Abstract
The concept of a novel patient-specific 3D-printed shelf implant should be evaluated in a relevant large animal model with hip dysplasia. Therefore, three dogs with radiographic bilateral hip dysplasia and a positive subluxation test underwent unilateral acetabular augmentation with a 3D-printed dog-specific titanium implant. The contralateral side served as control. The implants were designed on CT-based pelvic bone segmentations and extended the dysplastic acetabular rim to increase the weight bearing surface without impairing the range of motion. Outcome was assessed by clinical observation, manual subluxation testing, radiography, CT, and gait analysis from 6 weeks preoperatively until termination at 26 weeks postoperatively. Thereafter, all hip joints underwent histopathological examination. The implantation and recovery from surgery was uneventful. Clinical subluxation tests at the intervention side became negative. Imaging showed medialization of the femoral head at the intervention side and the mean (range) CE-angle increased from 94° (84°–99°) preoperative to 119° (117°–120°) postoperative. Gait analysis parameters returned to pre-operative levels after an average follow-up of 6 weeks. Histology showed a thickened synovial capsule between the implant and the femoral head without any evidence of additional damage to the articular cartilage compared to the control side. The surgical implantation of the 3D shelf was safe and feasible. The patient-specific 3D-printed shelf implants restored the femoral head coverage and stability of dysplastic hips without complications. The presented approach holds promise to treat residual hip dysplasia justifying future veterinary clinical trials to establish clinical effectiveness in a larger cohort to prepare for translation to human clinic.
Highlights
The concept of a novel patient-specific 3D-printed shelf implant should be evaluated in a relevant large animal model with hip dysplasia
General orthopedic examination and subjective locomotion evaluation revealed no other relevant joint abnormalities other than the findings related to hip dysplasia
The present study provides a proof-of-concept for a safe and feasible surgical approach to treat naturally occurring hip dysplasia with a personalized 3D-printed titanium shelf implant in a dog model
Summary
The concept of a novel patient-specific 3D-printed shelf implant should be evaluated in a relevant large animal model with hip dysplasia. Three dogs with radiographic bilateral hip dysplasia and a positive subluxation test underwent unilateral acetabular augmentation with a 3D-printed dog-specific titanium implant. Histology showed a thickened synovial capsule between the implant and the femoral head without any evidence of additional damage to the articular cartilage compared to the control side. The patient-specific 3D-printed shelf implants restored the femoral head coverage and stability of dysplastic hips without complications. The titanium 3D-printed shelf implant was previously biomechanically tested in a cadaveric dog model and demonstrated to stabilize the dysplastic hip joint by creating an acetabular rim extension in a predictable and Scientific Reports | (2022) 12:3032. Similar to the autologous shelf arthroplasty the 3D shelf implant is placed extra capsular with the synovial membrane lining the inner rim of the implant and thereby increasing the weight bearing surface of the dysplastic acetabulum
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