Digitally Designed Bone; A 3D-patient-specific Allograft Shelf for Severe Adolescent Hip Dysplasia: From Digital Design to Clinical Reality-A Conceptual Case Report.

Abstract

Adolescents with severe dysplasia of the hip regularly undergo a periacetabular osteotomy to prevent pain and early osteoarthritis. Unfortunately, this procedure is not suited for severe dysplasia with a non-congruent-deformed hip joint. The optimal treatment might be a tailor-made biologic optimization of femoral coverage with a shape matching the aberrant anatomy. This study introduces a novel approach using a patient-specific allograft shelf augmentation based on personalized 3D kinematic planning. A 17-year-old patient with severe right-sided hip dysplasia underwent 3D CT analysis showing a lateral center-edge angle of -7° and a craniocaudal femoral head coverage of 50%. Using digital augmentation techniques and kinematic simulations, the femoral coverage was optimized while respecting the range of motion. An allograft cortical shelf of a distal femur with a matching surface and curvature as digitally designed was found in the bone bank and implanted at the acetabular rim using patient-specific molds. After uncomplicated implantation of the patient-specific allograft shelf, the lateral center-edge angle and femoral head coverage increased to 18° and 77% while preserving range of motion. A CT scan at 9-month follow-up showed incorporation of the allograft in the native bone with sustained coverage of the weight-bearing area of the patient-specific allograft shelf. An acetabular augmentation shelf was digitally designed and implanted using a matching allograft donor in a case of severe hip dysplasia. The excellent and predictable functional and radiologic outcomes suggest that patient-specific allograft bone shelves could be a serious option for adolescents with severe hip dysplasia.