Patient-specific 3D models aid planning for triplane proximal femoral osteotomy in slipped capital femoral epiphysis

Abstract

PurposeSlipped capital femoral epiphysis (SCFE) can result in a complex three-dimensional (3D) deformity of the proximal femur. A three-plane proximal femoral osteotomy (TPFO) has been described to improve hip mechanics. The purpose of this study was to evaluate the benefits of using 3D print technology to aid in surgical planning.Patients and MethodsFifteen children treated with TPFO for symptomatic proximal femoral deformity due to SCFE were included in this study. Ten patients were treated by a single surgeon with (model group, n = 5) or without (no-model group, n = 5) a 3D model for pre-operative planning, and compared with patients treated by two senior partners without the use of a model (senior group, n = 5) to evaluate for a learning curve. Peri-operative data including patient body mass index (BMI), surgical time and fluoroscopy time were recorded.ResultsChildren in all three groups had similar BMIs at the time of the TPFO. Post-operative radiographic parameters were equally improved in all three groups. On average, surgical time decreased by 45 minutes and 38 minutes, and fluoroscopy time decreased by 50% and 25%, in the model group compared with the no-model and senior groups, respectively.ConclusionsPatient-specific 3D models aid in surgical planning for complex 3D orthopaedic deformities by enabling practice of osteotomies. Results suggest that 3D models may decrease surgical time and fluoroscopy time while allowing for similar deformity correction. These models may be especially useful to overcome steep learning curves for complex procedures or in trainee education through mock surgical procedures.

Three‐dimensional printing in orthopaedic preoperative planning improves intraoperative metrics: a systematic review

“…Across the board, the case–control studies showed that using 3D printed models as a part of the perioperative plan showed consistent improvements in intraoperative metrics but did not significantly affect the surgical outcome. All studies which measured operating time showed a clinically significant if not statistically significant reduction in operating time compared to the control cohorts . In the studies which measured blood loss volume and fluoroscopy time, the results were similar, with most finding statistically significant reductions in these metrics (two studies showed similar levels of intraoperative blood loss).…”

“…While the difference in the rate of complications is reported as statistically insignificant in all cases, it is important to note these small scale studies are not adequately powered, reinforcing the need for further large scale trials to be performed. Two papers showed an observable difference in complication rate …”

“…The sample sizes of these studies were insufficient to provide statistical significance to some of their results . While the papers managed to demonstrate that the intraoperative benefits were significant, the surgical outcomes were insufficiently powered to demonstrate any surgical improvement or decrease in complication rate . In particular, when evaluating the rates of serious complications, larger cohorts are necessary to arrive at a statistically significant conclusion .…”

“…While the models range from $2–3 to $1500 per model, the printers and software can represent a large initial investment. Whilst cheaper printers may only cost a few thousand dollars, reliable industrial printers can cost a minimum of $60 000 and up to $500 000. These factors require the establishment of a consistent protocol for the use of 3D printing technology with regards to case selection, image processing, 3D printing and the surgical simulation in order to streamline the process .…”

“…In addition, most studies involved the use of a single anatomical model. There is potential in select cases for multiple models to be used to allow the surgeon to simulate multiple approaches and select the optimal plan with more certainty …”