72.8%] of 449) in whom three-dimensional printing technology was used did not exhibit any complication or adverse event during or after their surgery, and most (354 [97.3%] of 364) subjects achieved convenient functional and oncological outcomes at last follow-up. The implementation of three-dimensional printing technology in the treatment of bone and soft tissue tumors is safe and efficient, as evidenced by the satisfactory functional and oncological outcomes, as well as the decrease in operative time and complication rates at 2-year follow-up. With recent innovations, three-dimensional printing has become cost-effective and reliable, so it is suitable for applications in orthopedic oncology.