Cargando…

Optimization of Revision Hip Arthroplasty Workflow by Means of Detailed Pre-Surgical Planning Using Computed Tomography Data, Open-Source Software and Three-Dimensional-Printed Models

Background. In revision hip arthroplasty (RHA), establishing the center of rotation (COR) can be technically challenging due to the acetabular bone destruction that is usually present, particularly in severe cases such as Paprosky type II and III defects. The aim of this study was to demonstrate the...

Descripción completa

Detalles Bibliográficos
Autores principales: Andrzejewski, Krzysztof, Domżalski, Marcin, Komorowski, Piotr, Poszepczyński, Jan, Rokita, Bożena, Elgalal, Marcin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10417331/
https://www.ncbi.nlm.nih.gov/pubmed/37568878
http://dx.doi.org/10.3390/diagnostics13152516
_version_ 1785088006344933376
author Andrzejewski, Krzysztof
Domżalski, Marcin
Komorowski, Piotr
Poszepczyński, Jan
Rokita, Bożena
Elgalal, Marcin
author_facet Andrzejewski, Krzysztof
Domżalski, Marcin
Komorowski, Piotr
Poszepczyński, Jan
Rokita, Bożena
Elgalal, Marcin
author_sort Andrzejewski, Krzysztof
collection PubMed
description Background. In revision hip arthroplasty (RHA), establishing the center of rotation (COR) can be technically challenging due to the acetabular bone destruction that is usually present, particularly in severe cases such as Paprosky type II and III defects. The aim of this study was to demonstrate the use of open-source medical image reconstruction software and low-cost 3D anatomical models in pre-surgical planning of RHA. Methods. A total of 10 patients, underwent RHA and were included in the study. Computed tomography (CT) scans were performed for all cases, before surgery and approximately 1 week after the procedure. The reconstruction of CT data, 3D virtual planning of the COR and positioning of acetabular cups, including their inclination and anteversion angles, was carried out using the free open source software platform 3D Slicer. In addition, anatomical models of the pelvis were built on a desktop 3D printer from polylactic acid (PLA). Preoperative and postoperative reconstructed imaging data were compared for each patient, and the position of the acetabular cups as well as the COR were evaluated for each case. Results. Analysis of the pre- and post-op center of rotation position data indicated statistically insignificant differences for the location of the COR on the X-axis (1.5 mm, t = 0.5741, p = 0.5868) with a fairly strong correlation of the results (r = −0.672, p = 0.0982), whilst for the location of the COR in the Y and Z-axes, there was statistical dependence (Y axis, 4.7 mm, t = 3.168 and p = 0.0194; Z axis, 1.9 mm, t = 1.887 and p = 0.1081). A strong correlation for both axes was also observed (Y and Z) (Y-axis, r = 0.9438 and p = 0.0014; Z-axis, r = 0.8829 and p = 0.0084). Analysis of inclination angle values showed a statistically insignificant difference between mean values (3.9 degrees, t = 1.111, p = 0.3092) and a moderate correlation was found between mean values (r = −0.4042, p = 0.3685). Analysis of the anteversion angle showed a statistically insignificant difference between mean values (1.9 degrees, t = 0.8671, p = 0.4192), while a moderate correlation between mean values was found (r = −0.4782, p = 0.2777). Conclusions. Three-dimensional reconstruction software, together with low-cost anatomical models, are very effective tools for pre-surgical planning, which have great potential use in orthopedic surgery, particularly RHA. In up and in- and up and out-type defects, it is essential to establish a new COR and to identify three support points within the revision acetabulum in order to correctly position acetabular cups.
format Online
Article
Text
id pubmed-10417331
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-104173312023-08-12 Optimization of Revision Hip Arthroplasty Workflow by Means of Detailed Pre-Surgical Planning Using Computed Tomography Data, Open-Source Software and Three-Dimensional-Printed Models Andrzejewski, Krzysztof Domżalski, Marcin Komorowski, Piotr Poszepczyński, Jan Rokita, Bożena Elgalal, Marcin Diagnostics (Basel) Technical Note Background. In revision hip arthroplasty (RHA), establishing the center of rotation (COR) can be technically challenging due to the acetabular bone destruction that is usually present, particularly in severe cases such as Paprosky type II and III defects. The aim of this study was to demonstrate the use of open-source medical image reconstruction software and low-cost 3D anatomical models in pre-surgical planning of RHA. Methods. A total of 10 patients, underwent RHA and were included in the study. Computed tomography (CT) scans were performed for all cases, before surgery and approximately 1 week after the procedure. The reconstruction