Conventional versus guide plate-assisted total hip arthroplasty for congenital hip dysplasia: a case-control study

Conventional versus guide plate-assisted total hip arthroplasty for congenital hip dysplasia: a case-control study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Conventional versus guide plate-assisted total hip arthroplasty for congenital hip dysplasia: a case-control study Haotian Zhu, kai Cheng, Yuanhao Peng, Yuning Wang, kang Liu, Huanwen Ding, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4543432/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Total hip arthroplasty effectively treats developmental dysplasia of the hip. Severe acetabular deformities present challenges for accurate positioning and prosthetic placement. The advent of three-dimensional printing offers a solution.The aim of this study was to investigate the clinical efficacy of 3D printed surgical guides in total hip arthroplasty for hip dysplasia. Patients and Methods: A retrospective case-control study was conducted on total hip arthroplasty for hip dysplasia patients treated between 2020 and 2023. Prosthetic implantation outcomes and prognostic indicators were assessed in 26 patients (13 guided procedures, 13 conventional procedures) utilizing customized surgical guides or conventional total hip arthroplasty. Results: No significant differences were observed between the groups regarding gender, age, affected hip side, Crowe grading, and central rim angle(P>0.05). However, significant disparities were noted in operative time, blood loss, acetabular prosthesis angle and horizontal and vertical distance from the centre of rotation(P<0.05). Conclusions: 3D-printed guides significantly reduce operative time, diminish blood loss, restore the hip joint's center of rotation, and enhance the prognosis of total hip arthroplasty in adults with hip dysplasia. Total hip arthroplasty Developmental Dysplasia of the Hip 3D printing Osteoarthritis Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Background Developmental dysplasia of the hip (DDH) is a hereditary hip joint disorder, has a global prevalence ranging from 0.06 to 76.1 per 1000 live births, varying by ethnicity and region, and showing higher incidence in females( 1 ). In China, DDH prevalence averages about 1.52%, with rates of 0.75% in men and 2.07% in women( 2 ). Clinical manifestations of DDH include acetabular undercoverage, dislocation, and abnormal femoral head wear due to acetabular dysplasia or improper development, leading to hip arthritis, degeneration, and joint dysfunction( 3 ). Early-stage DDH typically receives non-surgical interventions such as closed reduction, braces, medications, or surgical procedures like femoral osteotomy or open reduction to restore and maintain acetabular-femoral head congruency for joint remodeling. Research indicates a 4–7 year duration for complete joint remodeling post-repositioning in DDH( 4 ), with optimal results achievable before age 11 to prevent femoral head deformity and necrosis( 5 – 7 ). In adult DDH, long-term abnormal pressure and friction on the femoral head due to inadequate treatment result in dislocation, bone and cartilage wear, and femoral head deformation and necrosis secondary to hip osteoarthritis( 8 ). Treatment strategies focus on correcting head-socket abnormalities, enhancing hip joint stability, alleviating pain, and restoring function. Hip replacement surgery (HRS), including surface replacement and Total hip arthroplasty (THA), effectively addresses adult developmental dysplasia of the hip (DDH) by rectifying acetabular dysplasia and degeneration using an artificial hip prosthesis( 9 ). While the efficacy of surface replacement remains uncertain, it is suitable for milder DDH cases (Crowe's type I and II), whereas severe DDH (Crowe's type III or IV) typically necessitates THA due to complications such as femoral head flattening and hip osteoarthritis. However, THA efficacy depends on intraoperative osteotomy and precise prosthesis placement. Traditional THA relies on visual identification of anatomical landmarks for acetabular localization, osteotomy, and prosthesis placement, carrying risks of intraoperative fracture, nerve injury, and improper cup placement. This emphasizes the necessity for precise, personalized surgical adjuncts to optimize THA outcomes. In recent years, digital tech like computer-assisted surgery and 3D printing has revolutionized THA( 10 ). It allows for precise preoperative planning, custom surgical guides, and tailored prostheses based on patient imaging data, improving placement accuracy and adaptability( 11 ). 3D-printed guides offer quick production, cost efficiency, and personalized solutions, which can introduce novel treatment options to clinical practice. Henceforth, we have introduced a 3D-printed guide plate to aid in conducting THA for DDH, scrutinized its utilization, and investigated its influence on surgical precision and patient recuperation. Our objective is to furnish fresh insights and methodologies for clinical implementation. Patients And Methods 1. Data Collection This study retrospectively analyzed clinical data from DDH patients undergoing THA at our hospital between October 2020 and March 2023. Twenty-six DDH patients (26 hips) were selected based on specific criteria and divided into two groups: guide plate (n = 13, mean age 53.92 ± 19.15 years) and conventional (n = 13, mean age 51.38 ± 13.76 years), depending on 3D-printed guide plate usage during THA. All procedures were performed by the same experienced orthopedic surgeon(Table 1 ). Inclusion criteria: 1. Definitive DDH diagnosis; 2. Age ≥ 18 years; 3. Persistent severe hip joint pain and functional impairment; 4. Failure of adequate non-surgical therapy; 5. Complete medical records. Exclusion criteria: 1. Active hip joint infection or other infectious diseases; 2. Age < 18 years; 3. Severe systemic diseases; 4. Patient intolerance to anesthesia and surgery; 5. Severe osteoporosis; 6. Loss to follow-up or incomplete medical records. This study, approved by the Research Ethics Committee of the First People's Hospital of Guangzhou (Approval No. K-2018-137-01), adheres to the Helsinki Declaration. All patients provided informed written consent. Preoperatively, patients underwent pelvic X-rays, CT scans from the anterior superior iliac spine to the ankle joint (slice thickness 0.5-1.0 mm), routine chest X-rays, electrocardiograms, and laboratory tests. Data from the conventional group were managed routinely for preoperative discussions. Data from the guide plate group were saved in DICOM format for personalized surgical guide design and production based on patient anatomical data. 2. Preoperative Preparation 2.1 Standard Group Preoperative discussions in the standard group rely on imaging data such as X-rays and CT scans to determine the surgical incision, acetabular positioning, and prosthetic implantation. 