3D Printing and 3D Models as a part of Preplanning for Complex Total Hip Arthroplasty for full ppt mail drkkbriyan@gmail.com wassup +91-9790881689

1. 3D Printing and 3D Models as a part of Preplanning for Complex Total Hip Arthroplasty
Abstract no.: 54915
No Conflict of interest, Consent obtained , No disclosure

2. Gait , ROM, LLD, Dislocation, Abductor muscle strength, Impingement, Squeaking, Loosening, failure
Implant Sizing and Component positioning are the key factors , deciding the Success of THR
“Accurate placement of Acetabular and Femoral component of Accurate size is of vital importance
Total Hip Replacement is one of the best surgical procedure of our century

3. Component Positioning
Lewinnek Safe Zone
40* +/-10* , 15*+/-10*
Pre operative
Templating
Morse circle
Sir Ranawat’s Triangle
Native - High Hip Centre
Intra operative Templating
•Anatomical Landmarks – TAL ,
pulvinar fat pad, walls, ishial
tubeoristy
•Intra operative Jig
•Intraoperative imaging - CArm
Real time
Templating
•Navigation
•Robotics

5. AIM: To assess the role of 3D printing and 3D Models, as a part of preplanning in patients
undergoing Complex Total Hip Arthroplasty (CTHA) and their functional outcome.

6. Material and Method: This is a Retrospective analysis of on going prospective study.
The CTHA cases done with the help of 3D printing and 3D models since October 2015 to
October 2017 with minmum follow up period of 2 years were included in the study.
Case Distribution - Diagnosis :
05 Secondary Arthritis - Malunited Acetabular Fracture - no infection
03 Secondary Arthritis - Post Acetabular Fracture Fixation - Infection
01 Neglected Acetabular Fracture - Post Dynamic Hip Screw - Infection
01 Septic Revision Total Hip Arthroplasty

7. Sex Distribution : All were Males
3D Printer used : CretaBot
Study Pattern : Retrosceptive analysis
Material used : ABS - Acyylonitrile Butadiene Styrene plastic
Case Distribution - Etiology : 8 RTA, 1 Accidental Fall, 1 Revision (InflammatoryArthritis)
Study Period : October 2015 - October 2017
Case Distribution - Groups:
Group A: 05 Secondary Arthritis - Malunited Acetabular Fracture - no infection
Group B: 04 Secondary Arthritis - Post Peri Acetabular Fracture Fixation - Infection
Group C: 01 Septic Revision Total Hip Arthroplasty
A B C

8. fabrication of bone models.
The first step called ‘segmentation’
DICOM format, is processed.
stereolithography (STL) format.
digital 3D model
CT scan of desired region:
at least 0.625mm slice thickness

9. Cleaning up the model file
Trimming the Model to print size
Creating the 3D print job for the printer

10. • CT scan of desired region:
• at least 0.625mm slice thickness

11. RESULTS:
3D models were made as a part of preplanning for ten cases posted for CTHA. These cases
were grouped into three A, B, C depending on their aetiology and evidence of infection.
05 Secondary Arthritis - Malunited Acetabular Fracture - No infection
03 Secondary Arthritis - Post Acetabular Fracture Fixation - Infection
01 Neglected Acetabular Fracture - Post Dynamic Hip Screw - Infection
01 Septic Revision Total Hip Arthroplasty
Groups:
Group A: 05 Secondary Arthritis - Malunited Acetabular Fracture - no infection
Group B: 04 Secondary Arthritis - Post Peri Acetabular Fracture Fixation - Infection
Group C: 01 Septic Revision Total Hip Arthroplasty
Treatment:
Group A: 5 cases done as one stage procedure.
Group B: 2 out of 4 cases done as two stage procedure and other 2 cases with persistent
infection and elevated blood markers, excision arthroplasty.
Group C: 1 case done as two stage procedure.

12. 34 M, Right Acetabular # ORIF 2014, 3D assessment , 2014 Aug. Complex THR
Anterior wall & column intact, Posterior wall & column deficient 10* TO 5*
Femoral head Autograft / 3 x 3.5 screws , 63mm reaming,
66 Trabecular metal shell / 3 screws / 1 screw through shell ,9 CLS stem / +1 ceramic head

13. RESULTS:
Groups: Mean Age overall 39.5 years
Groups: Mean Follow up period 4.2 years
Groups: Mean Infection free period 4.2 years
Groups: Mean Operative time (final)
Group A: 220 minutes, Group B: 160 minutes Group C: 260 minutes
Groups: Mean Blood Transfusion (final)
Group A: 1.2 units, Group B: 2 units , Group C: 4 units
Groups: Mean 3D model maker time
Group A: 8.2 hours, Group B: 6 hourss, Group C: 6 hours
Groups: Mean % preplan execution
Group A: Cup 100% screw 90%,
Group B: Cup 100% screw 90%
Group C: Cup 90% screw 90%
Groups: Preop HSS 50.4 vs Post op HSS 70.2

14. 3D printing technology has great potential
to become a powerful tool for individualized and effective treatment in orthopedics.
Advances in radiology, Rapid prototyping and 3D printing have made three-dimensional
(3D) representation of osseous anatomy obtainable, which provide visual and tactile
feedback with life 3D models.
Acetabular reconstruction was planned and reconstructed efficiently with improved surgical
precision and reduced complications.
Accuracy and Cost effective

15. Won et al. demonstrated that this technique can reduce intraoperative
complications
The Rapid Prototype Model allowed a simulated procedure pre-operatively and was helpful in
determining the feasibility of THR pre-operatively, and to decide on implant type, size and position in
complex THRs.
Hung et al conducted a retrospective comparative study of 30 patients with the
above method and reported a 70-min reduction in surgical duration, a 270-
ml reduction in blood loss, fewer complications and better radiological
outcomes compared to conventional planning using CT images.

16. coming decade 3D printing technology will become increasingly
accessible.
3D printing , Rapid Prototype and PSI is studied with limited additional
benefits for routine hip replacements, but useful in complex pelvic tumour
resection and reconstruction.

17. https://doi.org/10.1093/jscr/rjz214
The 3D-printing process demonstrates some negative features
• Technically demanding process requiring computer skills
• Time extended process (model usually takes about 12 hours)
• CT- scan making it expensive and additional radiation
Medical application of 3D printers for production of custom-made medical
products: customized prosthetics, patient-specific implant (hip and knee joints),
pre contoured plates, prosthetic implants for ear ossicles, dermal skin grafts,
cranial prothesis, scaffolds as vertebral cages as well as menisci, patient-
specific antibiotic impregnated articular cement spacers, patient-specific
instrumentation to improve the precision and clinical outcome of surgical
procedures, anatomical models and simulation tools.

18. CONCLUSION:
3D printing and 3D model helped in a proper and precise preplanning, appropriate implant
selection, decreased operative time, less infection rate and good functional outcome
TAKE HOME MESSAGE : Advantages of 3D printed 3D Models
Provide a tactile feedback
Simulate complex anatomical movements, such as articulation of joints
Enhanced appreciation of the visuo-spatial relationship between anatomical structures
Shorter operative time & Reduced exposure to general anesthesia
Shorter wound exposure time & reduced infection
Reduced intraoperative blood loss & Blood transfusion
Intraoperative Guidance with Patient Specific templates
Customized Prosthesis / Patient Specific Implants PSI
Enabled rapid and convenient production of customized implants.