Addressing a Complex Proximal Femoral Deformity With Custom Cutting Guides Using 3D-Computer Design Software: A Case Report and 2-year Follow-Up
DOI:
https://doi.org/10.15438/rr.11.1.281Keywords:
Proximal Femoral Deformity, Patient-Specific Instrumentation, Proximal Femoral Osteotomy, 3D printing osteotomy template, Three-DimensionalAbstract
We report a case of a 23-year-old female with a history of congenital proximal femoral deformity and malunion of a prior proximal femoral corrective osteotomy, who presented seeking treatment for debilitating end-stage arthritis of her hip. Consideration for total hip arthroplasty (THA) for this patient was complicated by her young age and the complexity of her proximal femoral deformity. A 3-dimensional bone model of the patient’s femur was created using digital reconstructive software based on preoperative CT-imaging and used to plan our corrective osteotomy and arthroplasty component specifications. Using the detailed characterization of the femoral morphology, custom cutting guides were designed to fit uniquely into the correct position and ensure a high degree of accuracy with our osteotomy cuts. This unique case highlights the use of 3D-modeling software and printing technology for detailed surgical planning and precise execution in patients with complex deformities or otherwise abnormal anatomy.
References
S. M. J. Mortazavi, C. Restrepo, P. J. W. Kim, J. Parvizi, and W. J. Hozack, “Cementless femoral reconstruction in patients with proximal femoral deformity,” J. Arthroplasty, vol. 26, no. 3, pp. 354–359, Apr. 2011, doi: 10.1016/j.arth.2010.09.002.
X. Deng et al., “Total hip arthroplasty with femoral osteotomy and modular prosthesis for proximal femoral deformity,” J. Orthop. Surg., vol. 14, no. 1, p. 282, Aug. 2019, doi: 10.1186/s13018-019-1336-1.
L. Helgesson, P. K. Johansson, Y. Aurell, C.-J. Tiderius, J. Kärrholm, and J. Riad, “Early osteoarthritis after slipped capital femoral epiphysis,” Acta Orthop., vol. 89, no. 2, pp. 222–228, Apr. 2018, doi: 10.1080/17453674.2017.1407055.
F. T. Hoaglund and L. S. Steinbach, “Primary osteoarthritis of the hip: etiology and epidemiology,” J. Am. Acad. Orthop. Surg., vol. 9, no. 5, pp. 320–327, Oct. 2001, doi: 10.5435/00124635-200109000-00005.
V. Khanna and P. E. Beaulé, “Defining structural abnormalities of the hip joint at risk of degeneration,” J. Hip Preserv. Surg., vol. 1, no. 1, pp. 12–20, Jul. 2014, doi: 10.1093/jhps/hnu004.
D. A. Goodman, J. E. Feighan, A. D. Smith, B. Latimer, R. L. Buly, and D. R. Cooperman, “Subclinical slipped capital femoral epiphysis. Relationship to osteoarthrosis of the hip,” J. Bone Joint Surg. Am., vol. 79, no. 10, pp. 1489–1497, Oct. 1997, doi: 10.2106/00004623-199710000-00005.
T. M. Ecker, M. Tannast, M. Puls, K. A. Siebenrock, and S. B. Murphy, “Pathomorphologic alterations predict presence or absence of hip osteoarthrosis,” Clin. Orthop., vol. 465, pp. 46–52, Dec. 2007, doi: 10.1097/BLO.0b013e318159a998.
L. Al-Mouazzen, K. Rajakulendran, and N. Ahad, “Fibrous dysplasia, shepherd’s crook deformity and an intra-capsular femoral neck fracture,” Strateg. Trauma Limb Reconstr., vol. 8, no. 3, pp. 187–191, Nov. 2013, doi: 10.1007/s11751-013-0174-7.
Y. Hagiwara, S. Iwata, T. Yonemoto, and T. Ishii, “Rotational valgus osteotomy for shepherd’s crook deformity: a case report,” J. Orthop. Sci. Off. J. Jpn. Orthop. Assoc., vol. 20, no. 2, pp. 422–424, Mar. 2015, doi: 10.1007/s00776-013-0463-5.
F. Hefti, L. Donnan, and A. H. Krieg, “Treatment of shepherd’s crook deformity in patients with polyostotic fibrous dysplasia using a new type of custom made retrograde intramedullary nail: a technical note,” J. Child. Orthop., vol. 11, no. 1, pp. 64–70, 2017, doi: 10.1302/1863-2548.11.170002.
K. Watanabe, H. Tsuchiya, K. Sakurakichi, H. Matsubara, and K. Tomita, “Double-level correction with the Taylor Spatial Frame for shepherd’s crook deformity in fibrous dysplasia,” J. Orthop. Sci. Off. J. Jpn. Orthop. Assoc., vol. 12, no. 4, pp. 390–394, Jul. 2007, doi: 10.1007/s00776-007-1132-3.
