2025 ISAKOS Congress in Munich, Germany

2025 ISAKOS Biennial Congress Paper

 

The Impact Of 3D Printing On Pre-Operative Planning And Outcomes: A Randomized Control Trial

Devan Pancura, MSc, Bedford, Nova Scotia CANADA
Samora Onsare Maranya, MMed, Halifax, Nova Scotia CANADA
Ivan Wong, MD, FRCSC, MACM, Dip. Sports Med, Halifax, NS CANADA

Nova Scotia Health, Halifax, Nova Scotia, CANADA

FDA Status Not Applicable

Summary

This randomized control trial found that using 3D-printed models for arthroscopic hip surgery improved pre-operative planning, enhanced intra-operative visualization, and resulted in better CAM resection compared to traditional imaging methods.

Abstract

Purpose

Femoroacetabular impingement (FAI) is a painful condition caused by abnormal contact between the acetabulum and the femur. CAM-type impingement, due to abnormal femur morphology, can cause labral and cartilage damage, and contribute to osteoarthritic changes in the hip. Arthroscopic surgery can treat FAI; however, the anatomy of the hip joint makes visualization during surgery challenging. Innovations like 3D printing offer an avenue for advancing surgical planning and improving intra-operative visualization, however the use of 3D models for hip arthroscopy remains unexplored in the literature. This randomized control trial sought to determine whether 3D-printed models enhance pre-operative planning and intra-operative identification of CAM-type FAI, thereby improving resection over traditional imaging.

Methods

This randomized control trial included 126 patients who underwent arthroscopic hip surgery for CAM-type FAI. Patients were randomized to either a 3D Print (n = 63) or No Print (n = 63) group. The primary outcome was CAM resection measured by alpha-angle on post-operative AP, 45° Dunn and frog-leg X-ray views. The secondary outcomes were the number of times the 3D print and traditional imaging (X-Ray, CT, 3D CT, MRI or MRA) were referenced intra-operatively, International Hip Outcome Tool (iHOT-33) scores, and rate of revision surgery.

Results

There were no between-groups differences at baseline. On all radiographic views, alpha angle improved from pre- to post-operative in both groups. Alpha angle was lower on all x-ray views in the 3D Print group. Within the 3D Print group, 3D models were referenced more than all other imaging modalities (p<0.001). iHOT scores improved from pre- to post-operative for both groups (p<0.001), with no between-groups differences. Two patients underwent revision surgery, both in the No Print group (p=0.355).

Conclusions

Although both groups had significant pre- to post-operative improvements in alpha angle and patient-reported outcomes, the use of 3D models resulted in higher quality CAM resection. 3D models were referenced more frequently during surgery than traditional imaging. 3D models are a valuable tool for both pre- and intra-operative planning for arthroscopic FAI surgery.