case_images: PMC10546305_01
case_images: (A) A pelvic radiograph (anteroposterior view) shows the right acetabular prosthesis moving up significantly and the right femoral prosthesis sinking, with a slight and massive osseous defects on the pubis and proximal femur, respectively. (B,C) Three-dimensional computed tomography reconstruction reveals the abnormal position of the prosthesis and osseous defects.
case_images: fsurg-10-1237075-g001.jpg
case_images: PMC10546305_01_fsurg-10-1237075-g001.jpg
case_images: F1
case_images: The preoperative imaging data of the patient showed that the right acetabular prosthesis had moved up significantly, and the right femoral prosthesis had sunk (Figure 1).
case_images: (A,B) Right acetabulum bone defects shown by 3D-reconstruction. (C) The preoperative position planning of the cup and the rotational center of hip. (D,E) The preoperative position planning of the cup, augments and the arrangement of the screws. (F) Four different test models and prothesis varing in size and the surface (smmoth or rough). The size and the surface depend on the condition of the bone bed after removing the residual bone cement.
case_images: fsurg-10-1237075-g002.jpg
case_images: PMC10546305_01_fsurg-10-1237075-g002.jpg
case_images: F2
case_images: Tessellation Language) format that can be used for 3D printing, which was performed using EBM Q10Plus (Arcam, Sweden). Several digital images of the preoperative planning are shown in Figure 2, and the detailed design is attached in the Supplementary file 1. The patient's right acetabulum moved upward.
case_images: (A,B) Acetabular and femoral prostheses were removed intraoperatively. Residual bone cement was observed on the surface of the femoral prosthesis. (C) The appearance of the acetabulum after taking out the acetabular prosthesis. (D) A bone window with a length and width of approximately 1.3 cm-4 cm was created at the lateral side of the distal femur to remove the residual bone cement at the distal femoral medullary cavity and establish the true bone canal with a bone graft at the distal femur. (E) The artificial intelligence-designed three-dimensional-printing porous metal augmented modules were used to fill the bone defects at the external superior of the acetabulum to provide sufficient mechanical support for the revision acetabular prosthesis. (F) The artificial intelligence-designed positions of the augmentation modules were used to fill the pubic bone defects. (G) An augmented module was placed at the external superior of the acetabulum. (H) The placement of two augment modules, an acetabular cup, and a cup liner. (I) The proximal end of the femoral prosthesis wrapped the Lars ligament. (J,K) The muscles were sutured and fixed on the Lars ligament.
case_images: fsurg-10-1237075-g003.jpg
case_images: PMC10546305_01_fsurg-10-1237075-g003.jpg
case_images: F3
case_images: We removed the femoral prosthesis and cleaned the surrounding necrotic and pseudotumor tissues (Figures 3A,B). After exposing the acetabulum, we observed a large amount of bone absorption around the acetabular prosthesis (Figure 3C). We removed the acetabular prosthesis and reamed the acetabulum with a 60 mm acetabulum reamer (Figures 3A,B). We drilled and created a bone canal for screws and placed a 60 mm acetabular prosthesis and two augments that filled the osseous defects (Figures 3E-G). A 36 mm acetabulum liner was selected (Figure 3H). A window was opened at the lateral side of the distal femur, with a length and width of approximately 1.3 cm x 4 cm, to remove the residual bone cement at the distal end and establish the true bone canal with a bone graft at the distal femur (Figure 3D). The proximal end of the femoral prosthesis wrapped the ligament augmentation and reconstruction system (LARS) ligament, and the muscles were sutured and fixed (Figures 3I-K).
case_images: (A) Intraoperative C-arm radiograph showed a good position of augmented modules and prostheses. (B,C) Radiographs of the hip and femur were taken at the bedside 1 day postoperatively. (D,E) Radiographs of the hip and femur were taken at the outpatient clinic 5 weeks postoperatively.
case_images: fsurg-10-1237075-g004.jpg
case_images: PMC10546305_01_fsurg-10-1237075-g004.jpg
case_images: F4
case_images: A C-arm radiograph showed good positioning of the prosthesis and augmented modules (Figure 4A). On the first day after surgery, bedside radiography showed good positioning of the prosthesis and augmented modules (Figures 4B,C). The prosthesis and augmented modules were still fixed well to the surrounding bone bed, and no prosthesis loosening was observed at the 5-week follow-up (Figures 4D,E) and the VAS was 1, which indicated a good short-term outcome.