Application of 3D-printed patient specific cutting and reorientation jigs for Bernese periacetabular osteotomy

Abstract Periacetabular Osteotomy (PAO) is a well-established joint preserving surgery to correct acetabular coverage in hip dysplasia. However, it is technically demanding. We aim to design a 3D-printed patient specific cutting and reorientation jig that will improve the safety and precision of correction in PAOs, and describe the surgical technique of performing PAOs with these jigs. Five PAOs were performed across three females aged 36–44 for hip dysplasia. CT Pelvis’ were converted into virtual 3D models. Virtual surgical planning (VSP) was performed to plan the osteotomies, K-wire and screw positioning, and reorientation of the acetabular fragment to obtain desired coverage. Results of the VSP were used to manufacture personalized cutting and reorientation jigs. Trial PAOs were performed on patient-specific pelvic models before each PAO to fine-tune the jigs. PAOs were performed via a Smith Peterson and ilioinguinal approach. The ischial osteotomy was performed under image-intensifier guidance and the pubic osteotomy was done under direct vision with a straight osteotome. Supraacetabular and retroacetabular osteotomies were performed using the 3D-printed cutting jig which were fixed with K-wires. The cutting jig combined the retroacetabular and final osteotomy to complete the ischial cut. The acetabular fragment was then rotated according to the reorientation jig to achieve the pre-calculated correction of the acetabular coverage and fixed with screws. Post-operative pelvic radiographs were taken immediately whilst inpatient as well as during post-operative clinic reviews. There were no complications of articular extension or posterior column fracture in all five PAOs.