Revision surgery represents a challenging procedure, especially when it is not a first time revision. 3D technology helps in the comprehension of complex bone defects and drives the surgeon through the treatment planning and the procedure itself. Modern 3D printing may be used to create anatomical models and component trials for surgical preparation; the surgeon may try cup size, positions, screw directions and measurements and thickness of available bone for implants placement, drastically reducing surgery times. Regarding the femoral side, in the last few years, custom-made implants have been proposed for patients undergoing revision hip surgery. However, nowadays, long-stemmed standard implants or modular distal stems are more cost-effective than custom devices in revision surgery. For this reason, their use is not frequent. In cases of large acetabular bone loss, the goal is to provide a stable fixation of the cup, trying to fill the periacetabular bone defect and restoring correct centre of rotation of the hip. The custom 3D-printed acetabular implant has been introduced in the last 20 years as an exciting new option to address severe acetabular bone loss. These solutions are built custom-fitted to patient’s anatomy, obtained from CT reconstruction, to allow a broad stress distribution and best possible fit between bone and implant surface, and to restore a good joint biomechanics. Custom-made implant can be a reliable option either in Paprosky III A/B cases or in pelvic discontinuity. According to reported data in various arthroplasty registers, the demand for these implants will increase in the next years. Unfortunately up to date, there is still a lack of consistent published data, but preliminary results encourage this course.
3D customizing in revision hip replacement
Aprato A.;D'amelio A.;Marra F.;Mellano D.;Masse A.
2017-01-01
Abstract
Revision surgery represents a challenging procedure, especially when it is not a first time revision. 3D technology helps in the comprehension of complex bone defects and drives the surgeon through the treatment planning and the procedure itself. Modern 3D printing may be used to create anatomical models and component trials for surgical preparation; the surgeon may try cup size, positions, screw directions and measurements and thickness of available bone for implants placement, drastically reducing surgery times. Regarding the femoral side, in the last few years, custom-made implants have been proposed for patients undergoing revision hip surgery. However, nowadays, long-stemmed standard implants or modular distal stems are more cost-effective than custom devices in revision surgery. For this reason, their use is not frequent. In cases of large acetabular bone loss, the goal is to provide a stable fixation of the cup, trying to fill the periacetabular bone defect and restoring correct centre of rotation of the hip. The custom 3D-printed acetabular implant has been introduced in the last 20 years as an exciting new option to address severe acetabular bone loss. These solutions are built custom-fitted to patient’s anatomy, obtained from CT reconstruction, to allow a broad stress distribution and best possible fit between bone and implant surface, and to restore a good joint biomechanics. Custom-made implant can be a reliable option either in Paprosky III A/B cases or in pelvic discontinuity. According to reported data in various arthroplasty registers, the demand for these implants will increase in the next years. Unfortunately up to date, there is still a lack of consistent published data, but preliminary results encourage this course.
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