How 3D Printing Is Changing Orthopedic Surgery

How is 3D printing changing orthopedic surgery and patient care?

In this episode of Baptist Health Talk, host Sandra Peebles explores how 3D printing is being used in orthopedic care, from surgical planning to improving accuracy in the operating room. Guests Dr. Frantz Lerebours, orthopedic surgeon at Baptist Health Orthopedic Care, and Dr. Tyler Goodwin, FIU Baptist Health Orthopaedic Sports Medicine Fellow, explain how patient-specific 3D printed guides can help surgeons plan procedures before entering the OR.

They discuss:

• How 3D printing is used in shoulder replacement surgery
 • Why patient-specific guides can improve surgical precision
 • How this technology may reduce time in the operating room
 • The difference between 3D printed guides and implants
 • How 3D printing is helping with deformity correction
 • What the future may hold for robotics, implants and orthopedic innovation

Technology is helping surgeons better visualize anatomy, plan procedures more precisely and improve the overall patient experience.

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Host:
Sandra Peebles
Award-Winning Journalist

Guests:
Frantz Lerebours, M.D.
Orthopedic Surgeon 
Baptist Health Orthopedic Care

Tyler Goodwin, M.D.
FIU/Baptist Health Orthopaedic Sports Medicine Fellow

Transcript

SPEAKER_03 0:00

The cool thing is, is I can plan weeks in advance exactly where I'm going to put the implants, the orientation of the implants, and I can take into account things like their deformity, uh the amount of bone loss, and I can plan all those things, which allows me to not have to estimate in the OR.

SPEAKER_01 0:18

Welcome to Baptist Health Talk, a podcast on all things healthcare, powered by Baptist Health South Florida, your trusted source for healthcare prevention and wellness.

SPEAKER_02 0:28

I'm your host, Sandra Peebles. Welcome back to a new episode of Baptist Health Talk, where we answer your most searched questions on trending health topics. Today's topic is 3D printing and how it's changing orthopedic care, from surgery planning to patient outcomes. We'll break down how this technology is used in real cases, how it improves accuracy and efficiency, and what the future could look like. We're joined by Dr. Franz Laribor's orthopedic surgeon at Baptist Health Orthopedic Care, and Dr. Tyler Goodwin, FIU Baptist Health Orthopedic Sports Medicine Fellow. Thank you both for being here.

SPEAKER_03 1:03

Thanks for having us.

SPEAKER_02 1:05

I'm so excited about this topic because it joins two of my passions, which is health and technology. So let's start simple. Let's talk, Dr. Larabor, about 3D printing in medicine. Is it the same as a 3D printing that kids use?

SPEAKER_03 1:19

Yeah, so the concept is the same. It's essentially additive manufacturing. So you're essentially using computer models to have a device basically add layers, okay, layer by layer, uh to uh manufacture whether whether it's an implant or in our case, would be a custom 3D guide.

SPEAKER_02 1:40

And how has it um impacted patient care, Dr. Goodwin?

SPEAKER_00 1:45

So I think uh when you talk about patient care, I think for one, it gives patients confidence in what we do. Um it enhances the surgeries that we do, it makes things more accurate, more efficient. Uh, when patients come in, they want the newest, best technology. Uh, and oftentimes they ask about patient-specific implants or what kind of robotic systems that we use and things like that. Uh, so we can talk with them about uh patient-specific instrumentation, which is what we're gonna talk about today. Um, but we'll get into that a little bit later in the talk.

SPEAKER_02 2:15

So when you sit with a patient, you show them these parts. Yeah. You show them like what it's gonna look like in their body.

SPEAKER_03 2:21

Exactly. So powerful. So after after the after you go through the planning aspect of it, uh they actually uh manufacture and 3D print you these guides. Um and after I use them in the surgery, I actually give them back to the patients and I kind of explain to them this is your your socket. This is what we used to uh essentially execute the plan that we had before surgery. The cool thing is, is I can plan weeks in advance exactly where I'm gonna put the implants, the the orientation of the implants, and I can take into account things like their deformity, uh the amount of bone loss, and I can plan all those things, which allows me to not have to estimate in the OR.

