Three-Dimensional Printed Models in Pre-Operative Planning of Complex Primary and Revision Total Knee Arthroplasty

Round 1

Reviewer 1 Report

Comments for author File: Comments.pdf

Author Response

Dear Editors and Reviewers, 

 

we would like to thank you for your time in reviewing our manuscript and the valuable suggestions.

The Reviewers’ and Editors’ comments are reported with the original manuscript line numbering. The Authors answered to each point as shown in the list below. In the revised manuscript, changes have been highlighted using “track changes”.  Furthermore, language checking has been performed throughout the manuscript.

We hope the manuscript is now suitable for publication in your journal.

 

Sincerely, 

The Authors 

 

REVIEWER 1

1. I appreciate the author's contribution to the rapidly developing field of additive manufacturing in clinical practice, however major corrections and clarifications should be introduced into the manuscript.

REPLY: Thank you for your valuable suggestions. We hope you’ll appreciate our corrections.

 

1. Manuscripts must contain the required sections: Materials & Methods, Results, Funding Information, Author Contributions, Conflict of Interest, Institutional Review Board Statement, Informed Consent Statement. Check the Journal Instructions for Authors for more details.

REPLY: Thank you for your comment. The manuscript has been modified according to it and to the instruction for authors.

 

1. The “Reference” section should be formatted according to the journal guidelines (https://www.mdpi.com/journal/ijerph/instructions#references). I would recommend using “Zotero” software to correctly format all references in a semi-automatic way (use “Zotero” style file for “Multidisciplinary Digital Publishing Institute”; add sources by DOI – it will ease the whole process)

REPLY: Reference style has been modified,

Reviewer 2 Report

The manuscript attempts to present a review of 3D-printed models in the pre-operative planning of complex primary and revision total knee arthroplasty (TKA). The paper is very interesting with the explanations of the importance and details of these printed models in using of knee surgery, comprising difficulties from patients and technical sides in their design process. No doubt, that limited data about studies reporting 3D-printed models in pre-operative planning for primary and revision TKA, underline the role of this review and can offer new studies in the future. I have noticed a few, minor grammatical and format errors. Some additional information should be included, along with some corrections in several sections. The most important details I have underlined in the comments. Please, find the attached document describing a few of the major issues noted in the manuscript.

Comments for author File: Comments.pdf

Author Response

Dear Editors and Reviewers, 

 

we would like to thank you for your time in reviewing our manuscript and the valuable suggestions.

The Reviewers’ and Editors’ comments are reported with the original manuscript line numbering. The Authors answered to each point as shown in the list below. In the revised manuscript, changes have been highlighted using “track changes”.  Furthermore, language checking has been performed throughout the manuscript.

We hope the manuscript is now suitable for publication in your journal.

 

Sincerely, 

The Authors 

 

REVIEWER 2

1. I would like to suggest forming one great section “APPLICATIONS OF 3D-PRINTED MODELS” after the introduction with the following subsections “IN PRE-OPERATIVE PLANNING OF PRIMARY TOTAL KNEE ARTHROPLASTY” and “IN PRE-OPERATIVE PLANNING OF REVISION TOTAL KNEE ARTHROPLASTY” where the description of cases can be mentioned at first in every subsection but in new added section “Discussion” could be more explained things related to them.

REPLY: Thank you for your comment. The manuscript has been modified according to it, to the reviewer 1 comments and to the instruction for authors. Particularly, subsection have been added, including a brief introduction of standard planning and the clinical case. All the comments and comparison between standard planning and 3D printed models have been moved in a new section (“discussion”, Line 362-402)

 

1. What were the selections of only these two cases for their descriptions from any others (availability of patients, agreements with patients, possibility to form 3D-printed models, etc.), and where are these cases come from (hospital, literature, archive, etc.). Can you clarify, please, this in the text?

REPLY: Thank you for your comment. The authors decided to describe one case for primary and one case for revision TKA to give to the reader an example for the application of this technology. Collecting more cases would make the manuscript longer without adding more information. It is very hard to “quantify” the benefit from planning with 3D printing in primary or revision TKA. It is easier, for example, to quantify it for osteotomies, in which the accuracy of planned osteotomy can be measured. However, both the cases are from the same hospital, which will be blinded in the text for reviewer (Line 405-412).

