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Review
. 2022 Jan 19;92(6):e2021221.
doi: 10.23750/abm.v92i6.11703.

The use of 3D printed models for the pre-operative planning of surgical correction of pediatric hip deformities: a case series and concise review of the literature

Giulia Facco  1 , Daniele Massetti  2 , Valentino Coppa  3 , Roberto Procaccini  4 , Luciano Greco  5 , Michela Simoncini  6 , Alberto Mari  7 , Mario Marinelli  8 , Antonio Gigante  9
Affiliations
Review

The use of 3D printed models for the pre-operative planning of surgical correction of pediatric hip deformities: a case series and concise review of the literature

Giulia Facco et al. Acta Biomed. .

Abstract

Background and aim: Three-dimensional (3D) printing is prevailing in surgical planning of complex cases. The aim of this study is to describe the use of 3D printed models during the surgical planning for the treatment of four pediatric hip deformity cases. Moreover, pediatric pelvic deformities analyzed by 3D printed models have been object of a concise review.

Methods: All treated patients were females, with an average age of 5 years old. Patients' dysplastic pelvises were 3D-printed in real scale using processed files from Computed Tomography (CT) or Magnetic Resonance Imaging (MRI). Data about 3D printing, surgery time, blood loss and fluoroscopy have been recorded.

Results: The Zanoli-Pemberton or Ganz-Paley osteotomies were performed on the four 3D printed models, then the real surgery was performed in the operating room. Time and costs to produce 3D printed models were respectively on average 17:26 h and 34.66 €. The surgical duration took about 87.5 min while the blood loss average was 1.9 ml/dl. Fluoroscopy time was 21 sec. MRI model resulted inaccurate and more difficult to produce. 10 papers have been selected for the concise literature review.

Conclusions: 3D printed models have proved themselves useful in the reduction of surgery time, blood loss and ionizing radiation, as well as they have improved surgical outcomes. 3D printed model is a valid tool to deepen the complex anatomy and orientate surgical choices by allowing surgeons to carefully plan the surgery.

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Conflict of interest statement

Each author declares that he or she has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangement etc.) that might pose a conflict of interest in connection with the submitted article.

Figures

Figure 1.
Figure 1.
female patient with non-breech birth, no familiarity with DDH. No ultrasound screening for DHH had been performed. She did not respond to orthosis and cast treatment. Then a left hip close reduction surgery was performed with adductors muscle tenotomy. When she was 2 years old Pemberton-Zanoli osteotomy was proposed. a. preoperative X-ray. b. 3D model production from CT DICOM files on Syngo.via Frontier software. Bridges between isolated bone structures were created in order to obtain a one-piece model. c. left hip 3D printed model in real scale in ABS plus. d. mock surgery: landmark of the iliac cut, 1.5 cm above the superior hip joint line. e. mock surgery: using the Kirshner wire as a guide, a little osteotomy was realized to cut medially and anteriorly the iliac bone, following the direction to the sciatic notch. f. mock surgery: a spreader was used in order to enlarge the space created by the osteotomy and to push the distal fragment down. g., h. mock surgery: a protractor was used to define the dimension of the space created according to the bone graft’s size. A trapeze bone graft was prepared by wax and then inserted in the osteotomy space. i., j. real surgery: landmark of the iliac cut, 1.5 cm above the superior hip joint line. k., l. real surgery: iliac bone osteotomy. m., n. real surgery: bone graft and his positioning. o. final outcome, spica cast has been positioned.
Figure 2.
Figure 2.
MRI 3D model: a. 3D model production from MRI DICOM files on Syngo.via Frontier software; b. Virtual MRI 3D model; c. MRI 3D printed model
Figure 3.
Figure 3.
Ganz-Paley osteotomy: mock and real surgeries. a., d.: femoral head portion to remove has been assessed and drawn on the 3D printed model and during the real surgery. b., e.: the osteotomy was performed following the drawn line, and the femoral portion was removed. c., f.: the two remaining parts were put closer and assembled.
Figure 4.
Figure 4.
Pelvic X-rays: a. patient 1 six months follow-up; b. patient 2 six months follow-up; c. patient 3 six months follow-up; d. patient 4 one-year follow-up
See this image and copyright information in PMC

References

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