Using a 3D Printed Model as a Preoperative Tool for Pelvic Triple Osteotomy in Children: Proof of Concept and Evaluation of Geometric Accuracy

The clinical value of preoperative 3D planning and 3D surgical guides for Imhäuser osteotomy in slipped capital femoral epipysis: a retrospective study

BACKGROUND

Accurate repositioning of the femoral head in patients with Slipped Capital Femoral Epiphysis (SCFE) undergoing Imhäuser osteotomy is very challenging. The objective of this study is to determine if preoperative 3D planning and a 3D-printed surgical guide improve the accuracy of the placement of the femoral head.

METHODS

This retrospective study compared outcome parameters of patients who underwent a classic Imhäuser osteotomy from 2009 to 2013 with those who underwent an Imhäuser osteotomy using 3D preoperative planning and 3D-printed surgical guides from 2014 to 2021. The primary endpoint was improvement in Range of Motion (ROM) of the hip. Secondary outcomes were radiographic improvement (Southwick angle), patient-reported clinical outcomes regarding hip and psychosocial complaints assessed with two questionnaires and duration of surgery.

RESULTS

In the 14 patients of the 3D group radiographic improvement was slightly greater and duration of surgery was slightly shorter than in the 7 patients of the classis Imhäuser group. No difference was found in the ROM, and patient reported clinical outcomes were slightly less favourable.

CONCLUSIONS

Surprisingly we didn't find a significant difference between the two groups. Further research on the use of 3D planning an 3D-printed surgical guides is needed.

TRIAL REGISTRATION

Approval for this study was obtained of the local ethics committees of both hospitals.

3D Printing Technology in Pediatric Orthopedics: a Primer for the Clinician

PURPOSE OF REVIEW

This article reviews the basics of 3D printing and provides an overview of current and future applications of this emerging technology in pediatric orthopedic surgery.

RECENT FINDINGS

Both preoperative and intraoperative utilization of 3D printing technology have enhanced clinical care. Potential benefits include more accurate surgical planning, shortening of a surgical learning curve, decrease in intraoperative blood loss, less operative time, and fluoroscopic time. Furthermore, patient-specific instrumentation can be used to improve the safety and accuracy of surgical care. Patient-physician communication can also benefit from 3D printing technology. 3D printing is rapidly advancing in the field of pediatric orthopedic surgery. It has the potential to increase the value of several pediatric orthopedic procedures by enhancing safety and accuracy while saving time. Future efforts in cost reduction strategies, making patient-specific implants including biologic substitutes and scaffolds, will further increase the relevance of 3D technology in the field of pediatric orthopedic surgery.

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

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.

Virtual Reality in Preoperative Planning of Adolescent Idiopathic Scoliosis Surgery Using Google Cardboard

OBJECTIVE

Preoperative planning in spine surgery is a fundamental step of the surgical workup and is often assisted by direct visualization of anatomical 2-dimensional images. This process is time-consuming and may excessively approximate the 3-dimensional (3D) nature of spinal anatomy. Virtual reality (VR) is an emerging technology capable of reconstructing an interactive 3D anatomical model that can be freely explored and manipulated.

METHODS

Sixty patients with adolescent idiopathic scoliosis underwent correction of the scoliotic curve by posterior arthrodesis after preoperative planning using traditional on-screen visualization of computed tomography scans (control group, n = 30) or exploration of a 3D anatomical model in VR using Google Cardboard (Google Inc.) (VR group, n = 30). Mean operative time, blood loss, length of hospital stay, and surgeon's satisfaction were assessed after surgery.

RESULTS

The use of VR led to a significant decrease in operative time and bleeding while increasing the surgeon's satisfaction compared to the control group.

CONCLUSION

Preoperative planning with VR turned out to be effective in terms of operative time and blood loss reduction. Moreover, such technology proved to be reproducible, costeffective, and more satisfactory compared to conventional planning.

3D - Printed Patient Specific Instrumentation in Corrective Osteotomy of the Femur and Pelvis: A Review of the Literature

Background

The paediatric patient population has considerable variation in anatomy. The use of Computed Tomography (CT)-based digital models to design three-dimensionally printed patient specific instrumentation (PSI) has recently been applied for correction of deformity in orthopedic surgery. This review sought to determine the existing application of this technology currently in use within paediatric orthopaedics, and assess the potential benefits that this may provide to patients and surgeons.

Methods

A review was performed of MEDLINE, EMBASE, and CENTRAL for published literature, as well as Web of Science and clinicaltrials.gov for grey literature. The search strategy revolved around the research question: “What is the clinical impact of using 3D printed PSI for proximal femoral or pelvic osteotomy in paediatric orthopaedics?” Two reviewers, using predetermined inclusion criteria, independently performed title and abstract review in order to select articles for full text review. Data extracted included effect on operating time and intraoperative image use, as well as osteotomy and screw positioning accuracy. Data were combined in a narrative synthesis; meta-analysis was not performed given the diversity of study designs and interventions.

Results

In total, ten studies were included: six case control studies, three case series and a case report. Five studies directly compared operating time using PSI to conventional techniques, with two showing a significant decrease in the number of intraoperative images and operative time. Eight studies reported improved accuracy in executing the surgical plan compared to conventional methods.

Conclusion

Compared to conventional methods of performing femoral or pelvic osteotomy, use of PSI has led to improved accuracy and precision, decreased procedure times, and decreased intra-operative imaging requirements. Additionally, the technology has become more cost effective and accessible since its initial inception and use.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41205-020-00087-0.