Paediatric musculoskeletal (MSK) disorders often produce severe limb deformities, that may require surgical correction. This may be challenging, especially in case of multiplanar, multifocal and/or multilevel deformities. The increasing implementation of novel technologies, such as virtual surgical planning (VSP), computer aided surgical simulation (CASS) and 3D-printing is rapidly gaining traction for a range of surgical applications in paediatric orthopaedics, allowing for extreme personalization and accuracy of the correction, by also reducing operative times and complications. However, prompt availability and accessible costs of this technology remain a concern. Here, we report our experience using an in-hospital low-cost desk workstation for VSP and rapid prototyping in the field of paediatric orthopaedic surgery. From April 2018 to September 2022 20 children presenting with congenital or post-traumatic deformities of the limbs requiring corrective osteotomies were included in the study. A conversion procedure was applied to transform the CT scan into a 3D model. The surgery was planned using the 3D generated model. The simulation consisted of a virtual process of correction of the alignment, rotation, lengthening of the bones and choosing the level, shape and direction of the osteotomies. We also simulated and calculated the size and position of hardware and customized massive allografts that were shaped in clean room at the hospital bone bank. Sterilizable 3D models and PSI were printed in high-temperature poly-lactic acid (HTPLA), using a low-cost 3D-printer. Twenty-three operations in twenty patients were performed by using VSP and CASS. The sites of correction were: leg (9 cases) hip (5 cases) elbow/forearm (5 cases) foot (5 cases) The 3D printed sterilizable models were used in 21 cases while HTPLA-PSI were used in five cases. customized massive bone allografts were implanted in 4 cases. No complications related to the use of 3D printed models or cutting guides within the surgical field were observed. Post-operative good or excellent radiographic correction was achieved in 21 cases. In conclusion, the application of VSP, CASS and 3D-printing technology can improve the surgical correction of complex limb deformities in children, helping the surgeon to identify the correct landmarks for the osteotomy, to achieve the desired degree of correction, accurately modelling and positioning hardware and bone grafts when required. The implementation of in-hospital low-cost desk workstations for VSP, CASS and 3D-Printing is an effective and cost-advantageous solution for facilitating the use of these technologies in daily clinical and surgical practice.
Annually about 75000 hip arthroplasties are performed in Italy, which corresponds to 125 primary operations per 100.000 inhabitants. These numbers are constantly growing, as well as the amount of economical resources dedicated to this surgery. There are many types of pros-theses, and techniques, but basically no control on their efficacy and effectiveness is applied. So born in Apulia during 2001 the pilot project of Register for Apulia. The specific aims of Register are:
describe the current practeses in hip replacement, providing accurate information on the use of different types of prostheses in both primary and revision joint replacements; collect data for the evaluate the importance of patient-related factors on survival of implants; control the incidence of intra and post-operative complications; assess patient outcomes in medium ( 6 month ) and long term ( 12 month ); describe the different parts of the implant; Five thousand four hundred forms have been collected during the last three years. 55% of the Apulian Hospitals were involved in 2001, 77% in 2003. The average age of the patients undergoing surgery was 67 for the total hip replacement, 80 for the partial hip replacement and 70 for implant revision. 66% of the operations were performed on women. We recorded an increase in the use of antibiotic-containing cement. Systemic antibiotic prophylaxis has been used in almost every operation, e.g. teicoplanina (18% ). In 2003 we recorded 56 deaths (SMR 0.03) with a higher risk for revision of hip prostheses in younger compared to older patients and in men compared to women. During the first 60 post operative days we observed a statistically significant increase in mortality for all patients. During the study 37 types of cups and 53 types of stems have been registered. The 28mm head was used in 90% of cases. Most patients with primary osteoarthritis do not received cemented prostheses. The use of the bone impaction grafting technique has increased. Primary prostheses is the main indication for coxartrosi while hemiarthro-plasties for femoral neck fractures. Aseptic loosening is the most frequent diagnosis for revision. In Apulia hip arthroplasties are predominant in central and university hospitals. University hospitals and private clinics have proportionally revised younger patients. The number of revisions is increasing. The follow-up is limited (30%). All the orthopaedic departments involved are participating in the study on a voluntary basis. The data forms we have used, are suitable for an observational study. The Register has evolved to be an essential part of the quality improvement programs in Apulia’s health care structures. The Register gives important information for the decision-making process and facilitates quality improvement. The Register has the potential to bring problems to attention long before they may be reported and acknowledged by traditional clinical research methods.
