3D - Printed Patient Specific Instrumentation in Corrective Osteotomy of the Femur and Pelvis: A Review of the Literature

Abstract

Background The paediatric patient population has considerable variation in anatomy. The use of Computed Tomography (CT)-based digital models to design three-dimensionally printed patient specific instrumentation (PSI) has recently been applied for correction of deformity in orthopedic surgery. This review sought to determine the existing application of this technology currently in use within paediatric orthopaedics, and assess the potential benefits that this may provide to patients and surgeons. Methods A review was performed of MEDLINE, EMBASE, and CENTRAL for published literature, as well as Web of Science and clinicaltrials.gov for grey literature. The search strategy revolved around the research question: “What is the clinical impact of using 3D printed PSI for proximal femoral or pelvic osteotomy in paediatric orthopaedics?” Two reviewers, using predetermined inclusion criteria, independently performed title and abstract review in order to select articles for full text review. Data extracted included effect on operating time and intraoperative image use, as well as osteotomy and screw positioning accuracy. Data were combined in a narrative synthesis; meta-analysis was not performed given the diversity of study designs and interventions. Results In total, ten studies were included: six case control studies, three case series and a case report. Five studies directly compared operating time using PSI to conventional techniques, with two showing a significant decrease in the number of intraoperative images and operative time. Eight studies reported improved accuracy in executing the surgical plan compared to conventional methods. Conclusion Compared to conventional methods of performing femoral or pelvic osteotomy, use of PSI has led to improved accuracy and precision, decreased procedure times, and decreased intra-operative imaging requirements. Additionally, the technology has become more cost effective and accessible since its initial inception and use.

Meta-Analysis of 3D Printing Applications in Traumatic Fractures

“…Inclusion criteria used in the current study included: (1) randomised controlled trials (RCTs); (2) research for traumatic fractures of limbs and pelvis, regardless of exact cause of injury; (3) 3D fracture models were used for preoperative plan to determine where it best secured fracture fragments, suitable metal plates and screws with ideal location, length and orientation; (4) comparing efficacy of 3D-printed assisted surgery with conventional surgery, without 3D printing model, for traumatic fractures; (5)…”

“…Previous studies have reported that insufficient understanding of fractures may also increase surgical invasiveness in order to sufficiently expose fracture sites during operation to understand the fracture circumstance. This aggravates tissue damage, prolongs operation time and increases intraoperative blood loss ( 5 ). Therefore, therapeutic effects of traditional surgery are unsatisfactory.…”

“…Continuous improvement of radiological technology in recent years has led to explosive growth in application of 3D printing technology in surgery and plays key roles in clinical treatment of orthopaedic diseases. 3D printing technology is currently widely used in several orthopaedic surgery programs, ranging from complex fracture types to revision arthroplasty, especially in treatment of traumatic fractures, with 3D printing models providing visual and tactile assistance ( 5 ). Studies aver that 3D printing model provides more accurate pictures of fractures, whether preoperatively planned or postoperatively reviewed ( 6 , 7 ).…”

Correction of complex three-dimensional deformities at the proximal femur using indirect reduction with angle blade plate and patient-specific instruments: a technical note

“…Beside reduced radiation exposure and shortened surgery time, Shi et al [ 34 ] also showed improved accuracy using 3D planning and PSI compared to conventional techniques in children with proximal femoral corrective osteotomy in developmental dysplasia of the hip. In a review, Baraza et al [ 20 ] similarly stated improved accuracy in corrective femoral osteotomies using 3D planning and PSI compared to conventional techniques. The improved accuracy probably is a result of the assistance of the PSI, enabling the surgeon in a precise execution of the preoperative planning into the intraoperative situation.…”

“…Zheng et al [ 19 ] previously described the application of 3D-printed navigation templates for locking compression pediatric hip plates (LCP-PHP) in children with femoral neck fractures or hip dysplasia. A recent literature review of Baraza et al [ 20 ] summarized improved accuracy and decreased procedure times in corrective osteotomies of the femur by the application of PSI compared to conventional methods. Overall, an increasing trend of the implementation of 3D planning and the use of PSI at the proximal femur can be observed.…”