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Improvement of surgical time and functional results after do-it-yourself 3D-printed model preoperative planning in acetabular defects Paprosky IIA-IIIB - 05/08/22

Doi : 10.1016/j.otsr.2022.103277 
Alex Dos Santos-Vaquinhas a, Irene Isabel López-Torres a, José Antonio Matas-Diez a, José Antonio Calvo-Haro a, b, Javier Vaquero a, b, Pablo Sanz-Ruiz a, b,
a Department of Orthopaedic Surgery, Hospital General Universitario Gregorio Maranón, C/Doctor Esquerdo 46, 28007 Madrid, Spain 
b Faculty of Medicine, Universidad Complutense de Madrid, Av. Séneca 2, 28040 Madrid, Spain 

Corresponding author. San Martin de Porres no 22, 5o D, 28035 Madrid, Spain.San Martin de Porres no 22, 5o DMadrid28035Spain
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 05 August 2022

Abstract

Introduction

The correct positioning of the implant in revision total hip arthroplasty (rTHA) is critical to obtaining substantial functional outcomes, and to avoiding complications. Current literature supports three-dimensional (3D)-printed models as potentially useful tools for preplanning, as well as the “do it yourself (DIY)” methodology to reduce both the time and costs of this procedure. However, no study has determined the efficacy of both methods combined in a cohort of patients with severe acetabular defects. In the lack of bibliography, we performed rTHA after preoperative planning by DIY-3D-printed models to evaluate its influence in: 1) the surgical time, 2) the functional scores, 3) the intra and postoperative complications, and 4) the reconstruction of the center of rotation (COR) of the hip.

Hypothesis

Preoperative planning through 3D-DIY printed models will both improve the accuracy of the implant positioning, and the surgical time, leading the latter to improved functional scores and reduced complications.

Materials & methods

A comparative study of 21 patients with Paprosky IIB to IIIB acetabular defects who underwent rTHA after 3D-printed model preoperative planning by the DIY method between 2016 and 2019 was conducted. A historical cohort of 24 patients served as the comparator. Surgical time, reconstruction of the COR, functional scores, and complications were analyzed.

Results

The mean follow-up was 32.4 (range, 12 to 60) months. All the patients showed significant improvement of the Harris hip score (HHS) after the operation (3D group: 26.58±10.73; control group 22.47±15.43 (p=0.00)). In the 3D-printed model preoperative planning group the mean operation time and the intraoperative complications were significantly lower (156.15±43.03min vs 187.5±54.38min (p=0.045); and 19% vs 62.5% (p=0.003), respectively), and the HHS and patient satisfaction score (PSS) were significantly greater (83.74±8.49 vs 75.59±11.46 (p=0.019); and 8.17±0.88 vs 7.36±1.17 (p=0.023), respectively). No differences were found in the postoperative complications, nor in the restoration of the COR as determined from the acetabular index, verticalization or horizontalization, although the acetabular index was closer to the intended one in the 3D-printed model planning group (46.67°±7.63 vs 49.22±8.1 (p=0.284)).

Conclusion

Preoperative planning of severe acetabular defects through 3D-printed models shortens the surgical time, leading to a decrease in complications and thus to better functional outcomes and greater patient satisfaction. Moreover, the DIY philosophy could decrease both the time and costs of traditional 3D planning.

Level of evidence

III, retrospective case matched study.

Le texte complet de cet article est disponible en PDF.

Keywords : Acetabular defect, Joint revision, 3D printing, DIY philosophy


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