2.2 Template Group In the template group, DICOM format imaging data, including X-rays and CT scans, are imported into MIMICS 21.0 software (Materialize, Leuven, Belgium) to construct a 3D digital model of the patient's pelvis. The acetabular development is observed by rotating the model (Fig. 1 ) and exported in STL format. Alignment to the standard anatomical position and surgical template design are performed using ImageWare 13.0 software (developed by UGS Corporation, Plano, TX, USA). Table 1 Patient information (n = 26) Gender Age (years) Side Crowe Classification Guide Plate Group 9(M) 4(F) 23–79(53.92 ± 19.15) 7(L) 6(R) 0 4(Ⅲ) 9(IV) Conventional Group 4(M) 9(F) 31–72(51.38 ± 13.76) 5(L) 8(R) 2(Ⅱ) 7(Ⅲ) 4(IV) T/ χ2 / 0.388 / / P/Fisher's Exact Value 0.115 0.701 0.695 0.156 Pelvic Alignment (Fig. 2 ): A baseline is established by connecting the lowest points of the two ischial tuberosities (line 1). Spheres 1 (healthy side) and 2 (affected side) are fitted with the center of the femoral head as their centers. The centroids of these spheres are identified through point cloud recognition and connected to form line 2, representing the centers of the femoral heads. Alignment in the Y and Z planes is achieved using line 1 as the reference, with measured angles of 1.8067° and 2.0017°, respectively. The pelvic model is rotated in the Y and Z directions according to these angles to achieve complete alignment (blue and yellow colors). Lines 1'' and 2'' represent the alignment of the lowest points of the ischial tuberosities and the centers of the femoral heads after plane alignment, while spheres 1'' and 2'' represent the fitted spheres of the femoral heads after correction. Acetabular Matching (Fig. 3 ): After pelvic alignment, the height of the affected-side acetabulum is determined based on the lines connecting the centers of the femoral heads on both sides. The aim is to restore the rotational center of the acetabulum after joint replacement. Predicted acetabular prostheses are matched based on acetabular size, with a design of 40° abduction angle and 15° anteversion angle. Template Design (Acetabular Positioning Template and Grinding Navigator) (Fig. 4 ): Based on the shape of the acetabulum and the predicted acetabular prosthesis type, the shape of the positioning template is designed to fit, with a 40° abduction and 15° anteversion angle. The template is placed on the affected-side acetabulum, and channels for fixing Kirschner wires are designed on the template. A grinding navigator for the acetabulum is designed in parallel with Kirschner wire fixation, in conjunction with an acetabular file. Finally, the data is imported into Unigraphics NX software (Siemens PLM Software, Blaineau, TX, United States) for solidification. After designing and adding Kirschner wire fixation holes to the surgical template, model data is output in STL format. The template model is then produced using a 3D printer with photosensitive resin as the raw material. After sterilization with ethylene oxide, it is prepared for intraoperative use, ensuring precise acetabular positioning and prosthetic placement. 3. Intraoperative Procedure The patient is anesthetized and positioned laterally, followed by disinfection and a posterior lateral incision of the hip. The femoral neck, head, and joint capsule are exposed and excised. In the conventional group, the true acetabulum is identified visually, and the acetabular file is maintained at 40°abduction and 15°anterior tilt based on subjective assessment. In contrast, the guide group utilizes a positioning guide to locate the acetabulum, fixated by Kirschner wire and a grinding positioning device to ensure proper grinding angles. Grinding ceases upon subchondral bleeding, and a parallel K-wire, guided by the grinding positioning device, is put into the external cup of the acetabulum and secured. The femoral marrow cavity is routinely opened, a trial mold is inserted and assess joint stability, and an appropriate femoral stem prosthesis and artificial femoral head are selected and installed. Following joint reduction and suturing, operation time and intraoperative blood loss are recorded before concluding the procedure. Postoperatively, the abduction angle of the acetabular cup prosthesis, the anterior inclination angle measured by Liaw's method( 12 ), the V-COR, and the H-COR( 13 ) were measured in both groups based on the patient's review of X-ray, CT, and other imaging data. 4. Data availability statements : the data associated with the paper are not publicly available but are available from the corresponding author on reasonable request. 5. Statistical analyses Statistical analysis employed SPSS 22.0. Normal data: mean ± SD (`x±s), independent t-tests. Non-normal data: median (25th, 75th Q), rank-sum test. Gender, side, and diagnosis: Fisher's exact test. p 0.05). However, significant differences were noted in surgical duration, blood loss, postoperative acetabular prosthesis angles compared to preoperative design, vertical centre of rotation(V-COR), and horizontal centre of rotation(H-COR) (P < 0.05)(Table 3 ). Postoperative follow-ups lasted 6–24 months, with Harris scores increasing significantly. Initially, no significant difference in Harris scores between groups was observed (P = 0.534 > 0.05). Yet, differences emerged in the third and sixth postoperative months (P < 0.05)(Table 2 ). Table 2 Surgical outcomes (n = 26) Conventional Group Guide Plate Group T/Z value p Follow-up time/months 11.54 ± 2.73 13.23 ± 3.49 1.377 0.181 Surgical time/min 122.46 ± 53.86 85.85 ± 16.44 -2.344 0.028 Intraoperative bleeding/ml 430.77 ± 215.58 248.08 ± 73.50 -3.61 < 0.001 Preoperative Harris score/points 37.38 ± 6.04 34.46 ± 4.82 1.364 0.185 Harris score at 1 month postoperatively/points 74.08 ± 3.17 74.92 ± 3.64 -0.632 0.534 Harris score at 3 months postoperatively /points 87.77 ± 3.70 91.46 ± 2.47 -2.992 0.006 Harris score at 6 months postoperatively /points 91.15 ± 3.74 94.69 ± 2.66 -2.782 0.010 Table 3 Acetabular prosthesis angles (n = 26) Conventional Group Guide Plate Group T/Z value p CEA/°(preoperative) 15.41 ± 7.44 13.49 ± 6.09 -0.723 0.477 CEA/°(postoperative) 45.03 ± 9.82 47.36 ± 8.62 0.642 0.527 Difference between the anterior inclination of the acetabular prosthesis and the design angle/° 5.28 ± 2.42 2.25 ± 1.71, 1.85(1.22, 3.28) -3.359 0.001 Difference between acetabular prosthesis abduction angle and design angle /° 8.66 ± 5.20, 8.51(5.51, 11.80) 4.28 ± 4.28 -2.487 0.013 V-COR/mm 173.01 ± 38.08 48.80 ± 17.72 -10.663 < 0.001 H-COR/mm 267.45 ± 56.16 60.53 ± 19.28 12.565 < 0.001 Discussion THA represents the definitive treatment for adult DDH. Given the intricate nature of congenital dysplasia affecting the patient's acetabulum, compounded by long-term degeneration from activities such as sports, osteoarthritis and pseudoacetabular socket often ensues( 14 ). And it is difficult to accurately diagnose and correct severely deformed acetabular structures with conventional preoperative two-dimensional image planning and intraoperative placement of prostheses based on bony and cartilaginous landmarks such as sciatic notch and transverse acetabular ligament( 15 ). Prosthesis positioning based solely on visual and subjective sensation is both time-consuming and labor-intensive, yielding variable surgical outcomes. This method often results in an elevated risk of postoperative complications, including dislocation, prosthesis wear, and instability, consequently increasing the likelihood of prosthesis revision. Statistical estimates