Patient-specific template and electromagnetic navigation assisted bilateral periacetabular osteotomy for staged correction of bilateral injury-induced hip dysplasia: a case report

Abstract

Periacetabular osteotomy (PAO) for pelvic fracture sequelae presents a challenge in hip preservation surgery due to a combination of complex conditions involving post-traumatic altered anatomy and technically demanding procedure, with high surgical risk involved. To address these challenging conditions and evade potential devastating complications, a combination of patient-specific template (PST) and electromagnetic navigation (EMN) guidance can be used to increase the safety of the procedure and the accuracy of the acetabular reorientation. Herein we report our experience utilizing a combined PST- and EMN-assisted bilateral PAO for staged correction of bilateral severe, injury-induced hip dysplasia. The presented case report describes a unique method of successful surgical treatment of severe, bilateral injury-induced hip dysplasia with combined 3-D printing technology (PST) and intra-operative electromagnetic computer-assisted navigation (EMN) aided technically demanding surgical procedure (PAO), which emphasizes the benefits of PST and EMN use in hip preservation surgery in patients with complex pathoanatomic circumstances.

Fig. 1.

At the age of 20, patient was involved in a motor vehicle-pedestrian accident, sustaining a comminuted fracture of the sacrum and bilateral superior and inferior complicated fracture of the pubis with Morel-Lavallee lesion. X-rays of primary injury management (middle and right).

Fig. 2.

The imaging studies showed residual injury-induced alterations of the lumbosacral spine and pelvis with heavily altered bony anatomy.

Fig. 3.

Patient personalized 3-D-based virtual pre-operative planning: 3D model of hips and pelvis is generated from the DICOM files obtained by the pre-operative CT scan of hips and pelvis. Lateral views (left and right) and anteroposterior view (middle).

Fig. 4.

The design of the PST congruent to the exposed bone with two holes for guidance of the Kirschner wires along with the planned retroacetabular cut and a plane for the guidance of the supraacetabular cut for the left side PAO (left, middle). The PST made of biocompatible plastic (VisiJet, 3D systems, Rock Hill, SC, USA) for guiding the supra- and retro-acetabular osteotomy (right).

Fig. 5.

EMN system (Guiding Star, Ekliptik d.o.o., Ljubljana, Slovenia).

Fig. 6.

No clinical or radiological complications were seen on the regular follow-up visit 6 months after the second surgery. Axial view (left) and anteroposterior view (right).

Fig. 7.

On the final in-office follow-up 30 months after the second surgery patient reported bilaterally undisturbed hip function and complete resolution of hip pain. Imaging showed correction according to the pre-operative plan.