Three-dimensional-printing Technology in Hip and Pelvic Surgery: Current Landscape

Abstract

The use of three-dimensional (3D) printing is becoming more common, including in the field of orthopaedic surgery. There are currently four primary clinical applications for 3D-printing in hip and pelvic surgeries: (i) 3D-printed anatomical models for planning and surgery simulation, (ii) patient-specific instruments (PSI), (iii) generation of prostheses with 3D-additive manufacturing, and (iv) custom 3D-printed prostheses. Simulation surgery using a 3D-printed bone model allows surgeons to develop better surgical approaches, test the feasibility of procedures and determine optimal location and size for a prosthesis. PSI will help inform accurate bone cuts and prosthesis placement during surgery. Using 3D-additive manufacturing, especially with a trabecular pattern, is possible to produce a prosthesis mechanically stable and biocompatible prosthesis capable of promoting osseointergration. Custom implants are useful in patients with massive acetabular bone loss or periacetabular malignant bone tumors as they may improve the fit between implants and patient-specific anatomy. 3D-printing technology can improve surgical efficiency, shorten operation times and reduce exposure to radiation. This technology also offers new potential for treating complex hip joint diseases. Orthopaedic surgeons should develop guidelines to outline the most effective uses of 3D-printing technology to maximize patient benefits.

Keywords: Hip; Pelvis; Printing; Prostheses and implants; Three-dimensional.

Fig. 1. (A) The real sized models of the fractured hemiplevis and mirrored healthy hemipelvis were printed using 3-dimensional printing. (B) Then preoperative contouring of the plates on the mirrored hemipelvis model was performed while being consistent with virtual surgical procedures. (C) Postoperative radiograph showing the iliac oblique view of pelvis. Data from the article of Chen et al. (Orthop Traumatol Surg Res. 2019;105:877-84) published by Elsevier Masson SAS. All rights reserved.

Fig. 2. Images showing the MyHip™ patient-specific instruments system. (A) The acetabular guide is seated into the acetabulum, and two pins are inserted through attached drill sleeves. The guide is removed, leaving the two pins to act as a guide to reaming and component placement. (B) The femoral guide has a contoured fit to the femoral neck and is kept in place for the neck cut by two intraosseous pins. Data from Medacta, Chicago, IL, USA.

Fig. 3. Highly porous cups in total hip arthroplasty were eveloped in order to furtherly improve the osseointegration, enhance the long-term durability, and reduce the rate of aseptic loosening. Data from Lima Corporate, Udine, Italy.

Fig. 4. Regions prone to bone resorption in Gruen zones 1–7 for (A) fully solid implant and for (B) fully porous implant with tailored relative density distribution. The fully porous implant with an optimized material micro-structure can reduce the amount of bone loss secondary to stress shielding by 75% compared to a fully solid implant. Data from the article of Arabnejad et al. (Int Orthop. J Orthop Res. 2017;35:1774-83).

Fig. 5. (A) Preoperative radiograph after three revision surgeries with massive acetabular bone loss. (B) The design of custom-made triflanged acetabular components (CTAC) is based on 3-dimensional models produced from computed tomography scans taking into account the patient's anatomical geometry. (C) The medial side of CTAC can be provided with a porous defect-filling scaffold to favor osteointegration. (D) Postoperative radiograph.

Fig. 6. Distribution of countries that have published research on 3-dimensional printing technology in orthopaedic surgery.