Guiding prosthetic femoral version using 3D-printed patient-specific instrumentation (PSI): a pilot study

Abstract

Background: Implantation of the femoral component with suboptimal version is associated with instability of the reconstructed hip joint. High variability of Prosthetic Femoral Version (PFV) has been reported in primary Total Hip Arthroplasty (THA). Three-dimensional (3D) Patient-Specific Instrumentation (PSI) has been recently developed and may assist in delivering a PFV within the intended range. We performed a pilot study to better understand whether the intra-operative use of a novel PSI guide, designed to deliver a PFV of 20°, results in the target range of PFV in primary cemented THA.

Methods: We analysed post-operative Computed-Tomography (CT) data of two groups of patients who underwent primary cemented THA through posterior approach; 1. A group of 11 patients (11 hips) for which the surgeon used an intra-operative 3D-printed stem positioning guide (experimental) 2. A group of 24 patients (25 hips) for which the surgeon did not use the guide (control). The surgeon aimed for a PFV of 20°, and therefore the guide was designed to indicate the angle at which the stem was positioned intra-operatively. PFV angles were measured using the post-operative 3D-CT models of the proximal femurs and prosthetic components in both groups. Our primary objective was to compare the PFV in both groups. Our secondary objective was to evaluate the clinical outcome.

Results: Mean (± SD) values for the PFV was 21.3° (± 4.6°) and 24.6° (± 8.2°) for the experimental and control groups respectively. In the control group, 20% of the patients reported a PFV outside the intended range of 10° to 30° anteversion. In the experimental group, this percentage dropped to 0%. Satisfactory clinical outcome was recorded in both groups.

Conclusion: The intra-operative use of a PSI PFV guide helped the surgeon avoid suboptimal PFV in primary cemented THA. Further studies are needed to evaluate if the PSI guide directly contributes to a better clinical outcome.

Keywords: 3D-Printed patient-specific guides; Primary total hip arthroplasty; Prosthetic femoral version.

Fig. 1

Study design

Fig. 2

a PFV; b Coordinate system used to plan and measure PFV

Fig. 3

Descriptive illustration of the two PSI guides that were used: a To perform the femoral neck osteotomy; b To guide the PFV at an angle of 20°

Fig. 4

Box plot illustrating the PFV in experimental and control THA groups

Fig. 5

Histogram depicting the distribution of PFV in experimental and control THA groups

Fig. 6

3D-Printed models of the proximal femurs and of the PSI guides with incorporated slots indicating the target of the PFV that were used intra-operatively