Three-dimensional pre-operative planning of primary hip arthroplasty: a systematic literature review

Abstract

Three-dimensional (3D) pre-operative planning in total hip arthroplasty (THA) is being recognized as a useful tool in planning elective surgery, and as crucial to define the optimal component size, position and orientation. The aim of this study was to systematically review the existing literature for the use of 3D pre-operative planning in primary THA.A systematic literature search was performed using keywords, through PubMed, Scopus and Google Scholar, to retrieve all publications documenting the use of 3D planning in primary THA. We focussed on (1) the accuracy of implant sizing, restoration of hip biomechanics and component orientation; (2) the benefits and barriers of this tool; and (3) current gaps in literature and clinical practice.Clinical studies have highlighted the accuracy of 3D pre-operative planning in predicting the optimal component size and orientation in primary THAs. Component size planning accuracy ranged between 34-100% and 41-100% for the stem and cup respectively. The absolute, average difference between planned and achieved values of leg length, offset, centre of rotation, stem version, cup version, inclination and abduction were 1 mm, 1 mm, 2 mm, 4°, 7°, 0.5° and 4° respectively.Benefits include 3D representation of the human anatomy for precise sizing and surgical execution. Barriers include increased radiation dose, learning curve and cost. Long-term evidence investigating this technology is limited.Emphasis should be placed on understanding the health economics of an optimized implant inventory as well as long-term clinical outcomes. Cite this article: EFORT Open Rev 2020;5:845-855. DOI: 10.1302/2058-5241.5.200046.

Keywords: 3D pre-operative planning; primary total hip arthroplasty (THA); surgical planning.

Fig. 1

PRISMA flow chart.

Fig. 2

Line graph showing the growing trend of the use of 3D planning.

Fig. 3

Typical process of 3D pre-operative planning. Note. MRI, magnetic resonance imaging; CT, computed tomography.

Fig. 4

Illustration of ZedHip (LEXI Co., Ltd) planning software combining orthogonal views of the human body together with the 3D representation of the bones and the implant. Source. Image courtesy of Image courtesy of LEXI Co., Ltd, Tokyo, Japan.

Fig. 5

Illustration of Hip 3D (mediCAD, HecTec GmbH) planning software combing orthogonal views of the human body together with the 3D representation of the bones and the implant. Source. Image Courtesy of mediCAD, HecTec GmbH, Altdorf, Germany.

Fig. 6

Illustration of My Hip (Medacta International SA) planning software, which incorporates range-of-motion simulation during daily activities to detect the possibility of impingement. (a) Case example where no impingement was detected during simulation of walking; (b) however, more demanding activities such as shoe lacing are characterized by impingement. Source. Image Courtesy of Medacta International SA, Castel San Pietro, Switzerland.

Fig. 7

Illustration of hipEOS (EOS, EOS Imaging) planning software, which incorporates range-of-motion simulation to detect the possibility of impingement. Source. Image Courtesy of EOS imaging SA, Paris, France.