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Acetabular Revision with McMinn Cup: Development and Application of a Patient-Specific Targeting Device
Background: Surgeries of severe periacetabular bone defects (Paprosky ≥ 2B) are a major challenge in current practice. Although solutions are available for this serious clinical problem, they all have their disadvantages as well as their advantages. An alternative method of reconstructing such exten...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10526046/ https://www.ncbi.nlm.nih.gov/pubmed/37760197 http://dx.doi.org/10.3390/bioengineering10091095 |
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author | Csernátony, Zoltán Manó, Sándor Szabó, Dániel Soósné Horváth, Hajnalka Kovács, Ágnes Éva Csámer, Loránd |
author_facet | Csernátony, Zoltán Manó, Sándor Szabó, Dániel Soósné Horváth, Hajnalka Kovács, Ágnes Éva Csámer, Loránd |
author_sort | Csernátony, Zoltán |
collection | PubMed |
description | Background: Surgeries of severe periacetabular bone defects (Paprosky ≥ 2B) are a major challenge in current practice. Although solutions are available for this serious clinical problem, they all have their disadvantages as well as their advantages. An alternative method of reconstructing such extensive defects was the use of a cup with a stem to solve these revision situations. As the instrumentation offered is typically designed for scenarios where a significant bone defect is not present, our unique technique has been developed for implantation in cases where reference points are missing. Our hypothesis was that a targeting device designed based on the CT scan of a patient’s pelvis could facilitate the safe insertion of the guiding wire. Methods: Briefly, our surgical solution consists of a two-step operation. If periacetabular bone loss was found to be more significant during revision surgery, all implants were removed, and two titanium marker screws in the anterior iliac crest were percutaneously inserted. Next, by applying the metal artifact removal (MAR) algorithm, a CT scan of the pelvis was performed. Based on that, the dimensions and positioning of the cup to be inserted were determined, and a patient-specific 3D printed targeting device made of biocompatible material was created to safely insert the guidewire, which is essential to the implantation process. Results: In this study, medical, engineering, and technical tasks related to the design, the surgical technique, and experiences from 17 surgical cases between February 2018 and July 2021 are reported. There were no surgical complications in any cases. The implant had to be removed due to septic reasons (independently from the technique) in a single case, consistent with the septic statistics for this type of surgery. There was not any perforation of the linea terminalis of the pelvis due to the guiding method. The wound healing of patients was uneventful, and the implant was fixed securely. Following rehabilitation, the joints were able to bear weight again. After one to four years of follow-up, the patient satisfaction level was high, and the gait function of the patients improved a lot in all cases. Conclusions: Our results show that CT-based virtual surgical planning and, based on it, the use of a patient-specific 3D printed aiming device is a reliable method for major hip surgeries with significant bone loss. This technique has also made it possible to perform these operations with minimal X-ray exposure. |
format | Online Article Text |
id | pubmed-10526046 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-105260462023-09-28 Acetabular Revision with McMinn Cup: Development and Application of a Patient-Specific Targeting Device Csernátony, Zoltán Manó, Sándor Szabó, Dániel Soósné Horváth, Hajnalka Kovács, Ágnes Éva Csámer, Loránd Bioengineering (Basel) Article Background: Surgeries of severe periacetabular bone defects (Paprosky ≥ 2B) are a major challenge in current practice. Although solutions are available for this serious clinical problem, they all have their disadvantages as well as their advantages. An alternative method of reconstructing such extensive defects was the use of a cup with a stem to solve these revision situations. As the instrumentation offered is typically designed for scenarios where a significant bone defect is not present, our unique technique has been developed for implantation in cases where reference points are missing. Our hypothesis was that a targeting device designed based on the CT scan of a patient’s pelvis could facilitate the safe insertion of the guiding wire. Methods: Briefly, our surgical solution consists of a two-step operation. If periacetabular bone loss was found to be more significant during revision surgery, all implants were removed, and two titanium marker screws in the anterior iliac crest were percutaneously inserted. Next, by applying the metal artifact removal (MAR) algorithm, a CT scan of the pelvis was performed. Based on that, the dimensions and positioning of the cup to be inserted were determined, and a patient-specific 3D printed targeting device made of biocompatible material was created to safely insert the guidewire, which is essential to the implantation process. Results: In this study, medical, engineering, and technical tasks related to the design, the surgical technique, and experiences from 17 surgical cases between February 2018 and July 2021 are reported. There were no surgical complications in any cases. The implant had to be removed due to septic reasons (independently from the technique) in a single case, consistent with the septic statistics for this type of surgery. There was not any perforation of the linea terminalis of the pelvis due to the guiding method. The wound healing of patients was uneventful, and the implant was fixed securely. Following rehabilitation, the joints were able to bear weight again. After one to four years of follow-up, the patient satisfaction level was high, and the gait function of the patients improved a lot in all cases. Conclusions: Our results show that CT-based virtual surgical planning and, based on it, the use of a patient-specific 3D printed aiming device is a reliable method for major hip surgeries with significant bone loss. This technique has also made it possible to perform these operations with minimal X-ray exposure. MDPI 2023-09-18 /pmc/articles/PMC10526046/ /pubmed/37760197 http://dx.doi.org/10.3390/bioengineering10091095 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 | Article Csernátony, Zoltán Manó, Sándor Szabó, Dániel Soósné Horváth, Hajnalka Kovács, Ágnes Éva Csámer, Loránd Acetabular Revision with McMinn Cup: Development and Application of a Patient-Specific Targeting Device |
title | Acetabular Revision with McMinn Cup: Development and Application of a Patient-Specific Targeting Device |
title_full | Acetabular Revision with McMinn Cup: Development and Application of a Patient-Specific Targeting Device |
title_fullStr | Acetabular Revision with McMinn Cup: Development and Application of a Patient-Specific Targeting Device |
title_full_unstemmed | Acetabular Revision with McMinn Cup: Development and Application of a Patient-Specific Targeting Device |
title_short | Acetabular Revision with McMinn Cup: Development and Application of a Patient-Specific Targeting Device |
title_sort | acetabular revision with mcminn cup: development and application of a patient-specific targeting device |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10526046/ https://www.ncbi.nlm.nih.gov/pubmed/37760197 http://dx.doi.org/10.3390/bioengineering10091095 |
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