SPEAKER_02 3:00

So before 3D printing, you'd have to actually open the patient and then figure that plan out.

SPEAKER_03 3:06

Exactly. So you know, you're you know, especially for the shoulder, when you're doing uh reverse total shoulder replacement, okay, uh you're you really don't really get to see a lot of the bony anatomy around due to due to the exposure. So there is some guesswork, intuition, experience involved in how you place these implants. Um the socket itself, uh the medical term is is referred to as the glenoid. Okay, the glenoid itself is actually a very small bone. Um and in the past, one of the ways these implants would catastrophically fail is that there would be inadequate screw fixation in a very small bone. It's about the size of a potato chip. So now with the 3D plant, I can now make sure all my screws converge in the best amount of bone stock, okay, that's available, uh, and leave the OR with confidence and and ultimately uh improve the survivorship of the implant, uh, which will eventually kind of prevent the implant from uh loosening, which is by far the most catastrophic thing that can happen.

SPEAKER_02 4:10

So you've brought us something that we can see, and um you can show us this um this isn't the 3D printing, this is the actual um apparatus that goes uh or the implant that goes into the patient. Um here we go. We lost a little piece.

SPEAKER_03 4:25

Um so exactly.

SPEAKER_02 4:27

So tell us how you use um the 3D printing for the reverse total shoulder replacement.

SPEAKER_03 4:33

Sure, sure. So uh so this is the reverse total shoulder replacement. So it's exactly what it sounds like. It's actually we're actually reversing the configuration of the shoulder. So we're putting a ball where the socket is, and then we're putting a socket where the ball is. Okay. And as you can see here, as I was kind of explaining to you, there's not a whole lot of real estate. It's a very thin bone, and there's a a very small will be referred to as a vault where we have to place the screws. Okay. So um what's interesting about this implant is that uh it's different than the what we call the anatomic total shoulder, where we're placing a ball with a ball and a and the socket is flat, but because this implant protrudes, it actually places a little bit more of a lever arm, okay, on the implant, which could actually place shear forces across, which could, like a paper clip, fatigue fail. Right. So if I take a paper clip and I bend it three times, not a big deal. If I bend it five times, it breaks. All right. So same thing with this, because this implant has a little bit more of a lever arm, you're really reliant on getting this right the first time. So if this implant fails, you have a bunch of screw holes here. Uh, you've really kind of run out a lot of real estate to revise it.

SPEAKER_02 5:45

With the 3D printer, it takes out a lot of this guessing that you would have to then go in without exactly without having had the benefit of the plan. This is really incredible. Um, I know, Dr. Goodwin, that you're a fellow and that you've been uh studying uh all of these innovations. Tell us a little bit about some of the techniques, the innovations that you've learned through your studies on regarding uh the this training.

SPEAKER_00 6:08

Sure, yeah. So um it's really a neat time to be in training uh in orthopedic surgery and and going through residency and fellowship. And uh just a little bit of background. So orthopedic surgery residency is about five years. Um, and then your fellowship training is is an extra additional one year in a subspecialty training field. Um and so in residency for me uh with 3D printing, it really started in total knee replacement, and that's kind of where it gained a lot of traction. So traditionally, similar to shoulder replacement, uh, we would use metal cutting guides or jigs in the knee. Uh, and when you would use the patient's anatomy, and uh, like Dr. Laribore was explaining, there's a little bit of guesswork to that, but you're you're using references in the patient's anatomy to put these cutting blocks where they need to be uh to then place your final implants. And similar in the shoulder, I did that um a similar style uh in residency training in the shoulder, doing reverse shoulder replacements. Uh, and then here at Baptist, this was my first time using the uh 3D printed instruments to help in shoulder replacement surgery. So uh with Dr. Lairboard, it's been great learning that technique uh and you see it from start to finish. So you see the patient in the clinic. We sit down, we review the x-rays, we look at the CT scan. That ultimately gets built into a 3D model that they did that they then build these uh patient-specific instruments from that we then use in the operating room. So seeing that from start to finish is really, is really neat. Um and then in the operating room itself, we have these 3D printed guides and we're looking at the patient, we're seeing that anatomy in real time, and then we're referencing these 3D printed guides so we can see exactly what that patient's anatomy looks like, their bony anatomy, all the landmarks. We can reference our instruments and guides that we're gonna use in the patient off of these guides, and then we put that plan into action in the operating room.