K. Sakurakichi, H. Tsuchiya, T. Yamashiro, K. Watanabe, H. Matsubara, and K. Tomita, “Ilizarov technique for correction of the Shepherd’s crook deformity: a report of two cases,” J. Orthop. Surg. Hong Kong, vol. 16, no. 2, pp. 254–256, Aug. 2008, doi: 10.1177/230949900801600226.
X. Zhang, C.-Y. Chen, H. Duan, and C. Tu, “Multiple valgus osteotomies combined with intramedullary nail for shepherd ’ s crook deformity in polyostotic fibrous dysplasia : a case series and review of the literature,” 2016. /paper/Multiple-valgus-osteotomies-combined-with-nail-for-Zhang-Chen/bc8f7118820652c4b15b30e7947bf27768f226d5 (accessed Nov. 24, 2020).
M. R. DiCaprio and W. F. Enneking, “Fibrous dysplasia. Pathophysiology, evaluation, and treatment,” J. Bone Joint Surg. Am., vol. 87, no. 8, pp. 1848–1864, Aug. 2005, doi: 10.2106/JBJS.D.02942.
R. J. Sierra and M. E. Cabanela, “Total hip arthroplasty in patients with underlying fibrous dysplasia,” Orthopedics, vol. 32, no. 5, p. 320, May 2009, doi: 10.3928/01477447-20090501-14.
K. C. Wong, S. M. Kumta, N. V. Geel, and J. Demol, “One-step reconstruction with a 3D-printed, biomechanically evaluated custom implant after complex pelvic tumor resection,” Comput. Aided Surg. Off. J. Int. Soc. Comput. Aided Surg., vol. 20, no. 1, pp. 14–23, 2015, doi: 10.3109/10929088.2015.1076039.
M. Jacobi, P. Wahl, S. Bouaicha, R. P. Jakob, and E. Gautier, “Distal femoral varus osteotomy: problems associated with the lateral open-wedge technique,” Arch. Orthop. Trauma Surg., vol. 131, no. 6, pp. 725–728, Jun. 2011, doi: 10.1007/s00402-010-1193-1.
J. G. Boldt, J.-C. Cartillier, A. Machenaud, and J.-P. Vidalain, “Long-term Bone Remodeling in HA-coated Stems: A Radiographic Review of 208 Total Hip Arthroplasties (THAs) with 15 to 20 Years Follow-up,” Surg. Technol. Int., vol. 27, pp. 279–286, Nov. 2015.
L. O. A. Thanni and N. O. Aigoro, “Surgical site infection complicating internal fixation of fractures: incidence and risk factors,” J. Natl. Med. Assoc., vol. 96, no. 8, pp. 1070–1072, Aug. 2004.
J. Moore, L. Mychaltchouk, and F. Lavoie, “Applicability of a modified angular correction measurement method for open-wedge high tibial osteotomy,” Knee Surg. Sports Traumatol. Arthrosc. Off. J. ESSKA, vol. 25, no. 3, pp. 846–852, Mar. 2017, doi: 10.1007/s00167-015-3954-4.
G. Sys, H. Eykens, G. Lenaerts, F. Shumelinsky, C. Robbrecht, and B. Poffyn, “Accuracy assessment of surgical planning and three-dimensional-printed patient-specific guides for orthopaedic osteotomies,” Proc. Inst. Mech. Eng. [H], vol. 231, no. 6, pp. 499–508, Jun. 2017, doi: 10.1177/0954411917702177.
P. Zheng, P. Xu, Q. Yao, K. Tang, and Y. Lou, “3D-printed navigation template in proximal femoral osteotomy for older children with developmental dysplasia of the hip,” Sci. Rep., vol. 7, p. 44993, 21 2017, doi: 10.1038/srep44993.
D. H. Ballard, P. Mills, R. Duszak, J. A. Weisman, F. J. Rybicki, and P. K. Woodard, “Medical 3D Printing Cost-Savings in Orthopedic and Maxillofacial Surgery: Cost Analysis of Operating Room Time Saved with 3D Printed Anatomic Models and Surgical Guides,” Acad. Radiol., vol. 27, no. 8, pp. 1103–1113, Aug. 2020, doi: 10.1016/j.acra.2019.08.011.
C. U. Gwam et al., “Current Epidemiology of Revision Total Hip Arthroplasty in the United States: National Inpatient Sample 2009 to 2013,” J. Arthroplasty, vol. 32, no. 7, pp. 2088–2092, Jul. 2017, doi: 10.1016/j.arth.2017.02.046.
K. D. Collins, K. K. Chen, J. D. Ziegler, R. Schwarzkopf, J. A. Bosco, and R. Iorio, “Revision Total Hip Arthroplasty-Reducing Hospital Cost Through Fixed Implant Pricing,” J. Arthroplasty, vol. 32, no. 9S, pp. S141–S143, Sep. 2017, doi: 10.1016/j.arth.2017.02.082.
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Copyright (c) 2021 Zachary C. Hanson, MD, Donald D. Davis, MD, J. Weston Robison, MD, Jon E. Minter, DO

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