Reply to letter to the editor regarding pilot study of patient-specific 3D-printed titanium prosthesis/autograft composite reconstruction for large osteoarticular defect of metacarpal: A novel surgical technique

Reply

We are very grateful for the thoughtful comments on our recently published article “Pilot study of patient-specific 3D-printed titanium prosthesis/autograft composite reconstruction for large osteoarticular defect of metacarpal: A novel surgical technique”. ¹ The opportunity to address the important points that have been brought up is greatly appreciated. Please find the responses to the specific comments and suggestions below.

It is acknowledged that the major limitations of this work are the study design and sample size. The confidence intervals were not presented in this study. According to the small sample size, the normality assumption is violated and the central limit theorem may give unreliable estimation, resulting in confidence intervals that are misleading. The effect sizes and nonparametric tests were not included because of the absence of a controlled group. It is agreed that the interpatient heterogeneity may yield different results. Further studies with larger, more representative samples and more robust designs are required to validate the findings using the more powerful statistical methods.

The insightful comment regarding “the personalized reconstructive platform” is sincerely appreciated. It is fully agreed that integration of technological systems including 3D printing, medical imaging, computer-aided design and manufacturing, biomaterials, and potentially artificial intelligence, robot navigation, and mixed reality to plan and execute patient-specific reconstructive surgeries could contribute to reduced manufacturing and operative time, greater accuracy, and improved outcomes compared to standard implants.^2–4

The constructive feedback regarding the topics for further research is appreciated. We are interested and currently in the process of gathering information to answer the questions of cost utility of 3D-printed prosthesis/autograft composite reconstruction (3D-PAC) and the long-term durability of the 3D-printed titanium implants. We look forward to reporting our results in the future.

While this study has certain limitations, it is believed that it serves as a valuable starting point that demonstrates the potential role of 3D-PAC in treatment of large osteoarticular defect of metacarpal and provides the initial evidence for further related research.

We express our gratitude to the reviewers for providing a new perspective to our study. Lastly, we thank Journal of Orthopaedic Surgery for giving us the opportunity to shed further light on our research.