3D Printing Aids Acetabular Reconstruction in Complex Revision Hip Arthroplasty

Abstract

Revision hip arthroplasty requires comprehensive appreciation of abnormal bony anatomy. Advances in radiology and manufacturing technology have made three-dimensional (3D) representation of osseous anatomy obtainable, which provide visual and tactile feedback. Such life-size 3D models were manufactured from computed tomography scans of three hip joints in two patients. The first patient had undergone multiple previous hip arthroplasties for bilateral hip infections, resulting in right-sided pelvic discontinuity and a severe left-sided posterosuperior acetabular deficiency. The second patient had a first-stage revision for infection and recurrent dislocations. Specific metal reduction protocols were used to reduce artefact. The images were imported into Materialise MIMICS 14.12®. The models were manufactured using selective laser sintering. Accurate templating was performed preoperatively. Acetabular cup, augment, buttress, and cage sizes were trialled using the models, before being adjusted, and resterilised, enhancing the preoperative decision-making process. Screw trajectory simulation was carried out, reducing the risk of neurovascular injury. With 3D printing technology, complex pelvic deformities were better evaluated and treated with improved precision. Life-size models allowed accurate surgical simulation, thus improving anatomical appreciation and preoperative planning. The accuracy and cost-effectiveness of the technique should prove invaluable as a tool to aid clinical practice.

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

“…Case series focused on subjective measures. Clinical outcomes in all cases were satisfactory, with some of that success attributed to the use of 3D models.…”

“…The surgeons were able to better understand the patient's anatomy, with the models resulting in an altered surgical plan or approach in some cases. 19,21,26,37 Simulated surgery aided in instrument selection resulting in less need for adjustment intraoperatively as well as providing a better understanding of landmarks such as resection margins and screw placements. [17][18][19][20][21][22][23][24][25][26][27][28] Surgeons commented that they felt the models were less useful for simple pathologies but could greatly improve understanding of more complex fractures and deformities.…”

“…When analysing the subjective data regarding the benefits of 3D models, there is a consistent trend that surgeons found 3D models useful when dealing with complicated anatomy . 3D printed 1:1 scale models allowed surgeons to appreciate the structure and relations of the relevant anatomy much better than the visualization provided by two‐dimensional (2D) CT images conventionally used today.…”

Current perspectives on biological approaches for osteoarthritis

“…3D rapid prototyping models can be used for preoperative planning of advanced procedures, such as joint replacement surgery. This method has been used to aid in preoperative planning for the placement of the acetabular component in patients undergoing total hip arthroplasty . Virtual templates have been created on the basis of cadaveric modeling and translated into physical templates .…”

“…This method has been used to aid in preoperative planning for the placement of the acetabular component in patients undergoing total hip arthroplasty. 208 Virtual templates have been created on the basis of cadaveric modeling and translated into physical templates. 181 3D bioprinting has been successful in producing cartilage implants (polyethylene glycol dimethacrylate with human chondrocytes) to repair defects in osteochondral plugs (3D biopaper) in a layer-by-layer assembly.…”