Use of 3D Printed Models to Determine Accurate Bone Cuts during a Periacetabular Osteotomy for Developmental Hip Dysplasia

Abstract

The periacetabular osteotomy (PAO) is a powerful tool to delay the progression of hip arthritis by reorienting the acetabulum. This study aimed to use three-dimensional (3D)-printed models of the pelvis, reconstructed from the computed tomography (CT) scans of patients, to model how the level of dysplasia and its location ilium osteotomy affect radiographic outcomes following PAO. This pilot study aims to determine if preoperative 3D printing/planning can assist in predicting radiographic outcomes. We performed a retrospective review of five patients with differing levels of hip dysplasia for whom we had obtained CT scans before PAO surgery. For each patient, we printed two pelvis models that would undergo standardized cuts of the PAO procedure, with variations only in the distance of the ilium start point (one-third of the distance between the anterior superior iliac spine and anterior inferior iliac spine [AIIS] vs. two-thirds of the distance). We then mobilized the acetabular fragment into eight reproducible positions in space by moving the ilium cut a combination of 0, 1, or 2 cm anterior/lateral. Each position of the newly realigned acetabula was examined under fluoroscopy to obtain a standardized anteroposterior view, and to obtain standardized radiographic measurements in the form of lateral center edge angle (CEA), acetabular depth, Tonnis angle, and acetabular inclination. We performed 80 simulations of the PAO with varying degrees of acetabular mobilization. On average, in the models where the supra-acetabular cut was closer to the AIIS, we found more significant degrees of radiographic correction, regarding Tonnis angles (12.91 vs. 7.95, p = 0.0175), acetabular inclination (20.25 vs. 9.875, p = 0.027), and lateral CEA (11.75 vs. 2.5, p = 0.061). Patients who had greater dysplasia also had more significant degrees of radiographic Tonnis angle correction with the same mobilization movements of the acetabula (p = 0.005). When utilizing 3D printing to model PAO in dysplasia pelvises, we found that both a higher level of preoperative dysplasia and starting the supra-acetabular osteotomy closer to the AIIS were associated with more powerful corrections following smaller manipulations.

Keywords

3D printing - periacetabular osteotomy - joint

Note

Research was performed at the NYU Langone Orthopedic Hospital.

Publikationsverlauf

Eingereicht: 23. Februar 2021

Angenommen: 09. August 2021

Artikel online veröffentlicht:
17. September 2021

• References

• 1 Murphy SB, Ganz R, Müller ME. The prognosis in untreated dysplasia of the hip. A study of radiographic factors that predict the outcome. J Bone Joint Surg Am 1995; 77 (07) 985-989
• 2 Lane NE, Lin P, Christiansen L. et al. Association of mild acetabular dysplasia with an increased risk of incident hip osteoarthritis in elderly white women: the study of osteoporotic fractures. Arthritis Rheum 2000; 43 (02) 400-404
• 3 Ganz R, Klaue K, Vinh TS, Mast JW. A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results. Clin Orthop Relat Res 1988; (232) 26-36
• 4 Clohisy JC, Ackerman J, Baca G. et al. Patient-reported outcomes of periacetabular osteotomy from the prospective ANCHOR cohort study. J Bone Joint Surg Am 2017; 99 (01) 33-41
• 5 Novais EN, Duncan S, Nepple J, Pashos G, Schoenecker PL, Clohisy JC. Do radiographic parameters of dysplasia improve to normal ranges after Bernese periacetabular osteotomy?. Clin Orthop Relat Res 2017; 475 (04) 1120-1127
• 6 Mankovich NJ, Cheeseman AM, Stoker NG. The display of three-dimensional anatomy with stereolithographic models. J Digit Imaging 1990; 3 (03) 200-203
• 7 Ballard DH, Mills P, Duszak Jr R, Weisman JA, Rybicki FJ, Woodard PK. Medical 3D printing cost-savings in orthopedic and maxillofacial surgery: cost analysis of operating room time saved with 3D printed anatomic models and surgical guides. Acad Radiol 2020; 27 (08) 1103-1113
• 8 Daysal GA, Goker B, Gonen E. et al. The relationship between hip joint space width, center edge angle and acetabular depth. Osteoarthritis Cartilage 2007; 15 (12) 1446-1451
• 9 Garbuz DS, Masri BA, Haddad F, Duncan CP. Clinical and radiographic assessment of the young adult with symptomatic hip dysplasia. Clin Orthop Relat Res 2004; 1 (418) 18-22
• 10 Janzen DL, Aippersbach SE, Munk PL. et al. Three-dimensional CT measurement of adult acetabular dysplasia: technique, preliminary results in normal subjects, and potential applications. Skeletal Radiol 1998; 27 (07) 352-358
• 11 Albers CE, Rogers P, Wambeek N, Ahmad SS, Yates PJ, Prosser GH. Preoperative planning for redirective, periacetabular osteotomies. J Hip Preserv Surg 2017; 4 (04) 276-288
• 12 Tannast M, Fritsch S, Zheng G, Siebenrock KA, Steppacher SD. Which radiographic hip parameters do not have to be corrected for pelvic rotation and tilt?. Clin Orthop Relat Res 2015; 473 (04) 1255-1266
• 13 Minto J, Zhou X, Osborn J, Zhang LG, Sarkar K, Rao RD. Three-dimensional printing: a catalyst for a changing orthopaedic landscape. JBJS Rev 2020; 8 (02) e0076
• 14 Skelley NW, Smith MJ, Ma R, Cook JL. Three-dimensional printing technology in orthopaedics. J Am Acad Orthop Surg 2019; 27 (24) 918-925
• 15 Klaue K, Wallin A, Ganz R. CT evaluation of coverage and congruency of the hip prior to osteotomy. Clin Orthop Relat Res 1988; (232) 15-25
• 16 Millis MB, Murphy SB. Use of computed tomographic reconstruction in planning osteotomies of the hip. Clin Orthop Relat Res 1992; (274) 154-159
• 17 Dandachli W, Islam SU, Liu M, Richards R, Hall-Craggs M, Witt J. Three-dimensional CT analysis to determine acetabular retroversion and the implications for the management of femoro-acetabular impingement. J Bone Joint Surg Br 2009; 91 (08) 1031-1036
• 18 Zheng G, Liao H, Jannin P, Cattin P, Lee S-L. Medical Imaging and Augmented Reality. Switzerland: Springer International Publishing; 2016
• 19 Murphy RJ, Armiger RS, Lepistö J, Mears SC, Taylor RH, Armand M. Development of a biomechanical guidance system for periacetabular osteotomy. Int J CARS 2015; 10 (04) 497-508