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Resumen: La impresión 3D (I3D) es una tecnología de fabricación aditiva con un creciente interés en medicina y, sobre todo, en la especialidad de cirugía ortopédica y traumatología. Hay numerosas aplicaciones que aportan un valor añadido al tratamiento personalizado de los pacientes: planificación preoperatoria avanzada, cirugías con herramientas específicas para cada paciente, tratamientos ortésicos a medida, implantes o prótesis personalizadas y un desarrollo innovador en el campo de la ingeniería de tejidos óseos y cartilaginosos.En el presente trabajo se realiza una actualización sobre el papel que el cirujano ortopédico y traumatólogo desempeña como usuario y como médico prescriptor de esta tecnología y se hace un repaso a las etapas necesarias para una correcta integración de la I3D en el flujo asistencial hospitalario, desde los recursos necesarios hasta las recomendaciones legales actuales. Abstract: 3D printing (I3D) is an additive manufacturing technology with a growing interest in medicine and especially in the specialty of orthopaedic surgery and traumatology. There are numerous applications that add value to the personalised treatment of patients: advanced preoperative planning, surgeries with specific tools for each patient, customised orthotic treatments, personalised implants or prostheses and innovative development in the field of bone and cartilage tissue engineering.This paper provides an update on the role that the orthopaedic surgeon and traumatologist plays as a user and prescriber of this technology and a review of the stages required for the correct integration of I3D into the hospital care flow, from the necessary resources to the current legal recommendations.

3D printing (I3D) is an additive manufacturing technology with a growing interest in medicine and especially in the specialty of orthopaedic surgery and traumatology. There are numerous applications that add value to the personalised treatment of patients: advanced preoperative planning, surgeries with specific tools for each patient, customised orthotic treatments, personalised implants or prostheses and innovative development in the field of bone and cartilage tissue engineering. This paper provides an update on the role that the orthopaedic surgeon and traumatologist plays as a user and prescriber of this technology and a review of the stages required for the correct integration of I3D into the hospital care flow, from the necessary resources to the current legal recommendations.

Resumen Antecedentes El manejo de los defectos oseos completos secundarios a una infeccion periprotesica a nivel de la cadera y/o rodilla continua siendo un autentico reto quirurgico. Material y metodos Presentamos una modificacion tecnica para la realizacion de un espaciador femoral biarticulado con un enclavado femoral, sin necesidad de abordar la tibia proximal, ya sea para obtener la fijacion del espaciador o la articulacion del mismo. Resultados Se han intervenido 3 pacientes mediante esta tecnica, no existiendo ninguna complicacion intraoperatoria, resolviendose la infeccion y mejorando la funcion previa en todos ellos, volviendo a deambular con diferentes ayudas. Conclusiones Esta modificacion tecnica es una alternativa en aquellos casos donde es preciso resecar el femur completo pero no es necesario abordar la tibia.

Background The management of complete bone defects in hip and knee periprosthetic infection is still a real surgical challenge. Material and methods We present a technical modification for performing a biarticular total femoral spacer with a femoral nail without the need to approach the proximal tibia. Results Three patients were operated with this technique. There was no intraoperative complication. The infection was resolved in all patients operated at final follow-up. All patients improved their previous functional situation and could walk with different aids. Conclusions This technical modification is an alternative for cases where it is necessary to resect the complete femur, but it is not necessary to approach the tibia.

ResumenLa impresión 3D posibilita la traslación de una planificación virtual a modelos tangibles. El uso hospitalario de las impresoras 3D comercializadas para uso doméstico facilita la obtención de forma autónoma (do it yourself) de reproducciones realistas al mínimo coste.ObjetivoExponer nuestra metodología para la traslación clínica de la impresión 3D doméstica al campo de la Cirugía Ortopédica y Traumatología, definir sus indicaciones y aplicaciones específicas de acuerdo con la experiencia clínica.Material y métodosEstudio analítico observacional prospectivo de 63 casos intervenidos en nuestro servicio desde el año 2014, mometo desde el que la impresión 3D doméstica está incluida en el proceso asistencial. Variables como el grado de satisfacción percibida por los pacientes, la precisión, el tiempo o la exposición a radiaciones ionizantes durante la intervención son analizadas.ResultadosSe define un flujo de trabajo hasta la obtención del modelo impreso en 3D mediante el uso de programas de libre acceso e impresoras 3D domésticas, con una mejoría en todas las variables incluidas en el estudio.ConclusionesLa impresión 3D doméstica tiene numerosas aplicaciones en Cirugía Ortopédica y Traumatología. La experiencia clínica ha permitido definir un flujo de trabajo con unos resultados clínicos satisfactorios.Abstract3D printing allows translation of a virtual planning to tangible models. Domestic 3D printers in hospital facilitate obtaining autonomously («do it yourself») realistic reproductions at minimum cost.ObjectiveTo describe our methodology for clinical translation of domestic 3D printing in Orthopedic Surgery and Traumatology, define indications and specific applications according to clinical experience.Materials and methodsA prospective observational analytical study of 63 patients treated in our service from 2014 in which domestic 3D printing is included in the care process. Variables such as degree of satisfaction perceived by patients, accuracy, time or exposure to ionizing radiation during surgery are analyzed.ResultsA workflow is defined to obtaining 3D printed model using freely available programs and domestic 3D printers, and variables included in the study improved.ConclusionsDomestic 3D printing has numerous applications in Orthopedic Surgery and Traumatology. Clinical experience has allowed defining a workflow with satisfactory clinical results.

