Research Article 3D Printing Aids Acetabular Reconstruction in Complex Revision Hip Arthroplasty Andrew J. Hughes, 1 Cathal DeBuitleir, 1 Philip Soden, 1 Brian O’Donnchadha, 2 Anthony Tansey, 2 Ali Abdulkarim, 3 ColmMcMahon, 4 and Conor J. Hurson 1,3 1 Department of Orthopaedic Surgery, St. Vincent’s University Hospital, Dublin 4, Ireland 2 Department of Mechanical Engineering, Institute of Technology Tallaght, Dublin 24, Ireland 3 Department of Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Dublin 11, Ireland 4 Department of Radiology, St. Vincent’s University Hospital, Dublin 4, Ireland Correspondence should be addressed to Andrew J. Hughes;
[email protected] Received 26 July 2016; Accepted 28 November 2016; Published 3 January 2017 Academic Editor: Allen L. Carl Copyright © 2017 Andrew J. Hughes et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Revision hip arthroplasty requires comprehensive appreciation of abnormal bony anatomy. Advances in radiology and manufacturing technology have made three-dimensional (3D) representation of osseous anatomy obtainable, which provide visual and tactile feedback. Such life-size 3D models were manufactured from computed tomography scans of three hip joints in two patients. The first patient had undergone multiple previous hip arthroplasties for bilateral hip infections, resulting in right-sided pelvic discontinuity and a severe left-sided posterosuperior acetabular deficiency. The second patient had a first-stage revision for infection and recurrent dislocations. Specific metal reduction protocols were used to reduce artefact. The images were imported into Materialise MIMICS 14.12 . The models were manufactured using selective laser sintering. Accurate templating was performed preoperatively. Acetabular cup, augment, buttress, and cage sizes were trialled using the models, before being adjusted, and resterilised, enhancing the preoperative decision-making process. Screw trajectory simulation was carried out, reducing the risk of neurovascular injury. With 3D printing technology, complex pelvic deformities were better evaluated and treated with improved precision. Life-size models allowed accurate surgical simulation, thus improving anatomical appreciation and preoperative planning. The accuracy and cost-effectiveness of the technique should prove invaluable as a tool to aid clinical practice. 1. Introduction Total hip arthroplasty (THA) is one of the most successful and cost-effective interventions in medicine today, providing reliable pain relief and functional improvement to those with osteoarthritis or inflammatory arthritis of the hip [1, 2]. 90– 95% of total hip replacement (THR) prostheses survive for at least 10 years, and there is an increasing demand within our population for such an intervention due to rising life expectancy among the ageing cohort with degenerative joint disease [3, 4]. Revision hip arthroplasty is indicated when a primary THR fails due to a variety of reasons, such as asep- tic loosening (50%), instability (16%), infection (15%), debili- tating pain, periprosthetic fractures, or component failure [5]. This complicated articular reconstructive procedure requires a comprehensive understanding of the abnormal bony anatomy. Surgeons must be able to appreciate areas of bony insufficiency, deficiency, and discontinuity, in order to con- ceptualise complex corrective reconstructions. Conventional diagnostic imaging techniques provide only two-dimensional (2D) images of these deformities [6]. Orthopaedic surgeons develop experience in interpret- ing such 2D images when devising their operative strate- gies. More recently, advances in radiology combined with advances in computer and manufacturing technology have made the three-dimensional (3D) representation of anatomic structures relatively easily obtainable [7, 8]. Such images can be rotated and viewed from various angles, improving Advances in Orthopedics Volume 2017, Article ID 8925050, 7 pages https://doi.org/10.1155/2017/8925050 253 JUNE 2018 | The Surgical Technologist |