The orthopaedics industry has long been driven by innovation, aiming to improve patient outcomes and quality of life.
Over 30 years ago, 3D printing emerged as a transformative technology, opening up opportunities to reshape how orthopaedic professionals approach challenges in diagnosis, treatment, and recovery. From enhancing surgical precision to enabling personalized care, 3D printing and, even more evident, 3D planning are revolutionizing the field in ways once thought impossible.
This article will examine this innovative 3D journey and explore its applications, benefits, and potential to set new benchmarks in patient care.
A legacy of innovation: The birth of 3D printing in medicine
The foundation of medical 3D printing was laid in the early 1990s with the EU-funded PHIDIAS project. This groundbreaking initiative introduced 3D printing to healthcare by creating accurate, tangible models of human anatomy based on medical imaging. At the time, medical imaging was limited by the “salami method,” where CT scans were taken in slices, creating distortions whenever a patient moved. The PHIDIAS team revolutionized this process by introducing spiral CT scanning, which allowed for continuous imaging and produced far more accurate representations of the body.
These improved scan images, combined with the launch of the first medical engineering software, Materialise Mimics, enabled the creation of 3D virtual images and 3D-printed anatomical models of bones and organs. By converting CT scans into 3D models, surgeons gained an unparalleled understanding of the patient’s anatomy. These models provided a new way to plan and rehearse surgeries, giving surgeons a tangible representation of what they would encounter during procedures.
The PHIDIAS project demonstrated the transformative potential of this technology in healthcare, laying the groundwork for future advancements in surgical planning, tools, and implants.
3D printing enters the operating room
Building on this legacy, 3D technology evolved to revolutionise intraoperative procedures in orthopaedics. The first breakthrough came with the development of 3D-printed surgical guides, which enabled surgeons to transfer preoperative planning directly into the operating room with unmatched precision.
The earliest 3D-printed guides were developed for osteotomy surgeries—fully personalized tools designed for highly complex cases. Over the past 20 years, these guides have proven to be life-changing for patients with challenging limb deformities that are difficult to assess using standard imaging techniques. The personalized treatment approach assists surgeons at multiple stages: enabling digital visualization of complex pathology, 3D printing of anatomical models for planning, virtual surgical procedure design, and creation of personalized cutting guides. These guides are created through detailed planning by clinical engineers, allowing surgeons to execute intricate bone realignments with exceptional accuracy. While transformative, their implementation requires substantial engineering expertise because of the uniqueness and complexity of each case.
In 2009, the launch of the first 3D-printed personalised guides for knee arthroplasty marked a turning point. Developed by Materialise in partnership with Zimmer Biomet, the knee guides allowed surgeons to plan and order personalized surgical guides themselves, directly from the planning software. This innovation represented the first case of mass personalization in orthopaedics, combining 3D surgical planning with 3D-printed devices on a large scale.
These knee guides enable surgeons to create patient-specific plans and execute them with precision in the operating room, helping surgeons to perform accurate cuts and implant positioning. Over time, this technology expanded to other anatomies, including hips, shoulders, and other joints, enabling personalised care across a broad range of procedures.
While robotics, navigation systems, and augmented reality (AR) have emerged as alternatives, 3D-printed guides have maintained their unique value due to their reliability, cost-effectiveness, and ease of use. More importantly, these guides validated the power of 3D planning, which has become the cornerstone of many orthopaedic procedures, enabling better outcomes regardless of the intraoperative technology used.
Paradigm shift: From standardised to personalised care with the use of 3D planning
What began as a step to produce 3D-printed models and guides has evolved into the most essential part of modern orthopaedic surgery: 3D planning. Initially, 3D models were created to help visualise patient anatomy and produce personalized surgical tools or implants. However, as medical 3D planning software advanced, it became a standalone solution, allowing surgeons to perform full surgical planning virtually and make critical decisions before entering the operating room.
Today, 3D planning operates independently of the technologies used intraoperatively. Whether surgeons rely on 3D-printed surgical guides, robotics, navigation, AR, or traditional methods, 3D planning remains central to enhancing precision and better patient outcomes. Virtual surgery, combined with the ability to analyse anatomical challenges and simulate different scenarios, empowers surgeons to optimise their approach and reduce intraoperative surprises.
