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. 2022 Jan;14(1):119-128.
doi: 10.1111/os.13183. Epub 2021 Dec 13.

Restoring Rotation Center in Total Hip Arthroplasty for Developmental Dysplasia of the Hip with the Assistance of Three Dimensional Printing Technology: A Pilot Study

Heng Zhang  1   2 , Jian-Zhong Guan  2 , Zheng Zhang  2 , Xiao-Tian Chen  2 , Xiao-Dong Ma  3 , Jian-Ning Zhao  1 , Jian-Sheng Zhou  2
Affiliations

Restoring Rotation Center in Total Hip Arthroplasty for Developmental Dysplasia of the Hip with the Assistance of Three Dimensional Printing Technology: A Pilot Study

Heng Zhang et al. Orthop Surg. 2022 Jan.

Abstract

Objective: To develop a new method to restore hip rotation center exactly and rapidly in total hip arthroplasty (THA) with the assistance of three dimensional (3D) printing technology and evaluate its clinical and radiological outcomes.

Methods: From March 2014 to July 2018, a total of 17 patients (five hips of four men and 16 hips of 13 women) with end-stage osteoarthritis secondary to developmental dysplasia of the hip who underwent THA were analyzed and followed up retrospectively. The average age is 58.00 ± 8.12 years (range from 45 to 71 years). Simulated operations were performed on 3D printed hip models for preoperative planning. The morphology of Harris fossa and acetabular notches were recognized and restored to locate the acetabular center. The size of bone defect was measured by the bone wax method. The agreement on the size of acetabular cup and bone defect between simulated operations and actual operations were analyzed. Harris Hip Score (HHS) was used to evaluate the recovery of hip joint function. The vertical distance and horizontal distance of the rotation center on the pelvis plain radiograph were measured, which were used to assess the efficacy of restoring hip rotation center and acetabular cup migration.

Results: The mean sizes of bone defect in simulated operations and THA were 4.58 ± 2.47 cm2 and 4.55 ± 2.57 cm2 respectively. There was no significant difference statistically between the sizes of bone defect in simulated operations and the actual sizes of bone defect in THA (t = 0.03, P = 0.97). The sizes of the acetabular cup of simulated operations on 3D print models showed a high rate of coincidence with the actual sizes in the operations (ICC = 0.93). All 17 patients were available for clinical and radiological follow-up. The average follow-up time was 18.35 ± 6.86 months (range, 12-36 months. The average HHS of the patients was improved from (38.33 ± 6.07) preoperatively to the last follow-up (88.61 ± 3.44) postoperatively. The mean vertical and horizontal distances of hip rotation center on the pelvic radiographs were restored to 15.12 ± 1.25 mm and 32.49 ± 2.83 mm respectively. No case presented dislocation or radiological signs of loosening until last follow-up.

Conclusions: The application of 3D printing technology facilitates orthopedists to recognize the morphology of Harris fossa and acetabular notches, locate the acetabular center and restore the hip rotation center rapidly and accurately.

Keywords: 3D printing; Arthroplasty; Developmental dysplasia of the hip; Hip; Rotation center.

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Figures

Fig. 1
Fig. 1
Preoperative imageological examinations. (A, B) Preoperative X‐ray and 3D‐CT showed the complicated pathological changes of end‐stage hip osteoarthritis secondary to Crowe type III DDH. (C) Preoperative horizontal CT scan showed the Harris fossa existed and covered with osteophytes.
Fig. 2
Fig. 2
The simulated operation on 3D print model. (A) 3D print model. (B) Recognizing and restoring Harris fossa. (C) Locating the acetabular center. (D) Locating the acetabular center by ACL. (E) Reaming the acetabulum. (F) Installing the acetabular cup. (G) Filling and measuring the bone defect by bone wax. 3D, three‐dimensional; ACL, acetabular center locator.
Fig. 3
Fig. 3
Bone defect measurement using bone wax method. (A, B) Bone wax. (C) Using the gauze to cover the surface of bone wax needed to be measured. (D) Laying the gauze flat and placing it in the measured region. (E) Measuring the area of gauze by Photoshop software.
Fig. 4
Fig. 4
Illustration of the methods of locating the acetabular centers and installing the acetabular cup. (A) Illustration of the method of locating the acetabular center. The acetabular center was located at 28.7 mm on average above the intersection point of the perpendicular bisector and acetabular anterior and posterior notches' line. (B) Illustration of the method of installing the acetabular cup. The acetabular cup was installed stably on the basis of concentric circles reaming which was aimed at the acetabular center.
Fig. 5
Fig. 5
The process of restoring hip rotation center in THA. (A) Exposing the acetabulum. (B) Recognizing and restoring Harris fossa. (C) Locating the acetabular center. (D) Reaming the acetabulum. (E) Installing acetabular test model. (F) Installing acetabular prosthesis and impaction bone graft.
Fig. 6
Fig. 6
Postoperative X‐ray showed the hip rotation center was restored anatomically.
See this image and copyright information in PMC

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