3D Printed Guides and Preoperative Planning for Uncemented Stem Anteversion Reconstruction during Hip Arthroplasty: A Pilot Study.

Shimin Chang,Shijie Li,Yeqing Sun,Jincheng Zhang,Yingqi Zhang,Zhitao Rao

doi:10.1155/2021/6621882

Shimin Chang, Shijie Li + Show 4 more

Open Access

https://doi.org/10.1155/2021/6621882

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Abstract

Objective To investigate if 3D printed guides and preoperative planning can accurately control femoral stem anteversion. Methods A prospective comparative study was carried out from 2018 to 2020, including 53 patients who underwent hip arthroplasty for femoral neck fracture. The target rotation center of the femoral head is determined by three-dimensional planning. In group A, planning was made by 2D templates. In group B, preoperative 3D planning and 3D printed osteotomy/positioning guides were performed. After the operation, 3D model registration was performed to calculate the accuracy of anteversion restoration. Results We screened 60 patients and randomized a total of 53 to 2 parallel study arms: 30 patients to the group A (traditional operation) and 23 patients to the group B (3D preoperative planning and 3D printed guide). There were no significant differences in demographic or perioperative data between study groups. The restoration accuracy of group A was 5.42° ± 3.65° and of group B was 2.32° ± 1.89°. The number and rate of abnormal cases was 15 (50%) and 2 (8.7%), respectively. Significant statistical differences were found in angle change, restoration accuracy, and number of abnormal cases. Conclusion Three-dimensional preoperative planning and 3D printed guides can improve the accuracy of the restoration of femoral anteversion during hip arthroplasty.

Highlights

Hip arthroplasty is an extremely successful procedure, which help improving range of motion and decreasing pain and improving patients’ quality of life [1, 2]
The most common cause of revision surgery was due to cup mispositioning (33%), surgeons should be aware of the variability of the femoral anteversion of uncemented stems [5, 6]
Demographic information collected on all patients was age, gender, and body mass index (BMI)

Summary

Introduction

Hip arthroplasty is an extremely successful procedure, which help improving range of motion and decreasing pain and improving patients’ quality of life [1, 2]. Mispositioning of the implants can result in premature implant failure requiring revision [1,2,3,4]. The most common cause of revision surgery was due to cup mispositioning (33%), surgeons should be aware of the variability of the femoral anteversion of uncemented stems [5, 6]. The traditional methods of using preoperative anteroposterior pelvis radiographs for planning and standard surgical instrumentation have shown potential for inaccuracy which varies with surgeon experience. The implantation of the femoral stem is affected by the surgical incision, visual field, and irregular medullary cavity shape of the proximal femur. It is difficult to accurately restore the anteversion, even based on preoperative CT measurement results [6, 10]

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Results

Conclusion