Resumen Introduccion La baja incidencia y la heterogeneidad histologica de los sarcomas pelvicos primarios dificulta el analisis y publicacion de cohortes homogeneas. Objetivo Describir el pronostico vital y funcional dependiendo del tipo histologico en una serie de sarcomas primarios de localizacion pelvica de alto grado localmente avanzados tratados mediante hemipelvectomia. Material y metodos Estudio descriptivo, epidemiologico y funcional de 15 casos tratados entre 2006-2012. Se realizo analisis de supervivencia, valoracion funcional y estudio comparativo en funcion del tipo histologico, comparando los condrosarcomas frente al resto de diagnosticos histologicos. Resultados El tipo histologico mas frecuente en la serie fue el condrosarcoma (46%), y la localizacion mas frecuente la zona P2 (periacetabular) (73%). Se realizo una hemipelvectomia interna en el 66% de los casos, siendo mayor (83%) en el caso de los condrosarcomas. La supervivencia global a los 2 anos fue del 54%, siendo mas elevada en el grupo condrosarcoma (67%) que en el resto (43%). La situacion funcional dependio del tipo de intervencion, sin encontrar diferencias en funcion del tipo histologico ni de la realizacion de reconstruccion. Discusion y conclusiones La hemipelvectomia como procedimiento quirurgico esta indicada para el tratamiento de los sarcomas primarios de localizacion pelvica de alto grado localmente avanzados independientemente del tipo histologico. La incidencia de conservacion del miembro y la supervivencia global es mayor en los condrosarcomas frente al resto de tipos histologicos.

Introduction The low incidence and histological heterogeneity of primary sarcomas located in the pelvis make it difficult to find homogeneous cohorts. Objective To describe the life and functional prognosis depending on the histological type of sarcoma in a series of locally advanced high-grade pelvis located sarcomas treated by hemipelvectomy. Methods A descriptive epidemiological and functional study was conducted on 15 cases treated between 2006 and 2012. Survival analysis, functional assessment, and a comparative study by histological type were performed, comparing chondrosarcomas to other histological diagnoses. Results The most frequent histological type was chondrosarcoma (46%), and the most frequent location was P2 (periacetabular) (73%). An internal hemipelvectomy was performed in 66% of cases, with a higher incidence (83%) in chondrosarcomas. Overall two-year survival was 54%, with higher survival in the chondrosarcoma group (67%) than in the other sarcomas (43%). Functional status depended on the type of intervention, with no differences in histological type or the performance of the reconstruction. Discussion and conclusions Hemipelvectomy is a surgical procedure that is indicated for the treatment of locally advanced high grade pelvis located sarcomas, regardless of histological type. The incidence of limb preservation and overall survival is higher in chondrosarcomas compared to other sarcomas.

Osteogenesis imperfecta (OI) is a rare congenital disease characterized by alterations in bone quality, with susceptibility to fractures, instability, deformities, and osteoarthrosis. Prosthetic surgery in these patients is associated with an abnormally high rate of implant failures. On the other hand, abnormal bone fragility adds to the complexity of revision surgery in such individuals-thus representing a genuine challenge for the orthopaedic surgeon. We present a case of femoral reconstruction in a patient with OI and prosthetic loosening after reconstruction secondary to femoral septic pseudoarthrosis. Intramedullary total femoral reconstruction was carried out after exceeding the biological reconstruction limits. This is the first reported instance of the use of an intramedullary total femur arthroplasty as salvage technique in an OI patient. This technique should be considered when we have exceeded biological limits for femoral fixation.

Introduction Opening wedge osteotomy has recently gained popularity, thanks to the recent implementation of locking plates, which have shown equivalent stability with greater reproducibility, accuracy, and longevity than the closing wedge techniques and a lower prosthetic conversion rate. The two most important factors for success in opening HTO success are proper patient selection and correction accuracy of the mechanical axis. This accuracy depends on two basic steps- proper preoperative planning and precise surgical reproducibility. Based on digital image planification, we present a new “do-it-yourself” 3D cutting guides system. Material planification of the desired correction was performed using lower limb weight bearing digital xray and orthoview software. Based on a conventional CT scan, DICOM images were then imported into the radiological post-processing software (OsiriX). A positioning guide for Kirschner wires and wedge spacers were printed in three dimensions (Da Vinci, XYZ Printing) for facilitating the osteotomy and obtaining the planned correction. The surgeon makes the whole process in a do-it-yourself style. This new technique was used in a pilot feasibility study in eight patients. Previous opening osteotomies with the standard technique were used as control (20 cases). Surgical time, fluoroscopic time, cost and accuracy of the axial correction were measured. Results The use of a custom positioning guide reduced the surgical (31 minutes less) and fluoroscopic times (6.9 times less) while achieving a high-axis correction accuracy compared with the standard technique. Digitally planned and executed osteotomies under 3D printed osteotomy positioning guides help the surgeon to minimize human error while reducing surgical time. Once acquired the printer, the increase in cost is mostly due to the scanner expenses (150 euros) and the printed material (6 euros per set). Discussion Several techniques based on intraoperative navigation have shown an increased surgical accuracy in HTO for modifying axial alignment and for controlling tibial slope on the sagittal plane, with respect to classic techniques based on anatomic landmarks and introperative fluoroscopy. The main disadvantage of navigation is the long learning curve, coupled with increased surgical time. The 3D-guided technique allows for a more precise preoperative planning, a simpler and faster surgical technique with no learning curve and an accurate correction of the mechanical axis. In confront to the standard technique, it lowers exposure to radiation (6.9 times). Potential benefits related with shorter surgical time are a reduced blood loss and lower infection rates. At our institution, the reduction in surgical time represents a difference in costs of 507 euros per operation. Conclusion The reproducibility of this technique is very robust, allowing a transfer of the steps planned in a virtual environment to the operating table with non-negligible benefits.