This shift—from planning as a supporting tool to planning as a core component—has redefined how surgeries are approached.
Hip and shoulder surgeries exemplify the growing importance of 3D planning, which now spans the full spectrum of surgical needs—from standard procedures to complex revisions and even the use of 3D-printed personalized implants. In standard procedures, 3D planning provides detailed insights into the patient’s anatomy, allowing surgeons to optimize implant positioning and alignment while using off-the-shelf solutions.
In revision cases, where challenges like bone loss or prior implant failures complicate the surgical approach, 3D planning becomes indispensable. Surgeons can visualize the anatomy in three dimensions, simulate scenarios, and determine the best course of action. For complex cases involving severe deformities or unique anatomical challenges, 3D planning integrates seamlessly with 3D printing to deliver personalised guides and/or recommendations on the use of a 3D printed implant.
By enabling surgeons to tackle everything from routine cases to the most complex challenges, 3D planning has redefined how procedures are prepared and executed, potentially driving better outcomes across the board.
3D-printed implants: The next step in personalised surgery
While 3D-printed guides have enabled surgeons to execute their plans with precision, 3D-printed implants have elevated personalisation to a new level by addressing the unique anatomical needs of each patient. Unlike standardised implants, which are manufactured in fixed sizes and shapes, 3D-printed implants are custom-designed to fit seamlessly into a patient’s anatomy.
The transformative power of these implants lies in their ability to combine personalised design with unique properties. For example, 3D printing enables the integration of porous structures directly into the implant. These surfaces mimic the natural properties of bone, promoting bone ingrowth and creating a biological connection between the implant and the patient’s anatomy. This enhances stability, reduces the risk of loosening, and improves long-term outcomes.
In complex cases, such as severe bone loss or revision surgeries, 3D-printed implants address challenges that traditional implants cannot. By offering a tailored solution, they ensure better alignment, improved biomechanics, and a reduced likelihood of complications.
While personalised implants may seem expensive at the outset, they can deliver solid financial savings over time by reducing complications and sidestepping the high costs associated with revision surgeries. Revisions not only present higher clinical risk but also impose longer recovery times, doubling the burden for patients and their healthcare teams. Data shows that personalised implants can substantially lower revision rates. Take hip surgery, for instance: evidence shows up to 98% implant survival rate (Swedish Arthroplasty Register, Annual Report 2014), with follow-up studies reporting no signs of radiological loosening and no re-revision procedures required ( N=74, Citak et al., Colen et al., Myncke et al., & 2018).
This evolution demonstrates how 3D printing has become a cornerstone of orthopaedic care, offering transformative solutions that deliver both functional and economic benefits for patients and healthcare systems alike.
Conclusion: A future shaped by 3D printing and 3D planning
From the groundbreaking PHIDIAS project to the development of 3D-printed guides and personalized implants, 3D printing has transformed orthopaedics. It has enabled surgeons to plan and execute procedures with precision, improving outcomes for patients and making personalised care accessible on a larger scale.
The launch of 3D-printed knee guides marked a turning point in the mass personalisation of orthopaedic surgery, while the enduring value of 3D planning continues to shape the standard of care for procedures like shoulder surgery. Personalised implants demonstrate the potential of 3D printing to deliver innovative solutions that perfectly fit a patient’s anatomy, addressing even the most complex cases.
Beyond personalised care, 3D printing has also evolved into a production tool for standard implants. Manufacturers are now using it to create standard devices with complex geometries and porous designs that enhance bone ingrowth and implant stability. Additionally, 3D printing’s ability to facilitate small-series production has proven valuable for niche medical devices, offering flexibility and efficiency for specialised applications.
These developments highlight the growing versatility of 3D printing, but this evolution and its broader implications for healthcare and manufacturing are food for another article.
Author: Filip Jonkergouw, Ortho Market Manager, Materialise
Filip Jonkergouw brings nearly 15 years of specialized expertise in orthopaedic medical technology to his role as Market Manager for Orthopedics at Materialise. He manages partnerships with major medical device companies and commercially oversees the company’s comprehensive orthopaedic portfolio, drawing from his extensive experience in shoulder and knee applications.
Image: Market Manager Filip Jonkergouw showcases innovative 3D-printed shoulder anatomical models and surgical guides, enhancing predictability in shoulder arthroplasty. Submitted by Materialise
