Patient-Specific Surgical Guide for Total Hip Arthroplasty

  • Takashi SakaiEmail author
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 1093)


Three-dimensional printing technique has been adapted for orthopedic surgery, and a patient-specific surgical guide (PSG) has been introduced as a convenient surgical instrument and implicated in the ideal positioning of the components, including acetabular and femoral components in total hip arthroplasty (THA). PSG is designed and manufactured based on preoperative imaging data, mainly computed tomography (CT) data. PSGs for implantation in THA are classified into three types: PSG for guidewire insertion, PSG for bone cutting, and PSG for bone reaming and implant fixation. PSG positioning accuracy depends on the PSG design and surgical preparation in contact area on the bone surface. PSGs for the acetabular component, for the conventional femoral component, and for the resurfacing femoral component have been clinically used. To achieve precise implantation, precise PSG setting needs and careful surgical preparation of soft tissues are important.


Patient-specific surgical guide Total hip arthroplasty Guidewire insertion Bone cutting Accuracy 


  1. 1.
    Radermacher K, Portheine F, Anton M, Zimolong A, Kaspers G, Rau G, Staudte HW (1998) Computer assisted orthopaedic surgery with image based individual templates. Clin Orthop Relat Res 354:28–38CrossRefGoogle Scholar
  2. 2.
    Widmer KH, Zurfluh B (2004) Compliant positioning of total hip components for optimal range of motion. J Orthop Res 22:815–821CrossRefPubMedCentralGoogle Scholar
  3. 3.
    Miki H, Yamanashi W, Nishii T, Sato Y, Yoshikawa H, Sugano N (2007) Anatomic hip range of motion after implantation during total hip arthroplasty as measured by a navigation system. J Arthroplast 22:946–952CrossRefGoogle Scholar
  4. 4.
    Jolles BM, Zangger P, Leyvraz PF (2002) Factors predisposing to dislocation after primary total hip prosthesis. J Arthroplast 17:282–288CrossRefGoogle Scholar
  5. 5.
    Kennedy JG, Rogers WB, Soffe KE, Sullivan RJ, Griffen DG, Sheehan LJ (1998) Effect of acetabular component orientation on recurrent dislocation, pelvic osteolysis, polyethylene wear, and component migration. J Arthroplast 13:530–534CrossRefGoogle Scholar
  6. 6.
    Hananouchi T, Saito M, Koyama T, Hagio K, Murase T, Sugano N, Yoshikawa H (2009) Tailor-made surgical guide based on rapid prototyping technique for cup insertion in total hip arthroplasty. Int J Med Robot 5:164–169CrossRefPubMedCentralGoogle Scholar
  7. 7.
    Hananouchi T, Saito M, Koyama T, Sugano N, Yoshikawa H (2010) Tailor-made surgical guide reduces incidence of outliers of cup placement. Clin Orthop Relat Res 468:1088–1095CrossRefPubMedCentralGoogle Scholar
  8. 8.
    Kunz M, Rudan JF, Xenoyannis GL, Ellis RE (2010) Computer-assisted hip resurfacing using individualized drill templates. J Arthroplast 25:600–606CrossRefGoogle Scholar
  9. 9.
    Raaijmaakers M, Gelaude F, De Smedt K, Clijmans T, Dille J, Mulier M (2010) A custom-made guide-wire positioning device for hip surface replacement arthroplasty: description and first results. BMC Musculoskelet Disord 11:161–167CrossRefPubMedCentralGoogle Scholar
  10. 10.
    Zhang YZ, Chen B, Lu S, Yang Y, Zhao JM, Liu R, Li YB, Pei GX (2011) Preliminary application of computer-assisted patient-specific acetabular navigational template for total hip arthroplasty in adult single development dysplasia of the hip. Int J Med Robot Comput Assist Surg 7:469–474CrossRefGoogle Scholar
  11. 11.
    Andenaert E, De Smedt K, Gelaude F, Clijmans T, Pattyn C, Geebelen B (2011) A custom-made guide for femoral component positioning in hip resurfacing arthroplasty: development and validation study. Comput Aided Surg 16:304–309CrossRefGoogle Scholar
  12. 12.
    Buller L, Smith T, Bryan J, Klika A, Barsoum W, Ianntti JP (2013) The use of patient-specific instrumentation improves the accuracy of acetabular component placement. J Arthroplast 28:631–636CrossRefGoogle Scholar
  13. 13.
    Kitada M, Sakai T, Murase T, Hanada T, Nakamura N, Sugano N (2013) Validation of the femoral component placement during hip resurfacing: a comparison between the conventional jig, patient-specific template, and CT-based navigation. Int J Med Robot 9:223–229CrossRefPubMedCentralGoogle Scholar
  14. 14.
    Sakai T, Hanada T, Murase T, Kitada M, Hamada H, Yoshikawa H, Sugano N (2014) Validation of patient specific surgical guides in total hip arthroplasty. Int J Med Robot 10:113–120CrossRefPubMedCentralGoogle Scholar
  15. 15.
    Small T, Krebs V, Molloy R, Bryan J, Klika AK, Barsoum WK (2014) Comparison of acetabular shell position using patient specific instruments vs. standard surgical instruments: a randomized clinical trial. J Arthroplast 29:1030–1037CrossRefGoogle Scholar
  16. 16.
    Steppacher SD, Kowal JH, Murphy SB (2011) Improving cup positioning using a mechanical navigation instrument. Clin Orthop Relat Res 469: 423–428CrossRefPubMedCentralGoogle Scholar
  17. 17.
    Kitada M, Nakamura N, Iwana D, Kakimoto A, Nishii T, Sugano N (2011) Evaluation of the accuracy of computed tomography–based navigation for femoral stem orientation and leg length discrepancy. J Arthroplast 26:674–679CrossRefGoogle Scholar
  18. 18.
    Sakai T, Hamada H, Takao M, Murase T, Yoshikawa H, Sugano N (2017) Validation of patient-specific surgical guides for femoral neck cutting in total hip arthroplasty through the anterolateral approach. Int J Med Robot 13(3). Epub 2017 May 8CrossRefGoogle Scholar
  19. 19.
    Murase T, Oka K, Moritomo H, Goto A, Yoshikawa H, Sugamoto K (2008) Three-dimensional corrective osteotomy of malunited fractures of the upper extremity with use of a computer simulation system. J Bone Joint Surg Am 90:2375–2389CrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryOsaka University Graduate School of MedicineSuitaJapan

Personalised recommendations