of CT data, 3D virtual planning of the COR and positioning of acetabular cups, including their inclination and anteversion angles, was carried out using the free open source software platform 3D Slicer. In addition, anatomical models of the pelvis were built on a desktop 3D printer from polylactic acid (PLA). Preoperative and postoperative reconstructed imaging data were compared for each patient, and the position of the acetabular cups as well as the COR were evaluated for each case. Results. Analysis of the pre- and post-op center of rotation position data indicated statistically insignificant differences for the location of the COR on the X-axis (1.5 mm, t = 0.5741, p = 0.5868) with a fairly strong correlation of the results (r = −0.672, p = 0.0982), whilst for the location of the COR in the Y and Z-axes, there was statistical dependence (Y axis, 4.7 mm, t = 3.168 and p = 0.0194; Z axis, 1.9 mm, t = 1.887 and p = 0.1081). A strong correlation for both axes was also observed (Y and Z) (Y-axis, r = 0.9438 and p = 0.0014; Z-axis, r = 0.8829 and p = 0.0084). Analysis of inclination angle values showed a statistically insignificant difference between mean values (3.9 degrees, t = 1.111, p = 0.3092) and a moderate correlation was found between mean values (r = −0.4042, p = 0.3685). Analysis of the anteversion angle showed a statistically insignificant difference between mean values (1.9 degrees, t = 0.8671, p = 0.4192), while a moderate correlation between mean values was found (r = −0.4782, p = 0.2777). Conclusions. Three-dimensional reconstruction software, together with low-cost anatomical models, are very effective tools for pre-surgical planning, which have great potential use in orthopedic surgery, particularly RHA. In up and in- and up and out-type defects, it is essential to establish a new COR and to identify three support points within the revision acetabulum in order to correctly position acetabular cups. MDPI 2023-07-28 /pmc/articles/PMC10417331/ /pubmed/37568878 http://dx.doi.org/10.3390/diagnostics13152516 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Technical Note
Andrzejewski, Krzysztof
Domżalski, Marcin
Komorowski, Piotr
Poszepczyński, Jan
Rokita, Bożena
Elgalal, Marcin
Optimization of Revision Hip Arthroplasty Workflow by Means of Detailed Pre-Surgical Planning Using Computed Tomography Data, Open-Source Software and Three-Dimensional-Printed Models
title Optimization of Revision Hip Arthroplasty Workflow by Means of Detailed Pre-Surgical Planning Using Computed Tomography Data, Open-Source Software and Three-Dimensional-Printed Models
title_full Optimization of Revision Hip Arthroplasty Workflow by Means of Detailed Pre-Surgical Planning Using Computed Tomography Data, Open-Source Software and Three-Dimensional-Printed Models
title_fullStr Optimization of Revision Hip Arthroplasty Workflow by Means of Detailed Pre-Surgical Planning Using Computed Tomography Data, Open-Source Software and Three-Dimensional-Printed Models
title_full_unstemmed Optimization of Revision Hip Arthroplasty Workflow by Means of Detailed Pre-Surgical Planning Using Computed Tomography Data, Open-Source Software and Three-Dimensional-Printed Models
title_short Optimization of Revision Hip Arthroplasty Workflow by Means of Detailed Pre-Surgical Planning Using Computed Tomography Data, Open-Source Software and Three-Dimensional-Printed Models
title_sort optimization of revision hip arthroplasty workflow by means of detailed pre-surgical planning using computed tomography data, open-source software and three-dimensional-printed models
topic Technical Note
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10417331/
https://www.ncbi.nlm.nih.gov/pubmed/37568878
http://dx.doi.org/10.3390/diagnostics13152516
work_keys_str_mv AT andrzejewskikrzysztof optimizationofrevisionhiparthroplastyworkflowbymeansofdetailedpresurgicalplanningusingcomputedtomographydataopensourcesoftwareandthreedimensionalprintedmodels
AT domzalskimarcin optimizationofrevisionhiparthroplastyworkflowbymeansofdetailedpresurgicalplanningusingcomputedtomographydataopensourcesoftwareandthreedimensionalprintedmodels
AT komorowskipiotr optimizationofrevisionhiparthroplastyworkflowbymeansofdetailedpresurgicalplanningusingcomputedtomographydataopensourcesoftwareandthreedimensionalprintedmodels
AT poszepczynskijan optimizationofrevisionhiparthroplastyworkflowbymeansofdetailedpresurgicalplanningusingcomputedtomographydataopensourcesoftwareandthreedimensionalprintedmodels
AT rokitabozena optimizationofrevisionhiparthroplastyworkflowbymeansofdetailedpresurgicalplanningusingcomputedtomographydataopensourcesoftwareandthreedimensionalprintedmodels
AT elgalalmarcin optimizationofrevisionhiparthroplastyworkflowbymeansofdetailedpresurgicalplanningusingcomputedtomographydataopensourcesoftwareandthreedimensionalprintedmodels