Digitally Designed Bone; A 3D-patient–specific Allograft Shelf for Severe Adolescent Hip Dysplasia: From Digital Design to Clinical Reality—A Conceptual Case Report
JAAOS Global Research and Reviews, vol. 9
Abstract
BACKGROUND: Adolescents with severe dysplasia of the hip regularly undergo a periacetabular osteotomy to prevent pain and early osteoarthritis. Unfortunately, this procedure is not suited for severe dysplasia with a non-congruent-deformed hip joint. The optimal treatment might be a tailor-made biologic optimization of femoral coverage with a shape matching the aberrant anatomy. This study introduces a novel approach using a patient-specific allograft shelf augmentation based on personalized 3D kinematic planning. METHODS: A 17-year-old patient with severe right-sided hip dysplasia underwent 3D CT analysis showing a lateral center-edge angle of -7° and a craniocaudal femoral head coverage of 50%. Using digital augmentation techniques and kinematic simulations, the femoral coverage was optimized while respecting the range of motion. An allograft cortical shelf of a distal femur with a matching surface and curvature as digitally designed was found in the bone bank and implanted at the acetabular rim using patient-specific molds. RESULTS: After uncomplicated implantation of the patient-specific allograft shelf, the lateral center-edge angle and femoral head coverage increased to 18° and 77% while preserving range of motion. A CT scan at 9-month follow-up showed incorporation of the allograft in the native bone with sustained coverage of the weight-bearing area of the patient-specific allograft shelf. CONCLUSION: An acetabular augmentation shelf was digitally designed and implanted using a matching allograft donor in a case of severe hip dysplasia. The excellent and predictable functional and radiologic outcomes suggest that patient-specific allograft bone shelves could be a serious option for adolescents with severe hip dysplasia.
Authors 10
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Erik M. van Bussel Aachen
Utrecht University · Leiden University Medical Center · University Medical Center Utrecht
Affiliation as printed
From the Department of Orthopedic Surgery (Dr. van Bussel, Nasrabadi, Dr. Arbabi, Dr. van der Wal, Dr. Weinans, Dr. Sakkers), University Medical Center Utrecht, Utrecht, the Netherlands; the 3D Lab (Dr. Magré, Dr. Willemsen), Division of Surgical Specialties, University Medical Center Utrecht, Utrecht, Netherlands; the Department of Orthopedic Surgery (Dr. Kaptein), Leiden University Medical Center, Leiden, the Netherlands; the Department of Clinical Sciences (Dr. Meij, Dr. Tryfonidou), Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands; and the Orthopaedic-Biomechanics Research Group (Nasrabadi, Dr. Arbabi), Department of Mechanical Engineering, Faculty of Engineering, University of Birjand, Birjand, Iran
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