Di Laura Anna, Henckel Johann, Hothi Harry, Hart Alister
The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, HA7 4LP, UK.
Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK.
3D Print Med. 2020 Sep 23;6(1):25. doi: 10.1186/s41205-020-00077-2.
Modern designs of joint replacements require a large inventory of components to be available during surgery. Pre-operative CT imaging aids 3D surgical planning and implant sizing, which should reduce the inventory size and enhance clinical outcome. We aimed to better understand the impact of the use of 3D surgical planning and Patient Specific Instrumentation (PSI) on hip implant inventory.
An initial feasibility study of 25 consecutive cases was undertaken to assess the discrepancy between the planned component sizes and those implanted to determine whether it was possible to reduce the inventory for future cases. Following this, we performed a pilot study to investigate the effect of an optimized inventory stock on the surgical outcome: we compared a group of 20 consecutive cases (experimental) with the 25 cases in the feasibility study (control). We assessed: (1) accuracy of the 3D planning system in predicting size (%); (2) inventory size changes (%); (3) intra and post-operative complications.
The feasibility study showed variability within 1 size range, enabling us to safely optimize inventory stock for the pilot study. (1) 3D surgical planning correctly predicted sizes in 93% of the femoral and 89% of the acetabular cup components; (2) there was a 61% reduction in the implant inventory size; (3) we recorded good surgical outcomes with no difference between the 2 groups, and all patients had appropriately sized implants.
3D planning is accurate in up to 95% of the cases. CT-based planning can reduce inventory size in the hospital setting potentially leading to a reduction in costs.
现代关节置换设计要求手术期间有大量的组件库存。术前CT成像有助于进行三维手术规划和植入物尺寸确定，这应能减少库存规模并提高临床效果。我们旨在更好地了解三维手术规划和患者特异性器械（PSI）的使用对髋关节植入物库存的影响。
对连续25例病例进行初步可行性研究，以评估计划的组件尺寸与植入尺寸之间的差异，确定是否有可能减少未来病例的库存。在此之后，我们进行了一项试点研究，以调查优化库存对手术结果的影响：我们将连续20例病例的一组（实验组）与可行性研究中的25例病例（对照组）进行比较。我们评估了：（1）三维规划系统预测尺寸的准确性（%）；（2）库存规模变化（%）；（3）术中和术后并发症。
可行性研究显示在1个尺寸范围内存在变异性，这使我们能够安全地为试点研究优化库存。（1）三维手术规划正确预测了股骨组件93%和髋臼杯组件89%的尺寸；（2）植入物库存规模减少了61%；（3）我们记录到良好的手术结果，两组之间无差异，所有患者的植入物尺寸都合适。
三维规划在高达95%的病例中是准确的。基于CT的规划可减少医院环境中的库存规模，可能导致成本降低。
