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Orthopaedic 3D is driving major innovations in many areas, such as manufacturing, engineering, art, education and medicine (1). Especially, the orthopaedic field is greatly becoming interested in this technology with the ability to create solutions specific tailored to the patient. From the creation of 3D models that help surgeons plan operations to the fabrication of patient-specific titanium implants, 3D printing is already changing traditional musculoskeletal industry (2).

Three-dimensional (3D) printing technologies can now be applied to biocompatible materials, cells, and supporting components. This 3D bioprinting could allow printing of artificial organs. Although this potential is far from realized, and despite the constant technical changes, 3D bioprinting has already been valuable in orthopedic applications like bone and cartilage repair, with advances in 3D modeling of defective tissue, stem cell differentiation, bioprinting technology, and innovations in printing materials. In the present study, we reviewed the recent advances in 3D bioprinting, as well as a general procedure for 3D bioprinting for bone and cartilage transplantation. In addition, we review the applications that aim to replace damaged bone and cartilage tissues, and research of in vitro tissue culture models. Potential challenges are discussed based on the present limitations and technical perspective of 3D bioprinting for bone and cartilage transplantation.

Backgrounds: Three-dimensional (3D) measurement in computer software has become increasingly popular, which uses 3D visualization instead of traditional two-dimensional (2D) viewing angle by plain X-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI). The goal of this study is to introduce the 3D modeling of glenohumeral joint and a method of 3D measurement technique by using computer tool. We hope it can achieve accurate parameters by computer tool and help surgeons to choose the treatment of shoulder instability. Also, the parameters of normal shoulder can help us choose the prosthesis of both total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA). Methods: Three dimensional measurement and relative parameters of glenoid and humeral head in normal cadaver and one patient’s shoulder were evaluated with software of Mimics and Imageware, in order to choose the treatment of shoulder instability. We used the Chinese Digital Man No. 1 and Woman No. 1 as the normal cadaver and patient’s shoulder as instability modeling, which were collected and made by Southern Medical University in Guangzhou, China. Four shoulders (both shoulders of the Chinese Digital Man No. 1 and Woman No. 1) were collected from DICOM format by CT scans and three dimensional reconstructions were performed in Mimics software. Results: The parameters of normal glenoid and humeral head were the anteroposterior diameter, supra-inferior diameter, depth and curvature radius of glenoid labrum, and radius of humeral head. The Man No. 1: The left and right shoulder showed 24.66 and 23.70 mm of anteroposterior diameter, 34.70 and 33.43 mm of supra-inferior diameter, 4.05 and 4.01 mm of depth of glenoid labrum, 25.62 and 25.02 mm of curvature radius of glenoid labrum, 22.16 and 22.22 mm of radius of humeral head, respectively. The Woman No. 1: The left and right shoulder showed 20.40 and 19.96 mm of anteroposterior diameter, 29.68 and 29.35 mm of supra-inferior diameter, 2.48 and 2.34 mm of depth of glenoid labrum, 27.92 and 26.47 mm of curvature radius of glenoid labrum, 20.48 and 19.80 mm of radius of humeral head, respectively. In another case we considered a 27-year-old male with a history of shoulder recurrent dislocation in May, 2018. His CT showed he suffered from a bony bankart injury and Hill-sachs lesion. We calculated and measured the parameters of his shoulder by computer software. The length of the lesion is 31.67 mm. The radius of the circle is 11.64 mm given in the software. According to the distance between border-top and border-bottom of bankart lesion that is 21.74 mm, the area of the circle equals 425.2028 mm 2 and the area of bone loss equals 118.2855 mm 2 , for a calculated bone loss of 27.82%. The depth of the lesion is 11.13 mm. Conclusions: A 3D model can provide a more vivid vision of the glenohumeral joint. We hope that measuring parameters can be performed by using computer software tool, without manual measurement and calculated in minimum error range.

The development of three-dimensional (3D) images is causing many effects across the medical system. Other surgery departments are also working on 3D printing and simulation, but the majority of the field is the orthopedic field. Most of the medical training was done through cadaver, but with the development of 3D images, training and simulation can be conducted through virtual reality (VR). In surgery where complex and dangerous neurovascular structures are close, such as pelvic fractures, augmented reality (AR) technology may be used to minimize the risk of surgery. 3D printers allow special implants that are tailored to the individual’s characteristics rather than mass-produced implants during fracture or arthroplasty surgery. Using VR can also help the patient's rehabilitation. While there are still disadvantages of increased overall costs and verification of stability, some of the aforementioned techniques will help both patients and physicians. This document provides an overview of the 3D printing and simulation used in the orthopedics.