suggest a dislocation rate of up to 2% within the first year following routine THA and a revision rate as high as 28% among patients requiring prosthesis revision( 16 ). Therefore, meticulous preoperative deformity diagnosis, surgical planning, precise intraoperative acetabular positioning, restoration of the center of rotation, and meticulous control over the angle of acetabular cup placement are imperative facets of surgical management. The rapid evolution of computer technology has led to a revolutionary computer-assisted surgery (CAS) technology, integrating medical, engineering, materials, and technological disciplines( 17 ). CAS can virtually simulates surgical procedures through 3D data analysis, enabling real-time guidance, precise planning, and automated or semi-automated execution upon physician consent( 18 ), thereby optimizing surgical speed, safety, and efficiency( 19 ). This technology allows for real-time, in-depth analysis of hip joint lesions by dynamically manipulating a 3D model of the DDH patient's pelvis on a computer interface. This interactive approach offers precise data on acetabular deformities and enhances the accuracy of preoperative prosthesis prediction, significantly benefiting the primary surgeon's decision-making process( 20 , 21 ). In a cadaveric study, Savov( 22 ) et al. showcased the precision of preoperative 3D-planning in accurately determining the hip joint's center of rotation, the optimal angle for prosthesis positioning, and predicting the appropriate prosthetic size, thereby substantiating CAS technology significance in surgical decision-making. This study employed a three-dimensional (3D) pelvic model, generated through computer software and the image fitting method, to visually assess the hip deformity, locate the true socket, and predict prosthesis size prior to surgery. The study further employed a custom surgical guide plate, designed and printed to conform to the acetabular surface, which resulted in a shorter operation time (85.85 ± 16.44 minutes vs. 122.46 ± 53.86 minutes, P = 0.028), reduced bleeding (248.08 ± 73.50 ml vs. 430.77 ± 215.58 ml, P = 0.008), and enhanced the safety and surgical precision. CAS has significantly evolved in orthopedic surgery, primarily by enabling real-time, computer-assisted guidance for minimally invasive, accurate, and personalized procedures through virtual imaging. While 3D printing technology, capable of converting virtual images into physical models, has yet to be fully harnessed in surgical support, its current focus lies in the use of 3D-printed surgical guide plates and pelvic replicas for surgical planning and intraoperative guidance( 23 ). Tu( 24 ) et al. conducted a study using 3D-printed guide plates in a single-group crowe type IV DDH treated with THA, which corrected the patient's unequal legs in a timely manner and also resulted in a favourable prognosis. Xu et al. reported a discrepancy of no more than 2 sizes in the predicted prosthetic fit when utilizing a 3D-printed pelvic model to facilitate THA for osteoarthritis resulting from DDH( 25 ). Our study employed geometric mapping techniques to establish reference lines, such as the line connecting the centers of both femoral heads and the lowest point of the ischial tuberosities, for pelvic alignment. By securing the implant angle and designing custom positioning templates and grinding guides, the plates were sterilized and used intraoperatively to enhance the accuracy of THA acetabular component placement in DDH patients. In the guide plate group, the difference between the anterior inclination of the acetabular prosthesis and the design angle was 2.25 ± 1.71°,1.85 (1.22, 3.28), whereas in the conventional group, it was 5.28 ± 2.42°(P = 0.001). Similarly, the difference between the acetabular abduction angle and the predicted angle in the guide plate group was 4.28 ± 4.28°, compared to 8.66 ± 5.20° 8.51(5.51, 11.80) in the conventional group (P = 0.013). Additionally, the intervention aimed to address hip joint deformities and restore hip joint muscle strength, as evidenced by V-COR measurements in the guide group (48.80 ± 17.72mm) versus the conventional group (173.01 ± 38.08mm) (P < 0.001), and H-COR in the guide group (60.53 ± 19.28mm) versus the conventional group (267.45 ± 56.16mm) (P < 0.001). This finding is consistent with the results of several preceding studies( 26 , 27 ), indicating that 3D-printed guides indeed play a guiding role in hip arthroplasty for adult DDH patients. Furthermore, the subsequent follow-up revealed that the utilization of 3D printed guides also contributed to patients' postoperative rehabilitation. Our study's findings demonstrated a notable enhancement in postoperative joint function recovery attributed to precise acetabular positioning. Specifically, the Harris scores at the 3rd and 6th postoperative months were markedly higher in the guide plate group (91.46 ± 2.47 and 94.69 ± 2.66) compared to the conventional group (87.77 ± 3.70 and 91.15 ± 3.74). This underscores the pivotal role of accurate acetabular prosthesis placement in facilitating patients' postoperative functional recovery and overall quality of life. However, it is essential to acknowledge the limitations of this study. Firstly, the sample size is relatively small, and it is a single-center study, potentially introducing selection and geographical biases. Thus, expanding the sample size and conducting multicenter studies are imperative to validate the stability and reliability of the findings. Secondly, the follow-up period was relatively short, precluding a comprehensive assessment of the long-term efficacy and safety of 3D-printed guides. Subsequent research endeavors should focus on extending the observation duration to better evaluate long-term postoperative outcomes and enhance understanding of their clinical value. In conclusion, this study affirms the efficacy of 3D-printed guides in adult DDH total hip replacement, which can enhance accuracy, safety, and postoperative recovery. It introduces novel ideas and methods for clinical practice, offering a more effective treatment option for adult DDH. Future investigations should prioritize optimizing guide plate design and preparation techniques, as well as exploring personalized treatment strategies to achieve superior clinical outcomes and enhance patient satisfaction. Conclusions Application of three-dimensional printing guides in THA for correcting DDH can decrease surgical duration and blood loss. Additionally, it aids in reestablishing the hip joint's center of rotation, expediting joint function recovery, and enhancing the prognosis for adults undergoing DDH THA. Abbreviations Full name Abbreviations Developmental dysplasia of the hip DDH Total hip arthroplasty THA center-edge angle CEA vertical centre of rotation V-COR horizontal centre of rotation H-COR computer-assisted surgery CAS three-dimensional 3D Declarations Informed consent: Informed consent was obtained from all individual participants included in the study, This retrospective study involving human participants adhered to the ethical standards set by the Institutional and National Research Councils, as well as the 1964 Helsinki Protocol and its subsequent amendments or any