Abstract
BackgroundBernese periacetabular osteotomy (PAO) has been shown to be applicable as a hip-preserving technique for the treatment of developmental dysplasia of the hip (DDH). The approach could be designed preoperatively using various types of reverse-engineering software and finite element analysis, but how to implement it in the actual PAO remains a challenge. This study examines and evaluates a solution to achieve higher accuracy when performing a PAO.MethodsA patient-specific cutting and rotating template was predesigned through computer-aided design (CAD) with three-dimensional (3D) modeling programs. The templates were then reproduced with rapid prototyping (RP) technology and used in the actual PAO. Finally, the clinical and radiographic effects were assessed and compared between the newly developed PAO and conventional PAO groups.ResultsThe customized cutting template fit well with the bone surface and served as a guide for surgeons as they slid the osteotome to the precise location that had been determined prior to surgery. A very similar acetabular fragment was reproduced, and no major complications occurred when performing the osteotomy along the edge of the cutting template. The acetabular fragment was then corrected to the predetermined position through one-off manipulation with the customized rotating template. The final position of the acetabular fragment in the new developed PAO group was highly consistent with the planned position, and the postoperative morphological parameters were consistent with the preoperative planned data compared to the conventional PAO group. The duration of the operation and the number of irradiation decreased significantly. The Harris hip score (HHS) and visual analogue scale (VAS) score improved significantly with the use of the new developed PAO.ConclusionsWe demonstrate that our system, which was based on CAD-RP technology, is feasible and could realize the predicted results accurately during the actual PAO.
Highlights
Bernese periacetabular osteotomy (PAO) has been shown to be applicable as a hip-preserving technique for the treatment of developmental dysplasia of the hip (DDH)
The average duration of the operation and the number of irradiations required in the new developed PAO group were 102 ± 7 min and 4 ± 1, while those in the conventional PAO group were 117 ± 19 min and 7 ± 2, respectively
At the time of the last follow-up, the Harris hip score (HHS) had improved to 94 ± 2 in the new developed PAO group and 91 ± 1 in the conventional PAO group
Summary
Bernese periacetabular osteotomy (PAO) has been shown to be applicable as a hip-preserving technique for the treatment of developmental dysplasia of the hip (DDH). Acetabular dysplasia is a primary cause of secondary osteoarthritis of the hip in adolescents and young adults [5,6,7]. Many surgical procedures have been reported to improve joint coverage and femoral head-acetabular congruency [8,9,10]. Bernese periacetabular osteotomy (PAO), proposed by Ganz et al [11], because of its advantages such as the dorsal pillar remains mechanically intact without compromising the dimensions of the birth canal and allowing excessive potential for acetabular reorientation, has become the preferred hip-preserving surgery for treating DDH at many centers worldwide. Various studies have reported good to excellent PAO results in both clinical and radiological observations with both mid- and longterm follow-ups [12,13,14]
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