 

1. What were the limitations of this review? This point of view is very important and must be

explained in the text together with “future directions”

REPLY: Thank you for your valuable suggestion. A “limitation” section has been added (Line 403-412).

 

1. Please, accurately prepare all references in the list recommended by the manuscript and ACS style guidelines, including DOI links of them, correct abbreviated journal names, and remove names of the months in Italian.

REPLY: Thank you for your comment. Reference list has been modified according to the instruction for authors.

 

1. I suggest to the authors include in the text and the references list some publications from the last two years 2021 and 2022 too and skip repeating of some the same references in the general text.

REPLY: Thank you for your valuable suggestion. Reference list has been modified according to it. However, despite more studies have been published in the last 2 years, still no studies on the role of 3D printed models in primary and revision TKA have been published.

 

1. Please, look at the text in Lines 54-59: the words “different authors” or “authors” are repeated in all these three sentences. Is there any possibility to use other words, for example, “some researchers”, “several studies”, etc.?

REPLY: Thank you for your comment. The text has been modified according to it.

 

1. In Lines 105 and 206 I suggest to you remove punctuation in the titles of sections.

REPLY: Thank you for your comment. The text has been modified according to it.

 

144. Please, look at the text in Lines 95-96 and Lines 143-144. It looks like it repeats and maybe there exists another way how to describe the same things.

REPLY: Thank you for your comment. The text has been modified according to it.

 

1. I suggest using “kg” instead of “Kg” in Line 157 and Line 262

REPLY: Thank you for your comment. The text has been modified according to it.

 

1. In Line 160, please, look at the missing punctuation in the word “Fig 1” (which should be Fig. 1). REPLY: Thank you for your comment. The text has been modified according to it.

 

m.In Line 184, please, look at the missing punctuation in the word “Fig 2” (which should be Fig. 2).

REPLY: Thank you for your comment. The text has been modified according to it.

 

1. In Line 180, please, remove free space between 12, 08 mm (should be 12,08 mm).

REPLY: Thank you for your comment. The text has been modified according to it.

 

1. In Line 182, please, add mm between 18,7 and 30,5 (should be 18,7 mm x 30,5 mm).

REPLY: Thank you for your comment. The text has been modified according to it.

 

1. According to the guidelines of the manuscript all Figures must be inserted into the main text like Figure 1, Figure 2, etc. If there is used one style for marking the Figures in the text, then it should be everywhere in the text. But there are differences in Lines 177, 180, 188, and 202, for example. In Lines 177, 180, and 202 there are no spaces between (Fig.2A; Fig.2B; Fig.4) words and numbers but in Line 188 there is visible space (Fig. 3). Please, use one style (with or without space) in all text.

REPLY: Thank you for your comment. The text has been modified according to it.

 

1. In Line 190, please, use one style in the text, for example In Fig. 3 or Fig.3

REPLY: Thank you for your comment. The text has been modified according to it.

 

1. Are there any possibilities to use one colored background for all Pictures and label the side of the letters for them (right, downward) in Fig. 4?

 REPLY: Thank you for your comment. Figure 4 has been modified according to it.

 

483. In Line 204 after A) use the small letter “r”, because in some other Figures there was used the small letter r after A). the same thing repeated in line 483.

REPLY: Thank you for your comment. The text has been modified according to it.

 

1. What is the correct word “comorbidities” in Line 128 or “co-morbidities” in Line 262?

REPLY: Thank you for your comment. “Comorbidities” is the correct word, so the text has been modified.

 

1. In Line 258 you have written that “... 3D knee models can be used in pre-operative setting of revision TKA” but afterward Line 261 follows “Clinical case: re-revision TKA”. Maybe there can be included one sentence in the following section of the text that will be described the re-revision of the clinical case.

REPLY: Thank you for your comment. To reduce any confusion, re-revision has been deleted and in both the sentences “complex revision TKA” was chosen.

 

302. Please, remove free space between the words “diameter” and “for” in Line 302.

REPLY: Thank you for your comment. The text has been modified according to it.

 

1. Are there any possibilities to use one labeling side of the letters for pictures E, F and G (right, downward) in Fig. 6?