other comparable ethical standards. The study was also approved by the First People's Hospital of Guangzhou (K-2018-137-01). Conflict of Interest: The authors declare that they have no conflict of interest. Funding: This study was supported by the Science and Technology Program Fund of Guangdong Provincial Department of Science and Technology (2023A03J0957); the Featured Project of Guangzhou Municipal Family Planning and Health Commission of Guangdong Province (2023C-TS20); the Natural Science Foundation of Guangdong Province (2023A1515010557, 2021A1515012564), the Science and Technology Program Fund of Guangdong Province ( 2017B090911008) grants,The data materials in the study are available, and the software used in the study is open freeware. Author Contribution All authors contributed to the conceptualization and design of the study. Huanwen Ding, Han Yan, Haotian Zhu, Kai Cheng, and Yuanhao Peng were responsible for program implementation, data collection, and analysis. Kang Liu and Yuning Wang designed and optimized the surgical protocol. Haotian Zhu initially drafted the manuscript, which was subsequently reviewed and revised by all authors to produce the final draft. All authors acknowledge their responsibility for all aspects of the manuscript and the study. Data Availability All data generated or analysed during this study are included in this published article and specific detailed data are available from the corresponding author upon reasonable request. References Mulpuri K, Schaeffer EK, Price CT. Global Collaborations in Developmental Dysplasia of the Hip. Indian J Orthop. 2020;55(6):1357–9. Tian FD, Zhao DW, Wang W, Guo L, Tian SM, Feng A, et al. Prevalence of Developmental Dysplasia of the Hip in Chinese Adults: A Cross-sectional Survey. Chin Med J (Engl). 2017;130(11):1261–8. Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003(417):112–20. Li Y, Guo Y, Li M, Zhou Q, Liu Y, Chen W, et al. Acetabular index is the best predictor of late residual acetabular dysplasia after closed reduction in developmental dysplasia of the hip. Int Orthop. 2018;42(3):631–40. Novais EN, Hill MK, Carry PM, Heyn PC. Is Age or Surgical Approach Associated With Osteonecrosis in Patients With Developmental Dysplasia of the Hip? A Meta-analysis. Clin Orthop Relat Res. 2016;474(5):1166–77. Vallamshetla VR, Mughal E, O'Hara JN. Congenital dislocation of the hip. A re-appraisal of the upper age limit for treatment. J Bone Joint Surg Br. 2006;88(8):1076–81. Cherney DL, Westin GW. Acetabular development in the infant's dislocated hips. Clin Orthop Relat Res. 1989(242):98–103. Shen B. Hip preservation and replacement surgery for developmental hip dysplasia - a standardised stepwise treatment from childhood, adolescence to adulthood. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2021;35(12):1509–12. Chinese. Fahlbusch H, Budin M, Volk A, von Rehlingen Prinz F, Linke P, Citak M, et al. Long-term outcomes of total hip arthroplasty in patients with developmental dysplasia of the hip: a minimum 21-year follow-up. Arch Orthop Trauma Surg. 2023;143(11):6609–16. Levesque JN, Shah A, Ekhtiari S, Yan JR, Thornley P, Williams DS. Three-dimensional printing in orthopaedic surgery: a scoping review. EFORT Open Rev. 2020;5(7):430–41. Wong RMY, Wong PY, Liu C, Chung YL, Wong KC, Tso CY, et al. 3D printing in orthopaedic surgery: a scoping review of randomized controlled trials. Bone Joint Res. 2021;10(12):807–19. Liaw CK, Hou SM, Yang RS, Wu TY, Fuh CS. A new tool for measuring cup orientation in total hip arthroplasties from plain radiographs. Clin Orthop Relat Res. 2006;451:134–9. Cheng Feng. Evaluation of the efficacy of rotary centre upstaged total hip arthroplasty for Crowe's type. II and III DDH [Masters]; 2023. Stans AA, Pagnano MW, Shaughnessy WJ, Hanssen AD. Results of total hip arthroplasty for Crowe Type III developmental hip dysplasia. Clin Orthop Relat Res. 1998(348):149–57. Ondeck NT, Borsinger TM, Chalmers BP, Blevins JL. Correcting Hip Dysplasia in Young Adults: Intraoperative Navigation and Outcomes. Hss j. 2023;19(4):501–6. Dargel J, Oppermann J, Brüggemann GP, Eysel P. Dislocation following total hip replacement. Dtsch Arztebl Int. 2014;111(51–52):884–90. Nyirjesy SC, Heller M, von Windheim N, Gingras A, Kang SY, Ozer E, et al. The role of computer aided design/computer assisted manufacturing (CAD/CAM) and 3- dimensional printing in head and neck oncologic surgery: A review and future directions. Oral Oncol. 2022;132:105976. Gebhard F, Krettek C, Hüfner T. Computer aided orthopedic surgery (CAOS) -- a rapidly evolving technology. Injury. 2004;35(Suppl 1):S–a1. Joskowicz L, Hazan EJ. Computer Aided Orthopaedic Surgery: Incremental shift or paradigm change? Med Image Anal. 2016;33:84–90. LaCour M, Ta M, Nachtrab J, Nguyen T, Komistek R. Determination of optimal component positioning in THA using 3D preoperative planning. J Orthop Res. 2024. Zhang R, Lin J, Chen F, Liu W, Chen M. Clinical and radiological outcomes in three-dimensional printing assisted revision total hip and knee arthroplasty: a systematic review. J Orthop Surg Res. 2021;16(1):495. Savov P, Budde S, Tsamassiotis S, Windhagen H, Klintschar M, Ettinger M. Three-dimensional templating in hip arthroplasty: the basis for template-directed instrumentation? Arch Orthop Trauma Surg. 2020;140(6):827–33. Anzillotti G, Guazzoni E, Conte P, Di Matteo V, Kon E, Grappiolo G et al. Using Three-Dimensional Printing Technology to Solve Complex Primary Total Hip Arthroplasty Cases: Do We Really Need Custom-Made Guides and Templates? A Critical Systematic Review on the Available Evidence. J Clin Med. 2024;13(2). Tu Q, Ding HW, Chen H, Shen JJ, Miao QJ, Liu B, et al. Preliminary application of 3D-printed individualised guiding templates for total hip arthroplasty in Crowe type IV developmental dysplasia of the hip. Hip Int. 2022;32(3):334–44. Xu J, Li D, Ma RF, Barden B, Ding Y. Application of Rapid Prototyping Pelvic Model for Patients with DDH to Facilitate Arthroplasty Planning: A Pilot Study. J Arthroplasty. 2015;30(11):1963–70. Liaw CY, Guvendiren M. Current and emerging applications of 3D printing in medicine. Biofabrication. 2017;9(2):024102. Yan L, Wang P, Zhou H. 3D Printing Navigation Template Used in Total Hip Arthroplasty for Developmental Dysplasia of the Hip. Indian J Orthop. 2020;54(6):856–62. