Abstract
The objective of this experimental study was to develop and evaluate a three-dimensionally printed custom surgical guide system for performing bipolar coxofemoral osteochondral allograft transplantation in dogs. Five cadaver dogs, weighing 20-38 kg were used in the study. Custom surgical guides were designed and three-dimensionally printed to facilitate accurate execution of a surgical plan for bipolar coxofemoral osteochondral allograft transplantation. Guide-assisted technique was compared to freehand technique in each cadaver. Surgical time was recorded and postoperative computed tomography and three-dimensional segmentation was performed. Femoral version and inclination angles, femoral neck length, and gap present at the femoral and acetabular donor-recipient interface was compared between the virtual surgical plan and postoperative outcome for both techniques. One-tailed paired t-test (P < .05) was used for statistical analysis. When compared to free-hand preparation, mean donor femoral preparation time was 10 minutes longer and mean recipient preparation time was 2 minutes longer when using guides (p = 0.011 and p = 0.001, respectively). No difference in acetabular preparation time was noted between groups. Gap volume at the acetabular and femoral donor-recipient interface was not different between groups. Mean difference between the planned and postoperative version angle was 6.2° lower for the guide group when compared to the freehand group (p = 0.025). Mean femoral neck length was 2 mm closer to the plan when using guides than when performing surgery freehand (p = 0.037). Accuracy for femoral angle of inclination was not different between groups. Custom surgical guides warrants consideration in developing bipolar coxofemoral osteochondral allograft transplantation as an alternative surgical technique for managing hip disorders in dogs.
Highlights
Hyaline cartilage has long been recognized as a tissue with limited capacity for repair [1, 2]
Osteochondral allograft transplantation procedures follow the same principles of osteochondral restoration as osteochondral autografting, but the graft is recovered from a qualified tissue donor of the same species
No difference in acetabular preparation time was noted between groups
Summary
Hyaline cartilage has long been recognized as a tissue with limited capacity for repair [1, 2]. Resurfacing of the joint with functional hyaline cartilage is an attractive treatment strategy [5]. Implantation of osteochondral autograft plugs has been described in dogs with encouraging results but is associated with donor site morbidity and is usually limited to treating lesions 2 cm. The use of an osteochondral allograft allows for resurfacing of larger defects using sitespecific donor tissue and avoids donor-site morbidity [9,10,11,12]. Cartilage is immune-privileged such that donor hyaline cartilage with intact matrix is not associated with immune system rejection responses [13]. The subchondral bone component of an osteochondral allograft, is not immune-privileged and the recipient response must be dampened by limiting osteochondral allograft bone volume and removing donor marrow elements using pressurized lavage prior to implantation [14]
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