Can 3D surgical planning and patient specific instrumentation reduce hip implant inventory? A prospective study
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RESEARCH
Open Access
Can 3D surgical planning and patient specific instrumentation reduce hip implant inventory? A prospective study Anna Di Laura1,2* , Johann Henckel1, Harry Hothi1,2 and Alister Hart1,2
Abstract Background: 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. Methods: 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. Results: 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. Conclusions: 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. Keywords: Total hip Arthroplasty, Preoperative planning, Three-dimensional computerised planning, Implant cost, Implant inventory
Background In the United States (US), Total Hip Arthroplasty (THA) has been targeted for cost containment by Centers for Medicare and Medicaid Services (CMS) because of its high cost per procedure and its increasing prevalence [1–4]. The implant is the most expensive supply item for joint replacement [1, 5]. * Correspondence: [email protected] 1 The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London HA7 4LP, UK 2 Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK
Preoperative planning is an essential step in the preparation for elective surgery [6–8]. The technical goals of preoperative planning of the hip joint include restoration of femoral offsets and limb length [9, 10] as well as the restoration of the centre of rotation, all of which are dependent on implant size. Starting from Computed Tomography (CT) scans, Three-Dimensional (3D) models of the patient anatomy are created in a virtual 3D environment. These models are then used to plan the operation, determining implant size,
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