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4543432","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":314147918,"identity":"c45b41c7-21e7-4589-8bd7-d651ce1c2241","order_by":0,"name":"Haotian Zhu","email":"","orcid":"","institution":"South China University of Technology","correspondingAuthor":false,"prefix":"","firstName":"Haotian","middleName":"","lastName":"Zhu","suffix":""},{"id":314147919,"identity":"a7a4d886-e484-4dd6-ae27-afd56ec4dee6","order_by":1,"name":"kai Cheng","email":"","orcid":"","institution":"Guangzhou First People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"kai","middleName":"","lastName":"Cheng","suffix":""},{"id":314147920,"identity":"9a71a783-6438-4763-8108-33180b0e4fbd","order_by":2,"name":"Yuanhao Peng","email":"","orcid":"","institution":"South China University of Technology","correspondingAuthor":false,"prefix":"","firstName":"Yuanhao","middleName":"","lastName":"Peng","suffix":""},{"id":314147922,"identity":"97d6c187-9fc9-46a9-b81b-deee4a61360f","order_by":3,"name":"Yuning Wang","email":"","orcid":"","institution":"South China University of Technology","correspondingAuthor":false,"prefix":"","firstName":"Yuning","middleName":"","lastName":"Wang","suffix":""},{"id":314147924,"identity":"25fce789-98f1-433f-97ba-1f68060743b5","order_by":4,"name":"kang Liu","email":"","orcid":"","institution":"South China University of Technology","correspondingAuthor":false,"prefix":"","firstName":"kang","middleName":"","lastName":"Liu","suffix":""},{"id":314147926,"identity":"45074e85-5c48-4512-b442-07eca59c75d9","order_by":5,"name":"Huanwen Ding","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzklEQVRIiWNgGAWjYBACe2YGBiCygXLZiNBi2AzWksYApojSYnAArPYwKVqO8x5+Xdh23p5/Rv4Bhg9lhxn4ZzcQ0HKYL816ZtvtxBk3khkYZ5w7zCBx5wAhLTxmxrzbbicYSCQzMPO2HWYwkEggSss5e7CWv0RqMX7Mu+0A4waQFkZitBg285gx8/5LTpxx5rHBwZ5z6TwSNwhosec/Y/yZ54ydPX974sMHP8qs5fhnENACBGwSMNYBIOYhqB4ImD8Qo2oUjIJRMApGMAAAb6A+r7CBzuwAAAAASUVORK5CYII=","orcid":"","institution":"South China University of Technology","correspondingAuthor":true,"prefix":"","firstName":"Huanwen","middleName":"","lastName":"Ding","suffix":""},{"id":314147928,"identity":"02688b40-67f3-45bf-a1d8-2db5d124dfa5","order_by":6,"name":"Han Yan","email":"","orcid":"","institution":"Guangzhou First People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Han","middleName":"","lastName":"Yan","suffix":""}],"badges":[],"createdAt":"2024-06-07 04:38:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4543432/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4543432/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":59968421,"identity":"fd3f7f94-268a-4ed3-bb59-b96d08557094","added_by":"auto","created_at":"2024-07-10 02:35:31","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":82518,"visible":true,"origin":"","legend":"\u003cp\u003eA depicts a three-dimensional model of bilateral pelvises. B and C offer rotational comparisons, facilitating the observation of pelvic morphology on the healthy and affected sides, respectively. C specifically illustrates the abnormal development of the left acetabulum.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4543432/v1/ed1e45de1630dc71ab341774.jpg"},{"id":59968426,"identity":"bfcdb5df-a9d5-423d-a542-ab850f96a3c1","added_by":"auto","created_at":"2024-07-10 02:35:31","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":682138,"visible":true,"origin":"","legend":"\u003cp\u003eDemonstrates the alignment process of the pelvis to the standard anatomical position. A is the pelvic model remains unaligned. B depicts the Y-plane alignment achieved by using line 1 as the datum line, highlighted in red and black. C illustrates the pelvic Z-plane alignment with line 1 positioned at an angle of 2.0071° to the Z-plane, resulting in a fully aligned pelvic model, shown in blue and yellow. D presents the fully aligned pelvic model, denoted as line 1'', line 2'', sphere 1'', and sphere 2'' are completely aligned. Post-positioning datum marks are also aligned.\u003c/p\u003e","description":"","filename":"f2.png","url":"https://assets-eu.researchsquare.com/files/rs-4543432/v1/ec73a17e4337f315c8762cc5.png"},{"id":59968422,"identity":"50ce561e-219e-4586-9596-564ac238482c","added_by":"auto","created_at":"2024-07-10 02:35:31","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":48199,"visible":true,"origin":"","legend":"\u003cp\u003eProsthesis Prediction. A Prediction of the external cup of acetabulum size based on the shape of the deformed acetabulum. B Virtual model of the acetabular prosthesis.\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4543432/v1/b4660245d78d48029b48fa77.jpg"},{"id":59968423,"identity":"607cd25c-420d-4510-8517-542c71d91a11","added_by":"auto","created_at":"2024-07-10 02:35:31","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":181048,"visible":true,"origin":"","legend":"\u003cp\u003eGuide Design. A Identify the true acetabulum and manufacture a positioning guide customized to its contours. B and C Set the positioning guides for 40°of abduction and 15° of anterior tilt.D Simulate Kirschner wire fixation at a predetermined angle and add a needle slot. E Parallel K-wire design the grinding positioning device. F Virtual and tangible representations of the Acetabular Positioning Navigator. G Virtual and tangible models of the grinding positioning device.\u003c/p\u003e","description":"","filename":"Figure4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4543432/v1/05b3b7d025142223267fd208.jpg"},{"id":59969633,"identity":"b704514d-23c2-469e-bbd0-283d40f16d4d","added_by":"auto","created_at":"2024-07-10 02:51:31","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":598639,"visible":true,"origin":"","legend":"\u003cp\u003eA Place the acetabular positioning guide and insert Kirschner needles. B Position the grinding positioning device to guide acetabular file grinding. C and D After satisfactory acetabular grinding, select and install the appropriate prosthesis parallel to Kirschner needles.\u003c/p\u003e","description":"","filename":"Figure5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4543432/v1/385c4951e7bb58ab4f2c529c.jpg"},{"id":59969307,"identity":"8ad1ad84-ae25-4a30-83e3-4909abaab8cf","added_by":"auto","created_at":"2024-07-10 02:43:31","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":270179,"visible":true,"origin":"","legend":"\u003cp\u003ePresents a comparative analysis between the Conventional Group (A and B) and the Guide Plate Group (C and D). A and C The preoperative pelvic radiographs of patients with DDH exhibit clear signs of acetabular and femoral head dysplasia, along with dislocation. B and D The post-THA X-rays taken two days post-surgery illustrate that the prosthetic implants are correctly positioned and indicate a superior hip joint recovery.\u003c/p\u003e","description":"","filename":"Figure6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4543432/v1/5533b7f8b6624368af9a4fa2.jpg"},{"id":97330637,"identity":"11016e04-c4b1-41cf-ae83-bc6454dc0f69","added_by":"auto","created_at":"2025-12-03 09:09:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2450580,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4543432/v1/d19294bb-8463-4cd3-a419-34d6a8de89e5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Conventional versus guide plate-assisted total hip arthroplasty for congenital hip dysplasia: a case-control study","fulltext":[{"header":"Background","content":"\u003cp\u003eDevelopmental dysplasia of the hip (DDH) is a hereditary hip joint disorder, has a global prevalence ranging from 0.06 to 76.1 per 1000 live births, varying by ethnicity and region, and showing higher incidence in females(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In China, DDH prevalence averages about 1.52%, with rates of 0.75% in men and 2.07% in women(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Clinical manifestations of DDH include acetabular undercoverage, dislocation, and abnormal femoral head wear due to acetabular dysplasia or improper development, leading to hip arthritis, degeneration, and joint dysfunction(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Early-stage DDH typically receives non-surgical interventions such as closed reduction, braces, medications, or surgical procedures like femoral osteotomy or open reduction to restore and maintain acetabular-femoral head congruency for joint remodeling. Research indicates a 4\u0026ndash;7 year duration for complete joint remodeling post-repositioning in DDH(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), with optimal results achievable before age 11 to prevent femoral head deformity and necrosis(\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In adult DDH, long-term abnormal pressure and friction on the femoral head due to inadequate treatment result in dislocation, bone and cartilage wear, and femoral head deformation and necrosis secondary to hip osteoarthritis(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Treatment strategies focus on correcting head-socket abnormalities, enhancing hip joint stability, alleviating pain, and restoring function.