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A new approach for Paprosky 3 acetabular defects with patient matched 3D printed implants based on bone quality assessment

Published in N° 003 - September / October 2019
Article viewed 77 times

A new approach for Paprosky 3 acetabular defects with patient matched 3D printed implants based on bone quality assessment

By S.N van Laarhoven, M. Baauw, G.G van Hellemondt, M. Spruit in category UPDATE
Sint Maartenskliniek, Nijmegen, The Netherlands

Major acetabular defects are most complex and difficult to reconstruct especially if pelvic dissociation is present. Many techniques have been proposed such as bone impaction grafting, structural allografts, anti-protrusio or reconstruction cages, tantalum augments and cup-cage reconstruction.

Introduction

Major acetabular defects are most complex and difficult to reconstruct especially if pelvic dissociation is present. Many techniques have been proposed such as bone impaction grafting, structural allografts, anti-protrusio or reconstruction cages, tantalum augments and cup-cage reconstruction. However, in large defects with dissociation the results are inconsistent with high failure rates, because of insufficient primary construct stability, failure of bony ingrowth and the limitations with implants from the shelf. 1 to 3

One of the latest instruments in the orthopedic surgeon’s armamentarium to face these challenges is a patient matched revision system (aMace, Materialise, Leuven, Belgium). This system consists of a 3D-printed monobloc trabecular titanium implant with integrated flanges, augments, cup and holes to guide screw placement (figure 1).

Figure 1: AMace custom-made acetabular revision system with the trabecular titanium backside.

 

It allows pre-planned screw positioning in good host bone for optimal primary screw fixation and secondary bony ingrowth of the implant for long term survival. We will describe this new technology from planning up to implantation and share our preliminary clinical experience.

 

Preoperative planning

A CT scan of the...

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