A novel revision system for complex pelvic defects utilizing 3D-printed custom prosthesis()

BACKGROUND: Thus far, the hip revision surgery has been widely used and promoted, and the technology has been constantly innovated, such as tissue engineering, 3D printing prosthesis, etc. However, traditional standardized prosthesis, allograft, autograft, bone cement and reinforcing ring are still the main treatment methods in the mainstream pelvic defects classification systems for hip revision. In addition, the mainstream classification systems are still mainly focus on the peri-acetabulum, but less on the large-scale complex pelvic defects that widely affecting the regions far away from the acetabulum, which also have a significant impact on the holistic biomechanical properties of pelvis. METHODS: After integrating the design experience of custom prostheses and the understanding of biomechanical properties of pelvis, an innovative pelvic defects classification for custom revision was preliminarily proposed, and was practiced in surgeries. Some typical cases were chosen for elucidation in this study, and two observers each evaluated their CT data independently twice. Intraobserver and interobserver agreement were calculated using the kappa statistic to evaluate the reliability. The pelvis defects were classified into five types and two subtypes. The corresponding reconstruction principles, as the main basis to support the classification, were also described in detail. Prosthesis position examination and Harris hip score were utilized to evaluate the clinical outcome. RESULTS: The installed prostheses resulted in high concordance with preoperative position planning, significantly improved Harris score, low postoperative complication rate and no re-revision case. In addition, The interobserver and intraobserver agreement were both excellent. CONCLUSION: The presenting revision system for complex pelvic defects utilizing 3D-printed custom prosthesis and corresponding classification of pelvic defects can preliminarily guide patients’ grouping and prosthesis design, and may potentially provide an innovative, feasible, and efficient basis for complex total hip arthroplasty (THA) revision. TRANSLATIONAL POTENTIAL STATEMENT: This study provides a novel method for prosthetic revision of peri-acetabular pelvic defects, and is expected to systematically improve the efficiency of prosthesis design and surgery in clinical practice.