\u003c/p\u003e \u003cp\u003eHip replacement surgery (HRS), including surface replacement and Total hip arthroplasty (THA), effectively addresses adult developmental dysplasia of the hip (DDH) by rectifying acetabular dysplasia and degeneration using an artificial hip prosthesis(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). While the efficacy of surface replacement remains uncertain, it is suitable for milder DDH cases (Crowe's type I and II), whereas severe DDH (Crowe's type III or IV) typically necessitates THA due to complications such as femoral head flattening and hip osteoarthritis. However, THA efficacy depends on intraoperative osteotomy and precise prosthesis placement. Traditional THA relies on visual identification of anatomical landmarks for acetabular localization, osteotomy, and prosthesis placement, carrying risks of intraoperative fracture, nerve injury, and improper cup placement. This emphasizes the necessity for precise, personalized surgical adjuncts to optimize THA outcomes.\u003c/p\u003e \u003cp\u003eIn recent years, digital tech like computer-assisted surgery and 3D printing has revolutionized THA(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). It allows for precise preoperative planning, custom surgical guides, and tailored prostheses based on patient imaging data, improving placement accuracy and adaptability(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). 3D-printed guides offer quick production, cost efficiency, and personalized solutions, which can introduce novel treatment options to clinical practice.\u003c/p\u003e \u003cp\u003eHenceforth, we have introduced a 3D-printed guide plate to aid in conducting THA for DDH, scrutinized its utilization, and investigated its influence on surgical precision and patient recuperation. Our objective is to furnish fresh insights and methodologies for clinical implementation.\u003c/p\u003e \u003c/ul\u003e \u003c/p\u003e"},{"header":"Patients And Methods","content":"\n\u003ch3\u003e1. Data Collection\u003c/h3\u003e\n\u003cp\u003eThis study retrospectively analyzed clinical data from DDH patients undergoing THA at our hospital between October 2020 and March 2023. Twenty-six DDH patients (26 hips) were selected based on specific criteria and divided into two groups: guide plate (n\u0026thinsp;=\u0026thinsp;13, mean age 53.92\u0026thinsp;\u0026plusmn;\u0026thinsp;19.15 years) and conventional (n\u0026thinsp;=\u0026thinsp;13, mean age 51.38\u0026thinsp;\u0026plusmn;\u0026thinsp;13.76 years), depending on 3D-printed guide plate usage during THA. All procedures were performed by the same experienced orthopedic surgeon(Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Inclusion criteria: 1. Definitive DDH diagnosis; 2. Age\u0026thinsp;\u0026ge;\u0026thinsp;18 years; 3. Persistent severe hip joint pain and functional impairment; 4. Failure of adequate non-surgical therapy; 5. Complete medical records. Exclusion criteria: 1. Active hip joint infection or other infectious diseases; 2. Age\u0026thinsp;\u0026lt;\u0026thinsp;18 years; 3. Severe systemic diseases; 4. Patient intolerance to anesthesia and surgery; 5. Severe osteoporosis; 6. Loss to follow-up or incomplete medical records.\u003c/p\u003e \u003cp\u003e This study, approved by the Research Ethics Committee of the First People's Hospital of Guangzhou (Approval No. K-2018-137-01), adheres to the Helsinki Declaration. All patients provided informed written consent.\u003c/p\u003e \u003cp\u003ePreoperatively, patients underwent pelvic X-rays, CT scans from the anterior superior iliac spine to the ankle joint (slice thickness 0.5-1.0 mm), routine chest X-rays, electrocardiograms, and laboratory tests. Data from the conventional group were managed routinely for preoperative discussions. Data from the guide plate group were saved in DICOM format for personalized surgical guide design and production based on patient anatomical data.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2. Preoperative Preparation\u003c/h2\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003e2.1 Standard Group\u003c/h2\u003e \u003cp\u003ePreoperative discussions in the standard group rely on imaging data such as X-rays and CT scans to determine the surgical incision, acetabular positioning, and prosthetic implantation.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Template Group\u003c/h2\u003e \u003cp\u003eIn the template group, DICOM format imaging data, including X-rays and CT scans, are imported into MIMICS 21.0 software (Materialize, Leuven, Belgium) to construct a 3D digital model of the patient's pelvis. The acetabular development is observed by rotating the model (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) and exported in STL format. Alignment to the standard anatomical position and surgical template design are performed using ImageWare 13.0 software (developed by UGS Corporation, Plano, TX, USA).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient information (n\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eSide\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003eCrowe Classification\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGuide Plate Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9(M)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(F)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23\u0026ndash;79(53.92\u0026thinsp;\u0026plusmn;\u0026thinsp;19.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7(L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6(R)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4(Ⅲ)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e9(IV)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConventional Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(M)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(F)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31\u0026ndash;72(51.38\u0026thinsp;\u0026plusmn;\u0026thinsp;13.