Performance of Tönnis triple osteotomy in older children with developmental dysplasia of the hip (DDH) assisted by a 3D printing navigation template

Abstract

Background The objective of this study is to investigate the preparation of a navigation template via a computer-aided design (CAD) and 3D printing (3DP) in order to improve the effectiveness of Tönnis triple osteotomy in older children with developmental dysplasia of the hip (DDH). Method Thirty-eight older children who received Tönnis triple osteotomy were included in this study. Among them, 20 were categorized as the 3DP navigation template group (3DP group), and the remaining 18 were categorized as the conventional surgery group (CS group). Data, including preoperative and postoperative pelvic sharp angle (SA), lateral center-edge angle (LCEA), acetabular roof angle (ARA), acetabular head index (AHI), crossover sign (COS), ischial spine sign (ISS), operation time (OT), intraoperative blood loss (IBL), and number of radiation exposures (NORE) were recorded for both groups. In addition, the therapeutic effect was evaluated at the last follow-up, according to the McKay criteria and Severin’s criteria. Results In the 3DP and CS groups, the mean OT was 126.6 ± 17.6 min and 156.0 ± 18.6 min, respectively; the mean IBL was 115.0 ± 16.9 ml and 135.7 ± 26.5 ml, respectively; the NORE were 3.3 ± 0.8 times and 8.6 ± 1.3 times, respectively. There were significant differences in the OT, IBL, and NORE between the two groups (P = 0.03, 0.05, < 0.001, respectively). At the last follow-up, the 3DP and CS groups displayed SA of 41.8 ± 2.3° and 42.6 ± 3.1°, respectively; LCEA of 35.6 ± 4.2° and 37.1 ± 2.8°, respectively; ARA of 6.9 ± 1.8° and 9.8 ± 2.6°, respectively; and AHI of 86.6 ± 4.1% and 84.3 ± 2.8%, respectively; COS(+) of 5 hips and 4 hips, respectively; ISS(+) of 6 hips and 7 hips. We observed no statistical differences in the SA, LCEA, ARA, AHI, COS and ISS between the two groups (P = 0.918, 0.846, 0.643, 0.891, 0.841, 0.564, respectively). According to the McKay criteria, the 3DP group had 10 excellent, 6 good, and 4 general hips, whereas, the CS group had 12 excellent, 4 good, and 2 general hip. There was no statistical difference between the two groups (P = 0.698). In 3DP group the postoperative Severin’s grading included 13 hips in grade I, 4 in grade II, 3 in grade III. Alternately, in the CS group, the postoperative Severin’s grading included 11 hips in grade I, 5 in grade II, 2 in grade III. The Severin ‘s criteria also showed no statistical difference between the two groups (P = 0.945). Conclusions Base on our analysis, our CAD-3DP-fabricated navigation template assisted Tönnis triple osteotomy in older DDH children, it reduced operation time and number of radiation exposures. However, no significant differences in radiological assessment and functional outcomes were observed when an experienced surgeon performs the surgery. Therefore, Surgeons who have less experience in triple osteotomy profit more from the application of this technology.

Clinical Applications of “In-Hospital” 3D Printing in Hip Surgery: A Systematic Narrative Review

“…Among the limited evidence available, specific applications have demonstrated promising outcomes. A reduction in the surgical time [24,[26][27][28]35,37,57,58,63] can lead to a better efficiency of operating rooms as well as a reduction in the risk of infection. Additionally, a decreased fluoroscopy time [24,[26][27][28]35,37] has been reported, pointing towards a potential reduction in radiation exposure for both patients and surgical teams.…”

“…A reduction in the surgical time [24,[26][27][28]35,37,57,58,63] can lead to a better efficiency of operating rooms as well as a reduction in the risk of infection. Additionally, a decreased fluoroscopy time [24,[26][27][28]35,37] has been reported, pointing towards a potential reduction in radiation exposure for both patients and surgical teams. Surgical accuracy and precision [26,50,59] as well as safety [22,34] contribute to a more secure surgical environment.…”

“…The model can also be used to improve doctor-patient communication. [36,37] In the first step, the surgeon conducts virtual planning and design of the osteotomy according to the principles described by Ganz [38] or Tönnis. The design of the surgical guide is based on the surface of the resulting independent fragment after the osteotomy at the level of the quadrilateral plate.…”

3D printing in orthopedics and musculoskeletal birth defects: From surgical planning to bone-disease approach

“…The implementation of 3D printed osteotomy guide plates led to reduced surgical time by 30 minutes, decreased intraoperative hemorrhage, and minimized radiation exposure compared to the control group (free of 3D printed guided plates) (26,27). However, in view of McKay criteria, there was no association found between groups of 3D printing guided surgery and conventional surgery considering excellent and good outcomes after the procedure (28). As for 3D printing recommendations, bone should be printed with rigid material, and cartilage with flexible material to better simulate the structure and flexibility of the pelvic structures (29).…”

Three-dimensional-printing-guided preoperative planning of upper and lower extremity pediatric orthopedic surgeries: A systematic review of surgical outcomes

“…Of the four prospective studies, three studies did not collect data on intraoperative blood loss, except the study assessing the use of 3D printing in TPFO for slipped capital femoral epiphysis, which did not denote any statistical significance (Senior group vs C vs T, 981.5 ± 534.4 vs 962.6 ± 276.1 vs 979.8 ± 316.2 mL, p = 0.3; see Table 2). 18 Five out of ten retrospective studies recorded intraoperative blood loss, 14,19,[24][25][26] and four of the five stated they found a statistically significant decrease in blood loss during 3D printing surgeries compared to control surgeries. 19,[24][25][26]…”