The feasibility of three-dimensional visualization in determining the severity of bone defects in the acetabulum

Introduction: As is known, difficulties in revision hip arthroplasty are most often due to the deficiency and quality of bone tissue in the acetabulum. To determine the tactics of surgical treatment and components, various classifications of bone defects are used, which are periodically updated or undergo revision and refinement. However, it must be understood that even using such “convenient” classifications, it is not always possible to assess changes in the acetabular region using planar radiographs. To solve and resolve such controversial cases and the possibility of practical application of various classifications, it is advisable to use a three-dimensional reconstruction even at the planning stage.
Purpose. To determine the role and place of three-dimensional visualization of the pelvic bones in patients with severe defects of the acetabulum according to the classification of A.Gross/K.Saleh.
Materials and Methods: For this experimental study, a questionnaire was developed, consisting of two blocks: acquaintance with the examinee and direct questions on the assessment of 20 clinical cases. The examinees were asked to assess the state of the acetabulum for limited and unlimited bone defects according to the A.Gross/K.Saleh classification solely on the basis of X-ray examination. Subsequently, we compared the responses of surgeons for each clinical case with the type of defect (contained or uncontained) based on a three-dimensional reconstruction performed by the developer of the questionnaire.
Results: The study involved 12 surgeons with different experience in revision surgery. Cohen's Kappa consistency coefficient in the comparative assessment of X-ray image and three-dimensional visualization between students and developers was equal to 0.111 (95% CI 0.03 - 0.256), between experienced specialists - 0.1538 (95% CI 0.02-0.33), between professionals - 0.3043 (95% CI 0.036-0.576), respectively, which in all cases indicates low results, although it has small statistically insignificant differences.
Conclusions: Thus, the results of the experimental study revealed an insufficient understanding of the clinical situation based on planar radiographs (namely, the severity of the bone tissue defect in the acetabular region) and make it expedient to routinely use modern computer technologies in complex cases, namely, three-dimensional visualization.

1. Kovalenko A.N., Shubnyakov I.I., Tikhilov R.M., Cherny A.Z. Do new and more expensive implants provide better outcomes in total hip arthroplasty? Traumatology and Orthopedics of Russia. 2015; 21:5-20. doi: 10.21823/2311-2905-2015-0-1-30-36

2. Volchenko D.V., Terskov A.Yu., Akhtyamov I.F. Clinical-functional and instrumental results of total hip arthroplasty in primary osteoarthritis. Medical Alphabet. 2019; 2(37):34-39

3. Pabinger C., Lothaller H., Portner N., Geissler A. Projections of hip arthroplasty in OECD countries up to 2050 . Hip Int. 2018;28(5):498-506

4. Vanhegan I.S., Malik A.K., Jayakumar P., Islam S.Ul, Haddad F.S. A financial analysis of revision hip arthroplasty: the economic burden in relation to the national tariff. J Bone Joint Surg Br. 2012; 94(5): 619-623

5. Shon W.Y., Santhanam S.S. Choi J.W. Acetabular Reconstruction in Total Hip. Arthroplasty Hip Pelvis. 2016; 28, (1):1–14

6. Paprosky W.G., Perona P.G., Lawrence J.M. Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J. Arthroplasty. 1994; 9, (1):33–44

7. Tikhilov R.M., Shubnyakov I.I., Denisov A.O. Classifications of Acetabular Defects: Do They Provide an Objective Evidence for Complexity of Revision Hip Joint Arthroplasty? (Critical Literature Review and Own Cases) .Traumatology and Orthopedics of Russia. 2019;25. (1):122-141. doi: 10.21823/2311-2905-2019-25-1-122-141

8. Saleh, K.J. Development, test reliability and validation of a classification for revision hip arthroplasty. J. Orthop. Res. 2001;19,(1):50-56

9. Kovalenko A.N., Shubniakov I.I., Dzhavadov A.A., Bilyk S.S., Cherkasov M.A., Ambrosenkov A.V., Antipov A.P. The role of three-dimensional visualization in revision hip arthroplasty. Genij Ortopedii. 2020; 26, 3: 364-369. DOI 10.18019/1028-4427-2020-26-3-364-369.

10. Carter LW, Stovall DO, Young TR. Determination of accuracy of preoperative templating of noncemented femoral prostheses. J Arthroplasty. 1995 Aug;10(4):507–13.

11. Knight JL, Atwater RD. Preoperative planning for total hip arthroplasty. J Arthroplasty. 1992 Jan;7:403–9. 10. Miller AG, and others. Total knee arthroplasty component templating: a predictive model. J Arthroplasty. 2012 Oct;27(9):1707–9

12. Miller AG, and others. Total knee arthroplasty component templating: a predictive model. J Arthroplasty. 2012 Oct;27(9):1707–9. 11.

13. Shaarani SR, McHugh G, Collins DA. Accuracy of Digital Preoperative Templating in 100 Consecutive Uncemented Total Hip Arthroplasties. A Single Surgeon Series. J Arthroplasty. 2013;28(2):331–7

14. Zeng Y, and others. Three-dimensional Computerized Preoperative Planning of Total Hip Arthroplasty with High-Riding Dislocation Developmental Dysplasia of the Hip. Orthop Surg. 2014;6(2):95–102.,

15. Sariali E, and others. Accuracy of the preoperative planning for cementless total hip arthroplasty. A randomised comparison between three-dimensional computerised planning and conventional templating. Orthop Traumatol Surg Res. 2012;98(2):151–8.

16. Viceconti M, and others. CT-based surgical planning software improves the accuracy of total hip replacement preoperative planning. Med Eng Phys. 2003;25:371–7.

17. Sariali E, and others. Accuracy of reconstruction of the hip using computerised three-dimensional pre-operative planning and a cementless modular neck. J Bone Jt Surg - Br Vol. 2009;91–B(3):333–40

18. Viceconti M, and others. CT-based surgical planning software improves the accuracy of total hip replacement preoperative planning. Med Eng Phys. 2003;25:371–7.

19. Sariali E, Catonne Y, Pascal-Moussellard H. Threedimensional planning-guided total hip arthroplasty through a minimally invasive direct anterior approach. Clinical outcomes at five years’ follow-up. Int Orthop. 2016;1–7.

20. Tikhilov R.M., Dzhavadov A.A., Kovalenko A.N., et al. What Characteristics of the Acetabular Defect Influence the Choice of the Acetabular Component During Revision Hip Arthroplasty? // Traumatology and Orthopedics of Russia. – 2020; 26.(2): 31-49. doi: 10.21823/2311-2905-2020-26-2-31-49

21. Hung C.C., Li Y.T., Chou Y.C. Conventional plate fixation method versus pre-operative virtual simulation and three-dimensional printing-assisted contoured plate fixation method in the treatment of anterior pelvic ring fracture,” International Orthopaedics, 2019;43,(2):425–431

22. Xiao J.R., Huang W.D., Yang X. H. En bloc resection of primary malignant bone tumor in the cervical spine based on 3-dimensional printing technology. Orthopaedic Surgery. 2016;8,(2): 171–178.

23. Zhang Y.D., Wu R.Y., Xie D.D., Zhang L., He Y. Effect of 3D printing technology on pelvic fractures: a meta-analysis,” Zhongguo gu shang. China journal of orthopaedics and traumatology. 2018;31,(5):465–471, 2018