Donato Monopoli Forleo

The integration of 3D printing and artificial intelligence is transforming healthcare management by driving innovations in personalized care, supply chain operations, and clinical workflows. This review offers a comprehensive overview and in-depth analysis of recent (2018–2025) applications where AI technologies enhance 3D printing within healthcare. We explore how AI-powered design and optimization facilitate the creation of patient-specific medical devices, implants, and even bioprinted tissues, while intelligent process control increases both quality and efficiency. Additionally, we examine regulatory and ethical considerations, including the evolution of frameworks for AI-enabled devices, as well as challenges in data governance, validation, and equitable access. The review takes a global perspective, presenting real-world case studies that showcase both successful implementations and ongoing challenges. We also discuss various perspectives and controversies, such as the balance between innovation and safety in autonomous AI design, and highlight areas where further research is needed. In contrast to previous narrative reviews that focus solely on clinical applications or technical aspects, this review uniquely evaluates the combined impact of AI and 3D printing on healthcare management—including cost-effectiveness, governance, decision-making processes, and point-of-care manufacturing. This work is particularly valuable for hospital administrators, clinical operations leaders, health policymakers, and biomedical innovation teams seeking to understand the broader implications of AI-enhanced 3D printing in healthcare management. Nevertheless, despite promising advancements, the field is constrained by heterogeneous evidence, a lack of standardized evaluation metrics, and insufficient long-term outcome data, which together limit the ability to fully assess the sustained impact of AI-integrated 3D printing in healthcare environments.

Background: Hip degeneration in young patients poses a significant clinical challenge, especially when the acetabulum remains intact. Total hip arthroplasty (THA) is often postponed in these patients due to concerns about implant longevity and multiple revisions. Joint‐preserving alternatives are therefore crucial. Case Presentation: We present the case of a 29‐year‐old male with progressive left hip pain and limited mobility. Imaging revealed a large subchondral cyst and structural alteration of the femoral head, while the acetabular cartilage appeared preserved. The patient′s preoperative Harris Hip Score (HHS) was 80, indicating poor joint function, and the preoperative WOMAC score of 20 reflected moderate pain and functional limitation. Considering the location and depth of the lesion, conservative and biological options were excluded. A custom‐made 3D‐printed hemi‐resurfacing mini‐prosthesis in titanium was designed based on CT imaging. The implant was inserted using a minimally invasive anterior approach and patient‐specific surgical guides. Results: After 3 years of follow‐up, the patient demonstrated excellent clinical and radiographic outcomes, with significant pain reduction, improved function (HHS improved to 94, and WOMAC improved to 4), and no signs of implant loosening or joint deterioration. Conclusion: This case highlights the potential of personalized, 3D‐printed mini‐prostheses as a viable bone‐preserving alternative to conventional joint replacement in young patients with focal femoral head pathology.

The aim of this study was to objectively evaluate lameness in dogs affected by a unilateral cranial cruciate ligament rupture (CrCLR) treated with porous tibial tuberosity advancement before surgery and at three different timepoints after surgery, using the GAITRite^® system (version 4.9Wr), a pressure-sensitive walkway system that is able to calculate several spatiotemporal gait parameters simultaneously for each limb. The dogs walked on the pressure-sensitive walkway before (T0) and 30 (T1), 90 (T2), and 120 (T3) days after surgery. Pressure measurements (gait lameness score and total pressure index %) were collected for S (treated with porous TTA) and C (healthy contralateral limb) at T0, T1, T2, and T3 and statistically evaluated. An ANOVA test was performed to compare the data, and a value of p < 0.05 was considered significant. Twenty dogs (n = 20) of various common breeds and ages with CrCLR were enrolled in the study. The results showed that there was a statistically significant difference in the GAIT4Dog^® lameness score (GLS) and TPI% between S and C for each timepoint. Statistically significant differences in the GLS and TPI% between S at T0 and S at T2 and between S at T0 and S at T3 (p < 0.001) were found. The results showed that there was a statistically significant difference in the GAIT4Dog^® lameness score (GLS) and TPI% between S and C for each timepoint. Statistically significant differences in the GLS and TPI% between S at T0 and S at T2 and between S at T0 and S at T3 were found. The GLS and TPI% increased statistically significantly from 90 days after surgery compared to the preoperative measurements. Moreover, comparing the GLS and TPI% between the treated limb and the control limb showed that a statistically significant difference remained at each timepoint.

The use of three-dimensional (3D)-printed custom-made implants is spreading in the orthopedics field for the reconstruction of bone losses or for joint replacement, thanks to their unparalleled versatility. In particular, this novel technology opens new perspectives to formulate custom-made fixation strategies for the upper cervical region, sacrum and pelvis, where reconstruction is challenging. We report and analyze the literature concerning upper cervical reconstruction with 3D-printed personalized implants after tumor surgery, and discuss two cases of patients where this technology was used to reconstruct the anterior column after extracapsular debulking of C2 recurrent chordoma at our institution.