REPLY: Thank you for your comment. The figure has been modified according to it.

 

1. Please, look at the labeling style of the pictures in Fig. 7: in some pictures, letters are inside pictures (A, B, C, D) but in pictures E and F letters are outside pictures. In picture C letter C is not at the same level in comparison with the letters in pictures A and B.

REPLY: Thank you for your comment. The figure has been modified according to it.

 

1. In Line 304: please, put a comma after 17,8 mm because there are a lot of words “and” in this sentence.

REPLY: Thank you for your comment. The text has been modified according to it.

 

1. Please, look at the levels of the letters A-F in all pictures in Fig. 8, because now these labels are visible on different levels.

REPLY: Thank you for your comment. The figure has been modified according to it.

 

1. Please, look at the levels of the letters A-H in all pictures in Fig. 9, because now these labels are visible on different levels.

REPLY: Thank you for your comment. The figure has been modified according to it.

 

507. In Line 322 after A) use the small letter “a”, because in some other Figures there was used the small letter “a” after A). The same thing repeats in Line 507.

 REPLY: Thank you for your comment. The text has been modified according to it.

 

1. In Line 335 I suggest to authors use “CONCLUSIONS” for this section instead of writing “CONCLUSION”.

REPLY: Thank you for your comment. The text has been modified according to it.

 

10. Please, make attention to spaces between pictures in Fig. 1, 4, 6, 7, and 10. Some pictures haveno spaces between each other but between some of them, spaces are different.

REPLY: Thank you for your comment. The text has been modified according to it.

 

1. If there were no used frames for pictures in Fig. 3, 8, and 9 then I suggest not using them in Fig. 2 too.

REPLY: Thank you for your comment. The figure has been modified according to it.

 

Reviewer 3 Report

The authors succinctly summarise the novel role and applications of 3D printing technology as an adjunct to orthopaedic surgery planning.

In general, the content is of interest to orthopaedic clinicians and biomedical engineers.

The introduction is well rounded and justifies the publication. The attached case studies are interesting. The second case study documenting the revision arthroplasty was particularly interesting and would be of wider interest to the journal’s readership.

The article is sadly diminished by the number of errors. Indeed, the first line of the abstract has a typographical error.

Sentences have a range of errors, examples include:

1.    Too long – (e.g. line 132-136)

2.    Confusion between indefinite/definite articles - (e.g. line 162)

3.    Plurals – (e.g. 178, 276)

4.    Grammar – (e.g. line 168-169)

5.    Tenses - (e.g. line 206)

6.    Typographical errors – (e.g. 206)

7.    Incomplete? – (e.g. line 292)

I just highlight these errors as examples but there are others throughout the document.

I would support publication of the document once the article has the language revised.

 

Author Response

Dear Editors and Reviewers, 

 

we would like to thank you for your time in reviewing our manuscript and the valuable suggestions.

The Reviewers’ and Editors’ comments are reported with the original manuscript line numbering. The Authors answered to each point as shown in the list below. In the revised manuscript, changes have been highlighted using “track changes”.  Furthermore, language checking has been performed throughout the manuscript.

We hope the manuscript is now suitable for publication in your journal.

 

Sincerely, 

The Authors 

REVIEWER 3

A. The authors succinctly summarise the novel role and applications of 3D printing technology as an adjunct to orthopaedic surgery planning. In general, the content is of interest to orthopaedic clinicians and biomedical engineers.

REPLY: Thank you for your comment. We appreciated it

b. The introduction is well rounded and justifies the publication. The attached case studies are interesting. The second case study documenting the revision arthroplasty was particularly interesting and would be of wider interest to the journal’s readership.

REPLY: Thank you for your comment. We appreciated it

c. The article is sadly diminished by the number of errors. Indeed, the first line of the abstract has a typographical error.

REPLY: Thank you for your comment. According to all reviewers comment the manuscript has been modified and typos as well as English were revised.

 

d. Sentences have a range of errors, examples include: Too long – (e.g. line 132-136) - Confusion between indefinite/definite articles - (e.g. line 162) - Plurals – (e.g. 178, 276)- Grammar – (e.g. line 168-169) - Tenses - (e.g. line 206) - Typographical errors – (e.g. 206) - Incomplete? – (e.g. line 292) I just highlight these errors as examples but there are others throughout the document. I would support publication of the document once the article has the language revised.