SPEAKER_02 7:51

This is really amazing. It's like we are in the future of medicine. Do you use this in any other kind of orthopedics or only on shoulders?

SPEAKER_03 7:59

No, yeah. So I actually use it for another type of surgery known as osteotomies. Uh with osteotomy is basically a procedure in which we uh essentially will uh correct a deformity. Okay, so if you ever see someone with, let's say, bow legged bow legs or somebody who's knock-need, um, what it allows me to do is same thing, obtain a uh a CAT scan of that patient. I I then submit it to a vendor, and then I can plan exactly within a degree of uh standard error, okay, exactly what I want to correct that deformity to. So in the past, uh in the OR, we would kind of take x-rays and we would use these kind of uh referred to as a bovy cord to really kind of see if we got the alignment correct. And it's essentially kind of you're doing one of these, you know, you're estimating. Um now with these guys, it's it's a game changer. It's made a very complex surgery that is fraught with complications, uh, much easier. And the biggest thing is reproducibility. Uh for my shoulders, my my base plate, all my x-rays look the same because I'm able to reproduce uh uh and execute uh the same every time um without much kind of deviation. Um and and with same thing with deformity correction with osteotomies, um, I'm I'm able to do the same. And and the biggest thing now with the 3D printing that's kind of been the advent is really the guides. Um when I was uh training and I was a fellow, there was kind of kind of kind of the early advent of of uh 3D printing. This was kind of back in 2013. Um we were only able to actually 3D print the patient's anatomy, but there was no guides to actually execute the surgery. So uh it was kind of a way to rehearse surgery, get a practice run, have a better uh three-dimensional understanding of the anatomy, but you were you're still having to kind of go and execute the surgery based off of, you know, uh your x-rays, bony landmarks, and things like that. Now with these guides, you know, I'm able to uh again reproducibly place the implants in the right position. And not only that, it it makes the OR much more efficient. I'm able to do the surgery much quicker.

SPEAKER_02 10:09

Well, that's exactly what I was gonna ask you. What kind of impact does this have on the recovery time, on the time in the OR? Because so many people are concerned about being under anesthesia as they should be. Uh, so this limits that, I imagine.

SPEAKER_03 10:21

Exactly, exactly. It uh it really does uh help kind of get in and the out of the OR much quicker, um, where you're not necessarily kind of uh struggling with different types of deformities. Um the patient's incision is open for less amount of time, which leads to less infections, less blood loss, um, and you have to expose a lot less now. I don't have to see as much of the anatomy now because uh the guides really kind of fit on their native anatomy. So I don't have to necessarily make the incisions as bigger uh to be able to kind of really see the overall bony landmarks.

SPEAKER_02 10:54

And so how are these surgeries? Are these uh robotic or is there an actual incision? Are you cutting the patient open to get to the shoulder?

SPEAKER_00 11:01

So yeah, there's uh the the surgeon's still in control of the surgery. We're not we're not quite there where the robots are taking over yet. Uh there may be one day, but uh but not.

SPEAKER_02 11:08

Well there's robotic surgery in a lot of other areas of medicine.

