Intraoperative application of three-dimensional printed guides in total hip arthroplasty: A systematic review

BACKGROUND Acetabular component positioning in total hip arthroplasty (THA) is of key importance to ensure satisfactory post-operative outcomes and to minimize the risk of complications. The majority of acetabular components are aligned freehand, without the use of navigation methods. Patient specific instruments (PSI) and three-dimensional (3D) printing of THA placement guides are increasingly used in primary THA to ensure optimal positioning. AIM To summarize the literature on 3D printing in THA and how they improve acetabular component alignment. METHODS PubMed was used to identify and access scientific studies reporting on different 3D printing methods used in THA. Eight studies with 236 hips in 228 patients were included. The studies could be divided into two main categories; 3D printed models and 3D printed guides. RESULTS 3D printing in THA helped improve preoperative cup size planning and postoperative Harris hip scores between intervention and control groups (P = 0.019, P = 0.009). Otherwise, outcome measures were heterogeneous and thus difficult to compare. The overarching consensus between the studies is that the use of 3D guidance tools can assist in improving THA cup positioning and reduce the need for revision THA and the associated costs. CONCLUSION The implementation of 3D printing and PSI for primary THA can significantly improve the positioning accuracy of the acetabular cup component and reduce the number of complications caused by malpositioning.