Periacetabular osteotomy using three-dimensional cutting and reposition guides: a cadaveric study

Abstract

The goal of periacetabular osteotomy (PAO) is to reorient the acetabulum in a more physiological position. Its realization remains challenging regarding the final position of the acetabulum. Assistance with custom cutting- and reorientation-guides would thus be very helpful. Our purpose is to present a pilot study on such guides. Eight cadaveric hemipelvis were scanned using CT. After segmentation, 3D models of each specimen were created, a PAO was virtually performed and reorientation of the acetabula were defined. A specific guide was designed aiming to assist in iliac, posterior column and superior pubic ramus cuts as well as in acetabulum reorientation. Furthermore, the acetabular position was planned. Three-dimensional printed guides were used to perform PAO using the modified Smith-Peterson approach. The post-operative CT images and virtually planned acetabulum reorientation were compared in terms of acetabular index (AC), lateral centre edge angle (LCE), acetabular anteversion angle (AcetAV). There was no intra-articular or posterior column fracture seen. Two cadavers showed very low bone quality with insufficient stability of fixation and were excluded from further analysis. Correlation between the post-operative result and planning of the six included cadavers revealed the following mean deviations: 5° (SD ±3°) for AC angle, 6° (SD ±4°) for LCE angle and 15° (SD ±11°) for AcetAV angle. The use of 3D cutting and reorientation blocks for PAO was possible through a modified Smith-Peterson approach and revealed accurate fit to bone, accurate positioning of the osteotomies and acceptable planned corrections in cadavers with good bone quality.