A comparison between 3D printed models and standard 2D planning in the use of metal block augments in revision knee arthroplasty
Giovanni Balato1, Vincenzo De Matteo1
, Amedeo Guarino1
, Domenico De Mauro2
, Dario Baldi3
, Carlo Cavaliere3
, Marco Salvatore3
, Mustafa Citak4
, Massimo Mariconda1
1Department of Public Health, Unit of Orthopaedic Surgery, School of Medicine, Federico II University, Naples, Italy
2Department of Orthopedics and Geriatric Sciences, Catholic University of The Sacred Heart, Roma, Italy
3IRCCS SYNLAB SDN, Naples, Italy
4Department of Orthopaedic Surgery, ENDO-Klinik Hamburg, Hamburg, Germany
Keywords: Augmentation, preoperative planning, revision arthroplasty, templating, 2D Planning, 3D Planning, 3D printing.
Abstract
Objectives: The study focused on the ability to predict the need and size of femoral and tibial augmentation using standard two-dimensional (2D) templates and models created with three-dimensional (3D) printing in surgical planning.
Patients and methods: This observational cohort study included 28 consecutive patients (22 females, 6 males; mean age: 71±7.3 years; range, 54 to 82 years) with periprosthetic joint infection recruited between March 2021 and September 2023 undergoing revision total knee arthroplasty revision (TKA). Standard planning was made using calibrated X-ray images. The 3D planning started with computed tomography scans to generate a 3D template of the distal femur and proximal tibia. The model was exported to a 3D printer to produce a patient-specific phantom. The surgery was then simulated on the 3D phantom using revision knee arthroplasty instrumentation to evaluate the appropriate augmentation to use until a correct alignment was obtained.
Results: Three-dimensional planning predicted the need for femoral and tibial augments in 22 (78.6%) cases at both the tibial and femoral components, while 2D planning correctly predicted the need for augmentation in 17 (60.7%) for the tibial side and 18 (64.3%) for the femoral side. The Cohen’s kappa demonstrated a significant agreement between the 3D planning for the femoral metal block and the intraoperative requirement (kappa=0.553), whereas 2D planning showed only nonsignificant poor agreement (kappa=0.083). In contrast, the agreement between 2D or 3D preoperative planning for tibial augment and the intraoperative requirement was nonsignificant (kappa=0.130 and kappa=0.158, respectively). On the femoral side, 2D planning showed only a fair nonsignificant correlation (r=0.35, p=0.069), whereas 3D planning exhibited substantial agreement with the actual thickness of the implanted augment (r=0.65, p<0.001). On the tibial side, 3D and 2D planning showed substantial agreement with the actual size of implanted augments (3D planning, r=0.73, p<0.001; 2D planning, r=0.69, p<0.001).
Conclusion: Prediction based on 3D CT segmentation showed significant agreement with the intraoperative need for augmentations in revision TKA. The results suggest that planning with 3D printed models represents a stronger aid in this kind of surgery rather than standard 2D planning, providing greater accuracy in the prediction of the required augmentation in revision TKA.
Citation: Balato G, de Matteo V, Guarino A, de Mauro A, Baldi D, Cavaliere C, et al. A comparison between 3D printed models and standard 2D planning in the use of metal block augments in revision knee arthroplasty. Jt Dis Relat Surg 2024;35(3):473-482. doi: 10.52312/jdrs.2024.1591.
The study protocol was approved by the Federico II University of Naples Ethics Committee (date: 06.10.2020, no: 0029062). The study was conducted in accordance with the principles of the Declaration of Helsinki.
A written informed consent was obtained from each patient.
Dea/concept, design: G.B, V.D.M.; Control/supervision: M.M., M.C., G.B.; Data collection and/or processing: V.D.M., M.M., G.B.; Analysis and/or interpretation: M.M., M.C., V.D.M.; Literature review: M.M., D.B., D.D.M., C.C.; Writing the article: V.D.M., A.G., D.B., C.C.; Critical review: C.C., M.S., M.M., C.C.; References and fundings: G.B., V.D.M., M.S., D.B., C.C.; Materials: G.B., A.G.,C.C., D.B., M.S.; Other: D.D.M., A.G.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
This work was supported by a “Ricerca Corrente” Grant from the Italian Ministry of Health (IRCCS SYNLAB SDN).
The data that support the findings of this study are available from the corresponding author upon reasonable request.