SPEAKER_00 11:11

There is, and and and and there that's a it's a big field in joint replacement in general. So so they do use robotics in the hip and in the knee. Um what we're talking about today, the surgeon still makes the incision on the shoulder. Uh, you do the dissection down to to the glenoid or the socket, um, and you do your resection on the humeral head. Um and so you are doing that surgery. What the instruments in the 3D printed guides help you with is getting your implants in the most precise, accurate position that you possibly can.

SPEAKER_02 11:39

Okay, so that leads me to how are you using pre and post-op? How are you using these 3D printing, uh, these 3D prints? Yeah.

SPEAKER_00 11:45

Pre-op and post-op. So it's it's all kind of tied into one seamless thing. So you're starting before, like I mentioned, with X-ray, CT scan. Sometimes you have an MRI if you're if you're questioning the rotator cuff integrity. Um, but it's all kind of one seamless thing. So you're planning this surgery, you have the x-rays, you have the CT scan, you have all that information. The CT scan gives you the 3D model, which ultimately builds your your three-dimensional printed guide. And then that you are using during the surgery. And um, you know, post-operatively, we generally check with x-rays and we're checking range of motion and clinically how the patient's doing. But what that guide does is you have that printed model of the patient's anatomy. You have the guide, you can see exactly where your pieces need to be. And as you're doing that surgery, you can then reference back to that and look, you know, you're checking in real time whether your parts are in the right position.

SPEAKER_02 12:36

I have to ask, where is this, where's the the incision?

SPEAKER_00 12:39

G generally it's over the front of the shoulder.

SPEAKER_02 12:41

Okay. So here. I just have to ask. I know people are searching this, they probably know where that incision is, but you know, I was just curious to know. Um, how do patients react when they see the results? When they come in, you show them these pieces that uh you printed on on a 3D printer, and then you know, they're they're already post-op. And how do they react?

SPEAKER_03 13:01

So I think patients in general are very receptive to knowing that um you're using the most amount of data possible to improve their outcomes. I think that's the most important thing is that using all the possible data sets to know that you're gonna do something and you're gonna do it the best way you can. Can we do these surgeries without uh 3D printing? Yes, we can. We've been doing it for years and we've been we've been doing it well. But uh in in this case, it's all about leveraging the technology that's available to get the possible outcome, best possible outcome. And I think patients appreciate that.

SPEAKER_02 13:34

We'll have to ask, how long has has 3D printing been used in in these surgeries? And um how how do how does it help you explain to the patients what's going on?

SPEAKER_00 13:45

Yeah, so I mean it's been used, it gained the most traction initially in total near arthroplasty, but it's been used for um, you know, five to ten years in that in that realm. Uh initial 3D printing uh started back in in the 80s, even. Uh, and then it's really taken off, you know, in the medical field in the last 10-ish years or so.

SPEAKER_03 14:04

Which is yesterday, really. I think they were using it in the beginning just for engineers were using it for prototyping. So especially for auto parts. Um, that's kind of how it started, but it was kind of cumbersome, expensive. And a lot of the different resins that they were using weren't, we couldn't sterilize them. They couldn't, they weren't stable with uh some of the temperatures that we're using to sterilize. But so now the big difference now is is the is the actual the additive manufacturing, the ability to to make these implants that we can, not these implants, but these guides that we can use um that we can sterilize and use them in the OR. But they're all single use.

SPEAKER_02 14:37

This is incredible, and it must be a lot easier to explain to the patients what's going on. But I know a lot of people go into a surgery and there's a lot of people that are so fearful, of course, and it's understandable, but this will help you show and tell, literally, like you just showed us here today. Uh tell us if you can share some a story, a case if you are able to, um, that was innovative. That was an interesting case that you've seen during your training.