REPLY: Thank you for your comment. We are sorry about all these mistakes. The manuscript has been extensively revised. Some of these sentences have been deleted, while the remaining have been modified according to reviewer comments.

 

Reviewer 4 Report

The topic of the manuscript entitled “Three-Dimensional Printed Models in Pre-Operative Planning of Complex Primary and Revision Total Knee Arthroplasty” is fairly original and on time. This manuscript introduces the resource, applications, and strategies for the fabrication of 3D printed models. However, the authors need to address a few queries before the publication of the review article.

1.      Authors should carefully check the typographical errors. E.g., Line 22: “Fur-thermore, some companies provide”

2.      Introduction should be clear and concise. The application of 3D printing for 3D-printed models in the pre-operative planning for spine surgery, oncology, acetabular fracture treatment, and complex primary total hip arthroplasty (THA) or revision THA should be mentioned in a separate section. Therefore, I recommend authors to divide the introduction into two sections.

3.      A table indicating the current pre-operative planning research/methodology should be included in the manuscript. This will greatly enrich the content of this article and garner interest from readers from the wider application spectrum.

 

4.      This article involves the research content till 2020 only, authors should include the recent advancements also.

Author Response

Dear Editors and Reviewers, 

 

we would like to thank you for your time in reviewing our manuscript and the valuable suggestions.

The Reviewers’ and Editors’ comments are reported with the original manuscript line numbering. The Authors answered to each point as shown in the list below. In the revised manuscript, changes have been highlighted using “track changes”.  Furthermore, language checking has been performed throughout the manuscript.

We hope the manuscript is now suitable for publication in your journal.

 

Sincerely, 

The Authors 

 

REVIEWER 4

a. The topic of the manuscript entitled “Three-Dimensional Printed Models in Pre-Operative Planning of Complex Primary and Revision Total Knee Arthroplasty” is fairly original and on time. This manuscript introduces the resource, applications, and strategies for the fabrication of 3D printed models. However, the authors need to address a few queries before the publication of the review article.

REPLY: Thank you for your comment we really appreciated it.

 

b. Authors should carefully check the typographical errors. E.g., Line 22: “Fur-thermore, some companies provide”

REPLY: Thank you for your comment. The text has been reviewed and typos corrected

 

c.  Introduction should be clear and concise. The application of 3D printing for 3D-printed models in the pre-operative planning for spine surgery, oncology, acetabular fracture treatment, and complex primary total hip arthroplasty (THA) or revision THA should be mentioned in a separate section. Therefore, I recommend authors to divide the introduction into two sections.

 REPLY: Thank you for your comment. The text has been modified according to it and to the comments of reviewer 1 and 2

 

D. A table indicating the current pre-operative planning research/methodology should be included in the manuscript. This will greatly enrich the content of this article and garner interest from readers from the wider application spectrum.

REPLY: Thank you for your comment. Tables 1 and 2 have been added as suggested, summarizing the main features of standard pre-operative planning for both primary and revision TKA.

 

e.  This article involves the research content till 2020 only, authors should include the recent advancements also.

REPLY: Thank you for your valuable suggestion. Some recent studies have been added in the reference list

Round 2

Reviewer 1 Report

Please see the attachment.

Comments for author File: Comments.pdf

Author Response

Dear Editors and Reviewers, 

 

we would like to thank you for your time in reviewing our manuscript and the valuable suggestions.

The Reviewers’ and Editors’ comments are reported with the original manuscript line numbering. The Authors answered to each point as shown in the list below. In the revised manuscript, changes have been highlighted using “track changes”.  Furthermore, language checking has been performed throughout the manuscript.

We hope the manuscript is now suitable for publication in your journal.

 

Sincerely, 

The Authors 

 

REVIEWER 1

1. The Materials and Methods section should be fully rewritten, presenting only used equipment, techniques, and materials without any analysis/discussion.

Moreover, the used software as well as the 3D printing protocols along with technical equipment (3D printer, computed tomography machine (protocol for the procedure along with technical parameters of the scanning process), materials for 3D printing).

