Abstract
Purpose
3D-printed patient-specific instruments have become a useful tool to improve accuracy in pelvic tumour resections. However, their correct placement can be challenging in some regions due to the morphology of the bone, so it is essential to be aware of the possible placement errors in each region. In this study, we characterize these errors in common pelvic osteotomies.
Methods
We conducted an experiment with 9 cadaveric specimens, for which we acquired a pre-operative computed tomography scan. Small PSIs were designed for each case following a realistic surgical approach for four regions of the pelvis: iliac crest (C), supra-acetabular (S), ischial (I), and pubic (P). Final surgical placement was based on a post-operative scan. The resulting positions were compared with pre-operative planning, obtaining translations, rotations, and maximum osteotomy deviations in a local reference frame defined based on the bone’s morphology.
Results
Mean translations and rotations in the direction of the osteotomy plane were as follows: C = 5.3 mm, 6.7°; S = 1.8 mm, 5.1°; I = 1.5 mm, 3.4°; P = 1.8 mm, 3.5°. Mean translations in the remaining axes were below 2 mm. Maximum osteotomy deviations (75% of cases) were below 11.8 mm in C (7.8 mm for half-length), 7.8 mm in S (5.5 mm for half-length), 5.5 mm in I, and 3.7 mm in P.
Conclusion
We have characterized placement errors for small PSIs in four regions of the pelvis. Our results show high errors in C and S PSIs in the direction of the resection plane’s normal, and thus large osteotomy deviations. Deviations in short osteotomies in S, I and P and placement errors in the remaining directions were low. The PSIs used in this study are biocompatible and can be produced with a desktop 3D printer, thus minimizing manufacturing cost.
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Availability of data and material
The data analysed in the current study are available from the corresponding author on reasonable request.
Code availability
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Acknowledgements
Supported by project PI18/01625 (Ministerio de Ciencia, Innovación y Universidades, Instituto de Salud Carlos III and European Regional Development Fund "Una manera de hacer Europa").
Funding
This work was supported by project PI18/01625 (Ministerio de Ciencia e Innovación, Instituto de Salud Carlos III and European Regional Development Fund “Una manera de hacer Europa.
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All authors contributed to the study conception and design. Data acquisition and analysis were performed by Mónica García-Sevilla and María Teresa Ruiz-Alba. Mónica García-Sevilla wrote the main manuscript text and prepared all figures and tables. Lydia Mediavilla-Santos and José Antonio Calvo-Haro participated in the experiment. Javier Pascau substantially revised the manuscript text. All authors read and approved the final manuscript.
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García-Sevilla, M., Mediavilla-Santos, L., Ruiz-Alba, M.T. et al. Patient-specific desktop 3D-printed guides for pelvic tumour resection surgery: a precision study on cadavers. Int J CARS 16, 397–406 (2021). https://doi.org/10.1007/s11548-021-02322-3
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DOI: https://doi.org/10.1007/s11548-021-02322-3