SPEAKER_00 14:59

Yeah, absolutely. Um Dr. Lerbo mentioned uh I I like some of the deformity correction cases. So we've done a handful of those uh, you know, over the course of fellowship. And uh challenges. Yeah, it's interesting because it's a very hot topic in orthopedics right now. Um and when you go to some of the national meetings, people are speaking on it. And then in the general audience, when they ask how many people are doing it, not not a lot of people out there are doing it unless they're at big academic institutions or they've had training and that type of thing. So it's really unique to be able to do that down here. Um so I really like the deformity correction um surgeries where we're fixing angular deformities. So that's where you're bow legged or you're knock-need, um, and that puts you at risk for overloading one half of your joint or the other. Um, and so in sports, we're trying to preserve the joint for as long as possible and put off that that knee replacement. Um, and so with this technology, we can we can actually use vendors that are making patient-specific guides and implants that we are using to correct deformity.

SPEAKER_02 15:55

Um is it common? Are deformities common?

SPEAKER_00 15:58

They can be. And uh and we see them a lot in in uh revision settings for ACL anterior cruciate ligament surgery. Uh so when we are having to go back on a patient who failed their initial initial ACL surgery, uh, a lot of times it is due to alignment. And so that's something we take into consideration. And this gives us the tools to to accurately and and more confidently address those things.

SPEAKER_02 16:19

Well, this question is for both of you. Where do you see 3D printing and orthopedics going in the future?

SPEAKER_03 16:25

So I think um for for us, it's it's cost, right? So it's cost and uh the timing of it. So though the the limitations of this is has been there's there's a little bit of a lapse and a little bit of a a time constraint on from when you plan to uh from when you get the imaging to planning to manufacturing. Okay, so so I think certain things like fractures or th certain things where there's uh uh acuity, you know, they've they've started to use them in fractures and certain pelvic uh pelvis fractures and and using them to uh contour plates and things like that. But a lot of those fractures kind of have a uh a time limiting uh uh constraint as to when you need to fix them, right? So the turnaround for these is typically about a month.

SPEAKER_02 17:12

Oh, so it's a bit different. Right.

SPEAKER_03 17:14

So so exactly. So from when they uh we submit the images to when I complete my plan, it still takes about two weeks to manufacture the the guides. So um uh, but aside from that, I think uh a lot of it is gonna be, you know, training, people, uh a new younger generation of surgeons coming through and and and training under these things. You know, when I was training, and I'm not an older surgeon by any means, you know, I I finished my training about 14, 15 years ago. Um, I was not, I did not see this at all in during my training. So a lot of it is is is a new generation of surgeons adopting it and feeling comfortable with it, um, uh feeling comfortable with you know using the computers and and trusting uh the data that you're given. So I think a lot of that is gonna be uh uh is gonna be increasing adoption, less so than than I think the technology's there, you know. Um I think it's gonna be adoption, exactly.

SPEAKER_02 18:06

How we how we adapt to it as professionals. Uh Dr. Goodwin, what's your view of it? What's the future hold for us?

SPEAKER_00 18:12

Like I said, I think it's it's a great time to be in training and in the field of orthopedic surgery with this technology that's really ramping up. Um I think that that uh in the future when they can combine the robotic systems that we already use along with the 3D printed guides and then ultimately 3D printed implants that are going in as the final implants, I think we're heading in that direction.

SPEAKER_02 18:34

It sounds exciting. And thank you for saying the 3D printed guide, because it's not necessarily uh the implant itself just yet. No? Right. Or are you actually 3D printing the the actual implants?

SPEAKER_00 18:43

So so currently we're 3D printing the instruments that help us put the implants and that are not 3D printed in the correct position. Um there are some applications out there for it, but they're still early.

SPEAKER_02 18:55

So exciting. Honestly, this has been an amazing conversation. Thank you both so much uh for being here with us and and and sharing your knowledge and I think your passion with the world. Thank you so much. It's clear that technology and 3D printing is changing the way care is delivered and making a real difference for patients. Thank you both again for sharing your insight and thank you for the work you do because it's really important work. So thank you so much. And remember, viewers, be sure to hit that subscribe button on our channel here to keep up with the latest health and wellness information and tips from our experts. Thank you for watching.

SPEAKER_01 19:29

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