The main goal in the treatment of large bone defects is to guarantee a rapid loading of the affected limb. In this paper, the authors proposed a new reconstructive technique that proved to be suitable to reach this purpose through the use of a custom-made biomimetic porous titanium scaffold. An in vivo study was undertaken where a complete critical defect was experimentally created in the diaphysis of the right tibia of twelve sheep and replaced with a five-centimeter porous scaffold of electron beam melting (EBM)-sintered titanium alloy (EBM group n = 6) or a porous hydroxyapatite scaffold (CONTROL group, n = 6). After surgery, the sheep were allowed to move freely in the barns. The outcome was monitored for up to 12 months by periodical X-ray and clinical examination. All animals in the CONTROL group were euthanized for humane reasons within the first month after surgery due to the onset of plate bending due to mechanical overload. Nine months after surgery, X-ray imaging showed the complete integration of the titanium implant in the tibia diaphysis and remodeling of the periosteal callus, with a well-defined cortical bone. At 12 months, sheep were euthanized, and the tibia were harvested and subjected to histological analysis. This showed bone tissue formations with bone trabeculae bridging titanium trabeculae, evidencing an optimal tissue-metal interaction. Our results show that EBM-sintered titanium devices, if used to repair critical bone defects in a large animal model, can guarantee immediate body weight-bearing, a rapid functional recovery, and a good osseointegration. The porous hydroxyapatite scaffolds proved to be not suitable in this model of large bone defect due to their known poor mechanical properties.

Osseointegration of metal prosthetic implants is a yet unresolved clinical need that depends on the interplay between the implant surface and bone cells. The lack of a relationship between bone cells and metal has traditionally been solved by coating the former with “organic” ceramics, such as hydroxyapatite. A novel approach is hereby presented, immobilizing covalently dendrimeric structures onto titanium implants. Amide-based amino terminal dendrons were synthetized and coupled to titanium surfaces in a versatile and controlled way. The dendritic moieties provide an excellent scaffold for the covalent immobilization of bioactive molecules, such as extracellular matrix (ECM) protein components or antibiotics. Herein, tripeptide arginine-glycine-aspartic acid (RGD) motifs were used to decorate the dendritic scaffolds and their influence on cell adhesion and proliferation processes was evaluated.

Tibial tuberosity advancement (TTA) is used to treat cranial cruciate ligament rupture of the stifle joint in dogs. Tibial tuberosity fracture/fissure is a complication of TTA that may have a favorable prognosis. The aim of this study was to detect how tibial tuberosity fracture/fissure through the Maquet hole worsens the progression of osteoarthritis (OA) in the stifle joint of dogs treated with porous TTA. Seventeen cases were included in the study, divided into two groups. The first group (n = 10) included subjects that had tibial tuberosity fracture/fissure through the Maquet, and the second group included subjects that had no complications (n = 7). Both groups showed significant progression compared to OA at 3 months after surgery. We observed that at T0, the control group showed a higher level of OA. For this reason, we normalized the OA scores, evaluating the percentage difference from T0 and T1. We verified that there were no statistically significant differences between the two groups. The results confirm that OA progression in subjects undergoing TTA was not significantly influenced by fracture/fissure of the tibial tuberosity through the Maquet hole. Therefore, fracture fissure through the Maquet hole should be considered as a common minor complication during TTA.

Tibial Tuberosity Advancement (TTA) is a surgical technique based on a linear osteotomy that determines a cranial advancement of the tibial tuberosity in patients suffering from cranial cruciate ligament rupture (CCL). The aim is to neutralize the cranial tibial thrust (CTT) and to reach a 90° angle between the patellar tendon and the tibial plateau with a physiological knee extension of 135°. In our study, a Ti6AI4V ELI (Titanium Aluminium Vanadium) titanium scaffold for the Porous TTA, with excellent properties of osteointegration and osteoconduction when subjected to cyclic loading has been adopted. Based on the previous scientific work on an ovine model, the use of this type of porous scaffolds has subverted the previous models. Scaffold production technology is based on direct mechanical manufacturing called Electron Beam Melting (EBM). For this study, 41 dogs, different breeds, medium-large size, weighing between 10 and 80 kg, aged between 1 and 13 years, were enrolled. The inclusion criteria were based on clinical evaluations (different gaits), drawer test and tibial compression, LOAD score (Liverpool Osteoarthritis in Dogs questionnaire), radiographic diagnosis in sedation with a 135° positioning of the joint and baropodometric investigations (Stance Analyzer). The results show that Porous TTA is an excellent method for functional recovery of the knee joint following the partial and total rupture of the CCL.