REPLY: Thank you for your comment. The section has been completely re-written adding data on 3D printing technology which were removed from the results section.

 

1. Figure 4 is of no use as the ruler provided for the reference is not visible and the smartphone cannot be used for the reference size. All presented photos have shifted focus, making them appear blurry. Overall image quality is unsatisfactory. The photos shall be retaken.

REPLY: Thank you for your comment, we agree with the reviewer. Figure 4 has been modified according to it.

 

1. Figure 2 – low-resolution image leading to the unreadable text; Figure 3 - low-resolution image leading to the unreadable text, Figure 8 - low-resolution image leading to the unreadable text, Figure 9 - low-resolution image leading to the unreadable text. All the figures mentioned should be replaced in higher resolution.

REPLY: Thank you. Figures have been modified.

 

1. The text formatting of Table 2 is not even. The formatting of funding information, author contributions, conflict of interests, institutional review board statement, and informed consent statement is not correct (line spacing, etc.).

REPLY: Thank you for your comment. We are sorry for that. Formatting has been modified according to it.

 

1. Multiple misspelling – line 118 (extra space), 158, 312, 431, 432, 442; table 1.

REPLY: Thank you for your comment. We are sorry for that. The text has been modified according to it.

 

1. The Investigation, Formal analysis, and Project administration roles should be included in the Author Contribution section.

REPLY: Thank you for your comment. The Author contribution section has been modified.

 

1. Consider broadening the introduction with the following references about novel methods of creating 3D human bone models.

https://doi.org/10.3390/asi4030067

https://doi.org/10.3390/asi5040085

REPLY: Thank you for your comment. The References have been added

Reviewer 2 Report

Dear Authors,

The manuscript is revised well, all modifications are done and reported point by point. In the revised manuscript I have noticed just a few, minor grammatical and format errors in some sections. These details I have underlined in the comments. Please, find the attached document describing a few of the minor issues noted in the manuscript. After these revisions, an English spell check is required and afterward this manuscript can be published.

 

Comments for author File: Comments.docx

Author Response

Dear Editors and Reviewers, 

 

we would like to thank you for your time in reviewing our manuscript and the valuable suggestions.

The Reviewers’ and Editors’ comments are reported with the original manuscript line numbering. The Authors answered to each point as shown in the list below. In the revised manuscript, changes have been highlighted using “track changes”.  Furthermore, language checking has been performed throughout the manuscript.

We hope the manuscript is now suitable for publication in your journal.

 

Sincerely, 

The Authors 

 

2. Please, look at Table 1 and Table 2. These Tables should be prepared more accurately, according to the guidelines of the manuscript for authors. In both Tables sizes of the letters and spaces are different, fonts are different from the general text of the manuscript, and in several places repeat two punctuations at the end of one word.

REPLY: Thank you for your comment. Tables have been modified according to it

 

1. In Line 118, please, remove the free space between “in” and “Opening”.

REPLY: Thank you for your comment. Text has been modified according to it

 

1. Please, look at the text in Line 395: before the word “Considering” should be ending (punctuation) of the previous sentence.

REPLY: Thank you for your comment. Text has been modified according to it

 

1. In Line 427 I suggest to you use punctuation at the end of the sentence about Funding Information.

REPLY: Thank you for your comment. Text has been modified according to it

 

1. Please, look at the text in Lines 427-429: There are some extra lines and spaces. Please, prepare them, according to the guidelines of the manuscript, removing these extra lines and spaces.

REPLY: Thank you for your comment. Text has been modified according to it

 

444. I suggest finishing sentences with punctuations in Lines 435, 437 and Line 444.

REPLY: Thank you for your comment. Text has been modified according to it

 

1. In Line 447, please, look at the word “og” (this should be “of”).

REPLY: Thank you for your comment. Text has been modified according to it

 

h Please, look at the spaces in the text of the manuscript in Lines 427-447. The text should be formatted there, according to the guidelines for these sections.

REPLY: Thank you for your comment. Text has been modified according to it

 

Reviewer 4 Report

The authors have addressed the comments and queries and manuscript is improved significantly.

Author Response

Thank you for you comment and for reviewing our manuscript