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5(L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8(R)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2(Ⅱ)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7(Ⅲ)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4(IV)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT/ χ2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.388\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP/Fisher's Exact Value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.701\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.695\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003e0.156\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePelvic Alignment (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e): A baseline is established by connecting the lowest points of the two ischial tuberosities (line 1). Spheres 1 (healthy side) and 2 (affected side) are fitted with the center of the femoral head as their centers. The centroids of these spheres are identified through point cloud recognition and connected to form line 2, representing the centers of the femoral heads. Alignment in the Y and Z planes is achieved using line 1 as the reference, with measured angles of 1.8067\u0026deg; and 2.0017\u0026deg;, respectively. The pelvic model is rotated in the Y and Z directions according to these angles to achieve complete alignment (blue and yellow colors). Lines 1'' and 2'' represent the alignment of the lowest points of the ischial tuberosities and the centers of the femoral heads after plane alignment, while spheres 1'' and 2'' represent the fitted spheres of the femoral heads after correction.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAcetabular Matching (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e): After pelvic alignment, the height of the affected-side acetabulum is determined based on the lines connecting the centers of the femoral heads on both sides. The aim is to restore the rotational center of the acetabulum after joint replacement. Predicted acetabular prostheses are matched based on acetabular size, with a design of 40\u0026deg; abduction angle and 15\u0026deg; anteversion angle.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTemplate Design (Acetabular Positioning Template and Grinding Navigator) (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e): Based on the shape of the acetabulum and the predicted acetabular prosthesis type, the shape of the positioning template is designed to fit, with a 40\u0026deg; abduction and 15\u0026deg; anteversion angle. The template is placed on the affected-side acetabulum, and channels for fixing Kirschner wires are designed on the template. A grinding navigator for the acetabulum is designed in parallel with Kirschner wire fixation, in conjunction with an acetabular file. Finally, the data is imported into Unigraphics NX software (Siemens PLM Software, Blaineau, TX, United States) for solidification. After designing and adding Kirschner wire fixation holes to the surgical template, model data is output in STL format. The template model is then produced using a 3D printer with photosensitive resin as the raw material. After sterilization with ethylene oxide, it is prepared for intraoperative use, ensuring precise acetabular positioning and prosthetic placement.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e3. Intraoperative Procedure\u003c/h2\u003e \u003cp\u003eThe patient is anesthetized and positioned laterally, followed by disinfection and a posterior lateral incision of the hip. The femoral neck, head, and joint capsule are exposed and excised. In the conventional group, the true acetabulum is identified visually, and the acetabular file is maintained at 40\u0026deg;abduction and 15\u0026deg;anterior tilt based on subjective assessment. In contrast, the guide group utilizes a positioning guide to locate the acetabulum, fixated by Kirschner wire and a grinding positioning device to ensure proper grinding angles. Grinding ceases upon subchondral bleeding, and a parallel K-wire, guided by the grinding positioning device, is put into the external cup of the acetabulum and secured. The femoral marrow cavity is routinely opened, a trial mold is inserted and assess joint stability, and an appropriate femoral stem prosthesis and artificial femoral head are selected and installed. Following joint reduction and suturing, operation time and intraoperative blood loss are recorded before concluding the procedure. Postoperatively, the abduction angle of the acetabular cup prosthesis, the anterior inclination angle measured by Liaw's method(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), the V-COR, and the H-COR(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) were measured in both groups based on the patient's review of X-ray, CT, and other imaging data.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e4. Data availability statements\u003c/strong\u003e: the data associated with the paper are not publicly available but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5. Statistical analyses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analysis employed SPSS 22.0. Normal data: mean \u0026plusmn; SD (`x\u0026plusmn;s), independent t-tests. Non-normal data: median (25th, 75th Q), rank-sum test. Gender, side, and diagnosis: Fisher\u0026apos;s exact test. p \u0026lt; 0.05 denoted statistical significance.\u003c/p\u003e"},{"header":"Result","content":"\u003cp\u003eSurgical outcomes showed no significant difference in pre- and post-surgery center-edge angle (CEA) between the two groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, significant differences were noted in surgical duration, blood loss, postoperative acetabular prosthesis angles compared to preoperative design, vertical centre of rotation(V-COR), and horizontal centre of rotation(H-COR) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05)(Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePostoperative follow-ups lasted 6\u0026ndash;24 months, with Harris scores increasing significantly. Initially, no significant difference in Harris scores between groups was observed (P\u0026thinsp;=\u0026thinsp;0.534\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Yet, differences emerged in the third and sixth postoperative months (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05)(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSurgical outcomes (n\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConventional Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGuide Plate Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eT/Z value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFollow-up time/months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.54\u0026thinsp;\u0026plusmn;\u0026thinsp;2.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.23\u0026thinsp;\u0026plusmn;\u0026thinsp;3.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.377\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.181\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical time/min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e122.46\u0026thinsp;\u0026plusmn;\u0026thinsp;53.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85.85\u0026thinsp;\u0026plusmn;\u0026thinsp;16.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2.344\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative bleeding/ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e430.77\u0026thinsp;\u0026plusmn;\u0026thinsp;215.