Systematic evaluation and meta-analysis of total hip arthroplasty with three-dimensional printing model in preoperative planning / 中国组织工程研究

ABSTRACT

BACKGROUND: Three-dimensional (3D) printing-assisted total hip arthroplasty plays an important role in preoperative planning, intraoperative guidance and positioning, and production of individualized implants. It has important clinical significance for the treatment of hip joint diseases. OBJECTIVE: To evaluate the clinical efficacy of preoperative planning using 3D printed models to assist total hip arthroplasty by systematic evaluation and meta-analysis. METHODS: PubMed, Embase, Cochrane Libray, CNKI, Wanfang databases were retrieved electronically for the articles published before December 2019. The keywords were “hip arthroplasty, hip replacement, THA, 3D printing, three dimensional printing” in Chinese and English, respectively. The clinical controlled trials of 3D printed models versus non-3D printed models to assist total hip arthroplasty in the treatment of hip joint diseases were enrolled. The literature was screened according to the inclusion and exclusion criteria; data were extracted; and the quality of the included studies was evaluated using the Cochrane 5.1.0 bias risk assessment tool, followed by data analysis using RevMan 5.3 software. RESULTS AND CONCLUSION: (1) Fourteen controlled studies were included, involving 601 participants, including 279 cases in the 3D group and 322 cases in the traditional surgery group. (2) Meta-analysis results showed that during the first hip arthroplasty, the operation time in the 3D group was shorter than that in the traditional surgery group [SMD=-0.89, 95%CI (-1.15, -0.64), P 0.05]. During revision surgery, the operation time in the 3D group was shorter than that in the traditional surgery group [SMD=-1.39, 95% CI (-1.92, -0.86), P < 0.05], and Harris score was higher than that in the traditional surgery group [SMD=1.51, 95%CI (-0.05, 2.96), P < 0.05]. The intraoperative blood loss and postoperative drainage volume in the 3D group were less than those in the traditional surgery group [SMD=-1.90, 95%CI (-2.82, -0.99), P < 0.05; SMD=-2.87, 95%CI (-3.36, -2.37), P < 0.05]. The anteversion angle and abduction angle in the 3D group were closer to the preoperative design angle compared with the traditional surgery group [SMD=-1.24, 95%CI (-1.57, -0.91), P < 0.05; SMD=-1.71, 95%CI (-2.96, -0.45), P < 0.05]. (3) These results show that compared with traditional total hip arthroplasty, 3D printing assisted total hip arthroplasty can significantly shorten the operation time, reduce the amount of intraoperative blood loss and postoperative drainage, improve the accuracy of total hip arthroplasty, and can better relieve pain, and improve the quality of life. However, due to the low quality of the included literature, high-quality large-sample, multi-center randomized controlled trials are still needed to confirm the clinical efficacy.