Improving pre-operative planning for complex total hip replacement with a Rapid Prototype model enabling surgical simulation

Abstract

Pre-operative planning for total hip replacement (THR) is challenging in hips with severe acetabular deformities, including those with a hypoplastic acetabulum or severe defects and in the presence of arthrodesis or ankylosis. We evaluated whether a Rapid Prototype (RP) model, which is a life-sized reproduction based on three-dimensional CT scans, can determine the feasibility of THR and provide information about the size and position of the acetabular component in severe acetabular deformities. THR was planned using an RP model in 21 complex hips in five men (five hips) and 16 women (16 hips) with a mean age of 47.7 years (24 to 70) at operation. An acetabular component was implanted successfully and THR completed in all hips. The acetabular component used was within 2 mm of the predicted size in 17 hips (80.9%). All of the acetabular components and femoral stems had radiological evidence of bone ingrowth and stability at the final follow-up, without any detectable wear or peri-prosthetic osteolysis. The RP model allowed a simulated procedure pre-operatively and was helpful in determining the feasibility of THR pre-operatively, and to decide on implant type, size and position in complex THRs.

3D Printing Aids Acetabular Reconstruction in Complex Revision Hip Arthroplasty

“…Similar to our experience, Won et al showed that this technique can reduce the intraoperative complications as described above [17]. 3D models have also been described to be of significant use in acetabular surgery preoperatively when implants require contouring in three planes.…”

A New Diagnostic Approach for Periprosthetic Acetabular Fractures Based on 3D Modeling: A Study Protocol

“…No fracture around the acetabulum and the stem were evident. Diagnostics 2019, 9, x FOR PEER REVIEW 2 of 10 of hip surgery [10,11]. Clinical application of 3D digital and printed models has been focused particularly on hip arthroplasty for the development of patient-specific instrumentation (PSI) and custom-made implants [8,12,13].…”

“…The final phase of 3D modeling is represented by rapid prototyping, in which 3D models can be printed in real-life size plastic models. Several authors reported useful application of 3D printed models for preoperative implant templating, sizing and surgical simulation of hip surgery [10,11]. Clinical application of 3D digital and printed models has been focused particularly on hip arthroplasty for the development of patient-specific instrumentation (PSI) and custom-made implants [8,12,13].…”

Emerging Technologies in Arthroplasty: Additive Manufacturing

“…[21][22][23][24] This may involve understanding the fracture patterns, preoperative contouring of plates, as well as planning the trajectory of screws and positioning of plates during trauma surgery, or positioning screws and implants during difficult hip and knee reconstructions. 22,25 Although this technology has been used in the past in various specialties such as cardiothoracic surgery, 24 neurosurgery, 26 orthopedic trauma surgery, 22 spinal surgery, 27 dental surgery, 28 and craniomaxillofacial surgery, 29,30 it is only recently that its role has been evaluated in lower extremity total joint arthroplasty. 25 Won et al, in a study of 21 complex primary total hip arthroplasties, evaluated the accuracy of preoperative planning with simulated models of the patients' anatomy of the pelvis manufactured using additive layering technology.…”

“…22,25 Although this technology has been used in the past in various specialties such as cardiothoracic surgery, 24 neurosurgery, 26 orthopedic trauma surgery, 22 spinal surgery, 27 dental surgery, 28 and craniomaxillofacial surgery, 29,30 it is only recently that its role has been evaluated in lower extremity total joint arthroplasty. 25 Won et al, in a study of 21 complex primary total hip arthroplasties, evaluated the accuracy of preoperative planning with simulated models of the patients' anatomy of the pelvis manufactured using additive layering technology. 25 The authors found that in approximately 81% of cases (n ¼ 17), the acetabulum was sized accurately (within 2 mm of the predicted size).…”