Do custom 3D-printed revision acetabular implants provide enough value to justify the additional costs? The health-economic comparison of a new porous 3D-printed hip implant for revision arthroplasty of Paprosky type 3B acetabular defects and its closest alternative

Tack, P.J.; Victor, Jan; Gemmel, Paul; Annemans, Lieven

doi:10.1016/j.otsr.2020.03.012

Cited by 17 publications

(13 citation statements)

References 31 publications

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“…Most studies on preoperative planning in revision arthroplasty focus on 3D printing or patient-specific implants [ 17 , 18 , 19 ]. However, these two procedures are associated with significantly higher costs [ 20 , 21 , 22 ]. In primary hip arthroplasty, a cost analysis of 3D templating identified an additional cost of 53–116 € per patient.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Accuracy of 2D and 3D Templating for Revision Total Hip Replacement

Winter

Fritsch

König

et al. 2023

JPM

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Introduction: Revision hip arthroplasty is a challenging surgical procedure, especially in cases of advanced acetabular bone loss. Accurate preoperative planning can prevent complications such as periprosthetic fractures or aseptic loosening. To date, the accuracy of three-dimensional (3D) versus two-dimensional (2D) templating has been evaluated only in primary hip and knee arthroplasty. Methods: We retrospectively investigated the accuracy of 3D personalized planning of reinforcement cages (Burch Schneider) in 27 patients who underwent revision hip arthroplasty. Personalized 3D modeling and positioning of the reinforcement cages were performed using computed tomography (CT) of the pelvis of each patient and 3D templates of the implant. To evaluate accuracy, the sizes of the reinforcement cages planned in 2D and 3D were compared with the sizes of the finally implanted cages. Factors that may potentially influence planning accuracy such as gender and body mass index (BMI) were analyzed. Results: There was a significant difference (p = 0.003) in the accuracy of correct size prediction between personalized 3D templating and 2D templating. Personalized 3D templating predicted the exact size of the reinforcement cage in 96.3% of the patients, while the exact size was predicted in only 55.6% by 2D templating. Regarding gender and BMI, no statistically significant differences in planning accuracy either for 2D or 3D templating were observed. Conclusion: Personalized 3D planning of revision hip arthroplasty using Burch Schneider reinforcement cages leads to greater accuracy in the prediction of the required size of implants than conventional 2D templating.

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Section: Discussionmentioning

confidence: 99%

Comparison of the Accuracy of 2D and 3D Templating for Revision Total Hip Replacement

Winter

Fritsch

König

et al. 2023

JPM

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“…We do not know which design offers the optimal solution for achieving long-term fixation with bone, or indeed if we will observe any clinical differences at all; this understanding will come mainly from long-term follow up studies and registry data. An important factor influencing the performance of these types of patient-specific implants is the severity of the defect being treated and the quality of the underlying bone [ 2 , 7 ]. The broad variability in the structure of this bone may in part explain the variability in porous designs seen between manufacturers, particularly as the evidence of long-term performance is still being generated.…”

Section: Discussionmentioning

confidence: 99%

“…Author details 1 The Royal National Orthopaedic Hospital, Stanmore HA74LP, UK. 2 The Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK. 3 Department of Orthopaedic Surgery, St. Franziskus Hospital Köln, 50825 Cologne, Germany.…”

Section: Authors' Contributionsmentioning

confidence: 99%

“…Additive manufacturing (AM), commonly referred to as 3D-printing, is revolutionising orthopaedic implant engineering. This technology is used in numerous off-the-shelf implant designs but has demonstrated its greatest clinical impact by enabling patient-specific titanium cups to be printed for the treatment of patients with large and complex shaped acetabular defects [ 1 , 2 ]; without which many of these patients would otherwise have been unable to be reconstructed and walk.…”

Section: Introductionmentioning

confidence: 99%

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Morphometric analysis of patient-specific 3D-printed acetabular cups: a comparative study of commercially available implants from 6 manufacturers

et al. 2022

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Background 3D printed patient-specific titanium acetabular cups are used to treat patients with massive acetabular defects. These have highly porous surfaces, with the design intent of enhancing bony fixation. Our aim was to characterise these porous structures in commercially available designs. Methods We obtained 12 final-production, patient-specific 3D printed acetabular cups that had been produced by 6 manufacturers. High resolution micro-CT imaging was used to characterise morphometric features of their porous structures: (1) strut thickness, 2) the depth of the porous layer, (3) pore size and (4) the level of porosity. Additionally, we computed the surface area of each component to quantify how much titanium may be in contact with patient tissue. Statistical comparisons were made between the designs. Results We found a variability between designs in relation to the thickness of the struts (0.28 to 0.65 mm), how deep the porous layers are (0.57 to 11.51 mm), the pore size (0.74 to 1.87 mm) and the level of porosity (34 to 85%). One manufacturer printed structures with different porosities between the body and flange; another manufacturer had two differing porous regions within the body of the cups. The cups had a median (range) surface area of 756.5 mm2 (348 – 1724). Conclusions There is a wide variability between manufacturers in the porous titanium structures they 3D print. We do not currently know whether there is an optimal porosity and how this variability will impact clinically on the integrity of bony fixation; this will become clearer as post market surveillance data is generated.

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“…These factors can all be beneficial in reducing healthcare related costs. For acetabular fractures, a new technique was recently introduced using a new type of 3D-printed custom titanium implant (87). Compared to conventional revision hip arthroplasty, the new implant reduced costs by 1266 euros and delivered a health benefit of 0.05 QALY for a patient aged 65 years.…”

Section: Recommendationmentioning

confidence: 99%

Pelvic ring injuries

Banierink¹

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Do custom 3D-printed revision acetabular implants provide enough value to justify the additional costs? The health-economic comparison of a new porous 3D-printed hip implant for revision arthroplasty of Paprosky type 3B acetabular defects and its closest alternative

Cited by 17 publications

References 31 publications

Comparison of the Accuracy of 2D and 3D Templating for Revision Total Hip Replacement

Comparison of the Accuracy of 2D and 3D Templating for Revision Total Hip Replacement

Morphometric analysis of patient-specific 3D-printed acetabular cups: a comparative study of commercially available implants from 6 manufacturers

Pelvic ring injuries

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