Application of 3D-Printed Personalized Guide in Arthroscopic Ankle Arthrodesis

Abstract

Objective To accurately drill the Kirschner wire with the help of the 3D-printed personalized guide and to evaluate the feasibility of the 3D technology as well as the outcome of the surgery. Methods Patients' DICM data of ankle via CT examinations were introduced into the MIMICS software to design the personalized guides. Two 2mm Kirschner wires were drilled with the help of the guides; the C-arm fluoroscopy was used to confirm the position of the wires before applying the cannulated screws. The patients who underwent ankle arthrodesis were divided into two groups. The experimental group adopted the 3D-printed personalized guides, while the control group received traditional method, i.e., drilling the Kirschner wires according to the surgeon's previous experience. The times of completing drilling the Kirschner wires to correct position were compared between the two groups. Regular follow-ups were conducted to statistically analyze the differences in the ankle fusion time and AOFAS scores between the two groups. Results 3D-printed personalized guides were successfully prepared. A total of 29 patients were enrolled, 15 in the experimental group and 14 in the control group. It took 2.2 ± 0.8 minutes to drill the Kirschner wires to correct position in the experimental group and 4.5 ± 1.6 minutes in the control group (p=0.001). No obvious complications occurred in the two groups during and after surgery. Postoperative radiographs confirmed bony fusion in all cases. There were no significant differences in the fusion time (p=0.82) and AOFAS scores at 1 year postoperatively between the two groups (p=0.55). Conclusions The application of 3D-printed personalized guide in assisting the accurate drilling of Kirschner wire in ankle arthrodesis can shorten the operation time and reduce the intraoperative radiation. This technique does not affect the surgical outcome. Trial Registration Number This study is registered on www.clinicaltrials.gov with NCT03626935.

Application of 3D‐printed Customized Guides in Subtalar Joint Arthrodesis

“…The manufactured guide should be sterilized before surgery. This study suggests that 3D‐printed customized guides designed and manufactured based on patients’ CT data can simplify the key operative procedures without compromising the outcome. This is a recommended technique, especially for inexperienced surgeons.…”

“…To prepare the customized guides, we need to first collect the CT data of the patient to conduct the 3D image reconstruction. The engineer must fully understand the purpose of the operation so that the guides can be successfully manufactured according to the surgeon's plan, thus conducting a simplified and effective operation. The manufactured guide should be sterilized before surgery.…”

Three-dimensional printing in orthopaedic surgery: a scoping review

“…The majority of 3D printing research in orthopaedics is based in Asia, particularly in China. In addition, the Level I and Level II evidence consistently finds shorter operative times, 28 – 43 less blood loss, 28 – 30 , 32 – 38 , 41 – 43 and less fluoroscopy use 28 , 30 , 31 , 33 – 37 , 44 , 45 when 3D printing is used.…”

“…Across an overwhelming majority of the high-quality literature, the use of 3D printing significantly reduced operative time, 28 – 43 EBL, 28 – 30 , 32 – 38 , 41 – 43 and the number of fluoroscopy shots. 28 , 30 , 31 , 33 – 37 , 44 , 45 It is difficult to evaluate the clinical significance of these findings given the significant heterogeneity in terms of clinical context between the different studies. Nonetheless, a reduction in operative time is certainly beneficial from a cost perspective, and, given that the risk of complications increases with longer operative times, 46 it is reasonable to hypothesize that this is beneficial to the patient as well.…”

Surgical treatment for insertional Achilles tendinopathy and retrocalcaneal bursitis: more than 1 year of follow-up

“…Heel pain is a difficult disease to treat for surgeons. [1][2][3][4][5][6][7] There are many causes of this pain, including: (i) retrocalcaneal bursitis; (ii) posterosuperior calcaneal prominence; (iii) insertional Achilles tendinopathy (IAT); and (iv) inflammatory bursitis between the skin and the Achilles tendon. [8][9][10] The prominence of the posterosuperior calcaneus was first reported in 1928 and was considered to be an important cause of local heel pain.…”