Makarov Vasyl
City State Medical Hospital ?16, UkraineTitle: The short-term outcomes of total hip arthroplasty using custom 3d titanium porous printed implants for acetabular defects
Abstract
Background: total hip replacement with acetabular bone loss is a remains
a problematic and debatable topic far from its final solution.
Purpose: Improve results of total hip arthroplasty using 3D
custom-made titanium porous printed implants for acetabular defects in patients
with acetabular Paprosky ?? and III defects.
Methods: In a prospective analysis, we included 8 patients (all
females) undergoing cup primary (6 patients) and revision (2 patients) using a
custom 3D printed implant. The indication was protrusion arthritis with
osteoporosis as well as defect of posterior and superior wall of acetabular
Paprosky II and ??? defects. Using 3D CT, we created for the first step 3D
mathematical model in Solidwork software program. Then we simulated of the
pre-operative 3D custom cup estimated inclination, anteversion, and center of rotation.
There was 3D printed pelvic and cup from plastic and 3D custom cup from
titanium powder Ti-6Al?4V using the laser powder bed fusion machine (ISO
13485:2016). Titanium porous structure were hexagon 350-400 micron. Plastic
models facilitated during surgery orientation and identification of position
before implantation of 3D custom cup.
Results: Our short-term outcomes measures were the 3D-CT-measured
difference between planned and achieved of the 3D porous cup position were
correct with 100% restoration of center of rotation and inclination as well as
anteroposterior direction in 6 cases, in 2 cases we had insignificant upward
displacement of center of rotation – 8-10 mm, and increase in inclination angle
by 6-8°. There was no revision during 1 year after surgery. Post-operative
Harris hip scores ranged from 92 to 95 in the short-term study. Radiographic
outcomes were reported that in all patients was achieved total ingrowth
spongious bone in porous of 3D titanium printed custom cups.
Conclusion: Custom 3D titanium porous printed cups are a reliable
surgery option for severe acetabular defects and allow the reconstruction of
the center of rotation as well as inclination and anteroposterior position. The
authors propose using pre-op 3D planning and 3D printed plastic models to adapt
of implants during surgery that show promising results in complex hip primary
and revision surgery.
Keywords: 3D CT; custom 3D porous printed cups, image analysis for
component orientation, acetabular Paprosky II and III defects; custom-made
implant; revision hip surgery; total hip arthroplasty.
Biography
Vasyl Makarov
has completed his PHD at the age of 30 years from Sytenko Institute of
Spine and Joint Pathology, Kharkiv, Ukraine. He is the orthopedic surgeon of
polytrauma and adult reconstruction department of City Clinical Hospital No 16
in Dnipro, Ukraine. He has over 70 publications that have been cited over
100 times. He has been strong interest in shoulder and hip reconstruction
using custom design of implants using 3D laser additive technology.
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