Application of 3D-Printed Personalized Guide in Arthroscopic Ankle Arthrodesis

Xiaojun Duan, Peng He, Huaquan Fan, Chengchang Zhang, Fuyou Wang, Liu Yang, Xiaojun Duan, Peng He, Huaquan Fan, Chengchang Zhang, Fuyou Wang, Liu Yang

Abstract

Objective: To accurately drill the Kirschner wire with the help of the 3D-printed personalized guide and to evaluate the feasibility of the 3D technology as well as the outcome of the surgery.

Methods: Patients' DICM data of ankle via CT examinations were introduced into the MIMICS software to design the personalized guides. Two 2mm Kirschner wires were drilled with the help of the guides; the C-arm fluoroscopy was used to confirm the position of the wires before applying the cannulated screws. The patients who underwent ankle arthrodesis were divided into two groups. The experimental group adopted the 3D-printed personalized guides, while the control group received traditional method, i.e., drilling the Kirschner wires according to the surgeon's previous experience. The times of completing drilling the Kirschner wires to correct position were compared between the two groups. Regular follow-ups were conducted to statistically analyze the differences in the ankle fusion time and AOFAS scores between the two groups.

Results: 3D-printed personalized guides were successfully prepared. A total of 29 patients were enrolled, 15 in the experimental group and 14 in the control group. It took 2.2 ± 0.8 minutes to drill the Kirschner wires to correct position in the experimental group and 4.5 ± 1.6 minutes in the control group (p=0.001). No obvious complications occurred in the two groups during and after surgery. Postoperative radiographs confirmed bony fusion in all cases. There were no significant differences in the fusion time (p=0.82) and AOFAS scores at 1 year postoperatively between the two groups (p=0.55).

Conclusions: The application of 3D-printed personalized guide in assisting the accurate drilling of Kirschner wire in ankle arthrodesis can shorten the operation time and reduce the intraoperative radiation. This technique does not affect the surgical outcome.

Trial registration number: This study is registered on www.clinicaltrials.gov with NCT03626935.

Figures

Figure 1
Figure 1
Design and preparation of the 3D-printed personalized guide. (a, b) Computer software-assisted design of personalized ankle arthrodesis guide (the red lines in (a) demonstrate the positioning of the Kirschner wires that drill through, and the yellow parts in (b) are the guides). (c) Guide data converted into STL format and imported into the 3D printer for preparation. (d) The 3D-printed personalized guides.
Figure 2
Figure 2
Preoperative imageological examination suggesting end-stage traumatic arthritis in the right ankle. (a) Preoperative radiograph of the ankle joint (anteroposterior view). (b) Preoperative radiograph of the ankle joint (lateral view). (c) Preoperative MRI of the ankle joint (lateral view). (d) Preoperative MRI of the ankle joint (anteroposterior view).
Figure 3
Figure 3
Arthroscopy. (a) Position and noninvasive traction. (b) Debridement of residual cartilage using curette. (c) Microfractures treatment for the fusion surface. (d) Articular surface after treatment.
Figure 4
Figure 4
Ankle arthrodesis assisted by 3D printed personalized guide. (a, b) Intraoperative operation, drilling of two Kirschner wires with the help of the guides. (c, d) C-arm fluoroscopy confirmed satisfactory ankle reduction and Kirschner wire position. (e, f) C-arm fluoroscopy showed satisfactory position of the screws.

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