Patient-specific 3D-printed titanium prosthesis/autograft composite reconstruction for large osteoarticular defect of metacarpal: Comment

Dear Editor,

We would like to comment on “Pilot study of patient-specific 3D-printed titanium prosthesis/autograft composite reconstruction for large osteoarticular defect of metacarpal: A novel surgical technique. ¹ ” This study is significant for its innovative approach, revealing a new surgical procedure for rehabilitating major finger joint deformities using a 3D-printed titanium scaffold mixed with autograft bone (3D-PAC), a delicate and challenging area to treat. This design’s strength comes from the adoption of a patient-specific prosthesis, which adapts to the patient’s actual anatomy, eliminating joint mismatch and enhancing mechanical stability. However, because this is a pilot trial with only seven participants, the results are both equivocal and generalizable.

Methodologically, hand movement and performance measurements such as MCP motion, grip strength, pinch strength, VAS, MHQ, and DASH score serve as comprehensive indicators of both functional and quality of life. However, the retrospective descriptive approach limits statistical analysis by not allowing for comparisons with a control group or typical techniques such as conventional bone transplants or commercial prostheses. Using merely mean and range (mean ± range) is insufficient for assessing variability and determining statistical significance of individual variables. Including confidence intervals, effect sizes, or nonparametric testing would improve the results.

Furthermore, relevant variables such as the etiology of injury (tumor vs fracture), age, infection status, and autograft quality have not been examined individually or thoroughly controlled for. This makes it difficult to determine whether the surgical improvements are solely attributable to the 3D-PAC approach or suitable case selection. This reading of the data may imply that 3D printing is more than just a tool for making replacement parts, but also a “personalized reconstructive platform” that may incorporate biomaterials and imaging data to improve functional outcomes.

Finally, issues that require further academic discussion include (1) the cost limitations and availability of this technology in general hospitals; (2) the long-term durability of titanium materials against compression and wear; (3) the risk of infection in areas where synthetic materials are used; and (4) the potential role of bioresorbable scaffolds or hybrid composites. A prospective controlled trial comparing them to standard treatment using biomechanical and quality-of-life variables might be planned. This will further prove the efficacy of 3D-PAC, elevating it to the future standard for big finger joint replacement.