Starting up an in-house 3D lab for orthopaedics: essential considerations and steps—a narrative review

Background and Objective: 3D printing (3DP) is increasingly integrated into orthopaedic and trauma surgery, enabling patient-specific (PS) planning, surgical simulation, and custom device production. Growing clinical demand, technological improvements and the limitations related to outsourcing are driving in-house 3DP laboratories to become important infrastructure within healthcare facilities. Orthopaedics was among the first specialties to explore 3DP and now represents one of the driving sectors for technology adoption. Although numerous studies have demonstrated the value of 3DP within orthopaedics, developing such a facility requires thorough planning, financial investment, skilled personnel and the willingness to strive for innovation. Moreover, developing a 3DP lab is inherently a multifaceted process that varies considerably depending on local realities, clinical specialty, and 3DP technology. As a result, the literature presents heterogeneous data, contributing to a lack of standardized protocols that may hinder 3DP adoption in clinical settings. This review aims to outline a practical, European-focused roadmap for establishing a hospital-based 3DP service, detailing workflow, resources, costs, and regulatory requirements. Methods: A literature review was performed across PubMed, Scopus, Web of Science and Google Scholar. Articles published between January 2015 and February 2025 were screened for relevance using keywords related to in-house 3DP in orthopaedic and hospital settings. Only articles in English were considered. A final selection was reviewed in full text, and references were screened manually. Key Content and Findings: Clinical applications of 3DP in orthopaedic trauma include surgical planning, simulation, and the creation of PS instruments and implants. These applications can reduce surgical time and blood loss while enhancing case understanding and overall patient treatment. This article outlines the workflow of 3DP in orthopaedic surgery, from image acquisition and segmentation to computer-aided design, printing, and post-processing. It identifies critical infrastructure and personnel requirements, presents cost-effectiveness data, and outlines European regulatory considerations for healthcare institutions. Conclusions: In-house 3DP laboratories hold significant potential to enhance orthopaedic care by enabling faster, cost-effective, and PS solutions. By sharing practical insights and outlining key requirements, this work contributes to ongoing efforts aimed at establishing standardized frameworks for clinical 3DP integration.