Planning acetabular fracture reduction using a patient-specific biomechanical model: a prospective and comparative clinical study

Abstract

Purpose: A simple, patient-specific biomechanical model (PSBM) is proposed in which the main surgical tools and actions can be simulated, which enables clinicians to evaluate different strategies for an optimal surgical planning. A prospective and comparative clinical study was performed to assess early clinical and radiological results.

Methods: From January 2019 to July 2019, a PSBM was created for every operated acetabular fracture (simulation group). DICOM data were extracted from the pre-operative high-resolution CT scans to build a 3D model of the fracture using segmentation methods. A PSBM was implemented in a custom software allowing a biomechanical simulation of the surgery in terms of reduction sequences. From July 2019 to December 2019, every patient with an operated for acetabular fracture without PSBM was included in the standard group. Surgery duration, blood loss, radiological results and per-operative complications were recorded and compared between the two groups.

Results: Twenty-two patients were included, 10 in the simulation group and 12 in the standard group. The two groups were comparable regarding age, time to surgery, fracture pattern distribution and surgical approaches. The mean operative time was significantly lower in the simulation group: 113 min ± 33 (60-180) versus 184 ± 58 (90-260), p = 0.04. The mean blood loss was significantly lower in the simulation group, p = 0.01. No statistical significant differences were found regarding radiological results (p = 0.16). No per-operative complications were recorded.

Conclusion: This study confirms that pre-operative planning in acetabular surgery based on a PSBM results in a shorter operative time and a reduction of blood loss during surgery. This study also confirms the feasibility of PSBM planning in daily clinical routine.

Level of evidence: II: prospective study.

Keywords: Acetabular fracture; Biomechanical simulation; Computer-assisted surgery; Patient-specific biomechanical model; Segmentation; Virtual planning.