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Research Papers

Patient-Specific Guides for Total Hip Arthroplasty: A Paired Acetabular and Femoral Implantation Approach

[+] Author and Article Information
Jacob Stegman

Department of Biomedical, Chemical, and
Environmental Engineering,
College of Engineering and Applied Science,
University of Cincinnati,
Engineering Research Center—601,
Cincinnati, OH 45221-0012
e-mail: stegmajo@mail.uc.edu

Chris Casstevens

Department of Orthopaedic Surgery,
University of Cincinnati,
231 Albert Sabin Way,
ML 0212,
Cincinnati, OH 45267-0212
e-mail: cassteec@ucmail.uc.edu

Todd Kelley

Department of Orthopaedic Surgery,
University of Cincinnati,
231 Albert Sabin Way,
ML 0212,
Cincinnati, OH 45267-0212
e-mail: kelleyto@ucmail.uc.edu

Vasile Nistor

Mem. ASME
Department of Biomedical, Chemical, and
Environmental Engineering,
College of Engineering and Applied Science,
University of Cincinnati,
Engineering Research Center—601,
Cincinnati, OH 45221-0012
e-mail: nistorve@ucmail.uc.edu

Manuscript received June 27, 2014; final manuscript received October 13, 2014; published online November 14, 2014. Assoc. Editor: Rita M. Patterson.

J. Med. Devices 9(1), 011006 (Mar 01, 2015) (7 pages) Paper No: MED-14-1198; doi: 10.1115/1.4028945 History: Received June 27, 2014; Revised October 13, 2014; Online November 14, 2014

While total hip arthroplasty (THA) is a common orthopedic procedure for treatment of hip arthritis, current techniques demonstrate poor implant alignment accuracy and precision, which is critical to the replacement's long-term survivorship. Patient-specific instruments to guide bone preparation and implantation could improve accuracy, thereby improving replacement survivorship. A single cadaver was CT (computer tomography) scanned to extract the 3D bone geometry, from which the operating surgeon planned a THA. Patient-specific guides were designed, 3D printed, and used in the cadaveric THA procedure. Postprocedural CT data were used to compare measured implant positioning versus the preprocedural template. Implanted component accuracy ranged from 1 deg–12 deg.

Copyright © 2015 by ASME
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References

Figures

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Fig. 1

X-ray of poorly implanted THA demonstrating suboptimal positioning measures: (A) leg length discrepancy, (B) hip width discrepancy, (C) low acetabular vertical inclination and no acetabular anteversion, (D) undersized femoral stem, and (E) a pelvic screw penetrating the pelvis near the sciatic notch

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Fig. 2

Anterior view of a pelvis showing the cup implant's angle of vertical inclination (line A)

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Fig. 3

Oblique view of a pelvis, down the line of vertical inclination (point A), showing the cup implant's angle of anteversion (line B)

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Fig. 4

Superior view of a femur showing the femoral head's angle of anteversion

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Fig. 5

Anterior view of a femur showing the coordinate planes

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Fig. 6

Anterior view of a pelvis, showing the coordinate planes

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Fig. 7

Left view of a pelvis, showing the coordinate planes

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Fig. 8

Three-dimensional cad template overlays the total hip replacement implant over the hip anatomy

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Fig. 9

X-ray illustrating a common method of templating a THA

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Fig. 10

Three-dimensional cad template overlays the patient-specific guides over the hip anatomy

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Fig. 11

Three-dimensional cad template of femur with a resection guide showing the design features: (1) the patient-specific surface, (2) the resection surface, and (3) the medial edge to mark femoral version

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Fig. 12

Femoral resection guide on foam bone model, showing the medial edge to guide anteversion

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Fig. 13

Femoral resection guide in use on the cadaveric femoral neck with surgical pins drilled into bone

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Fig. 14

Three-dimensional cad model of acetabular pin locator

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Fig. 15

Acetabular pin locator guide on a foam bone model

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Fig. 16

Acetabular pin locator guide in use on the cadaveric acetabulum with surgical pins drilled into bone

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Fig. 17

Three-dimensional cad model of reamer and impactor guide

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Fig. 18

Reamer/impactor guide in use on a foam bone model

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Fig. 19

Reamer/impactor guide in use on the cadaver

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