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e248.08\u0026thinsp;\u0026plusmn;\u0026thinsp;73.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-3.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative Harris score/points\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37.38\u0026thinsp;\u0026plusmn;\u0026thinsp;6.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.46\u0026thinsp;\u0026plusmn;\u0026thinsp;4.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.364\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.185\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHarris score at 1 month postoperatively/points\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74.08\u0026thinsp;\u0026plusmn;\u0026thinsp;3.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74.92\u0026thinsp;\u0026plusmn;\u0026thinsp;3.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.632\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.534\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHarris score at 3 months postoperatively /points\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e87.77\u0026thinsp;\u0026plusmn;\u0026thinsp;3.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91.46\u0026thinsp;\u0026plusmn;\u0026thinsp;2.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2.992\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHarris score at 6 months postoperatively /points\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91.15\u0026thinsp;\u0026plusmn;\u0026thinsp;3.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94.69\u0026thinsp;\u0026plusmn;\u0026thinsp;2.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2.782\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAcetabular prosthesis angles (n\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConventional Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGuide Plate Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eT/Z value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCEA/\u0026deg;(preoperative)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.41\u0026thinsp;\u0026plusmn;\u0026thinsp;7.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.49\u0026thinsp;\u0026plusmn;\u0026thinsp;6.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.723\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.477\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCEA/\u0026deg;(postoperative)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45.03\u0026thinsp;\u0026plusmn;\u0026thinsp;9.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.36\u0026thinsp;\u0026plusmn;\u0026thinsp;8.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.642\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.527\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDifference between the anterior inclination of the acetabular prosthesis and the design angle/\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.28\u0026thinsp;\u0026plusmn;\u0026thinsp;2.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.25\u0026thinsp;\u0026plusmn;\u0026thinsp;1.71, 1.85(1.22, 3.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-3.359\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDifference between acetabular prosthesis abduction angle and design angle /\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.66\u0026thinsp;\u0026plusmn;\u0026thinsp;5.20, 8.51(5.51, 11.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.28\u0026thinsp;\u0026plusmn;\u0026thinsp;4.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2.487\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV-COR/mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e173.01\u0026thinsp;\u0026plusmn;\u0026thinsp;38.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.80\u0026thinsp;\u0026plusmn;\u0026thinsp;17.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-10.663\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eH-COR/mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e267.45\u0026thinsp;\u0026plusmn;\u0026thinsp;56.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.53\u0026thinsp;\u0026plusmn;\u0026thinsp;19.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.565\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTHA represents the definitive treatment for adult DDH. Given the intricate nature of congenital dysplasia affecting the patient's acetabulum, compounded by long-term degeneration from activities such as sports, osteoarthritis and pseudoacetabular socket often ensues(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAnd it is difficult to accurately diagnose and correct severely deformed acetabular structures with conventional preoperative two-dimensional image planning and intraoperative placement of prostheses based on bony and cartilaginous landmarks such as sciatic notch and transverse acetabular ligament(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eProsthesis positioning based solely on visual and subjective sensation is both time-consuming and labor-intensive, yielding variable surgical outcomes. This method often results in an elevated risk of postoperative complications, including dislocation, prosthesis wear, and instability, consequently increasing the likelihood of prosthesis revision. Statistical estimates suggest a dislocation rate of up to 2% within the first year following routine THA and a revision rate as high as 28% among patients requiring prosthesis revision(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Therefore, meticulous preoperative deformity diagnosis, surgical planning, precise intraoperative acetabular positioning, restoration of the center of rotation, and meticulous control over the angle of acetabular cup placement are imperative facets of surgical management.\u003c/p\u003e \u003cp\u003eThe rapid evolution of computer technology has led to a revolutionary computer-assisted surgery (CAS) technology, integrating medical, engineering, materials, and technological disciplines(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). CAS can virtually simulates surgical procedures through 3D data analysis, enabling real-time guidance, precise planning, and automated or semi-automated execution upon physician consent(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), thereby optimizing surgical speed, safety, and efficiency(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis technology allows for real-time, in-depth analysis of hip joint lesions by dynamically manipulating a 3D model of the DDH patient's pelvis on a computer interface. This interactive approach offers precise data on acetabular deformities and enhances the accuracy of preoperative prosthesis prediction, significantly benefiting the primary surgeon's decision-making process(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn a cadaveric study, Savov(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) et al. showcased the precision of preoperative 3D-planning in accurately determining the hip joint's center of rotation, the optimal angle for prosthesis positioning, and predicting the appropriate prosthetic size, thereby substantiating CAS technology significance in surgical decision-making.\u003c/p\u003e \u003cp\u003eThis study employed a three-dimensional (3D) pelvic model, generated through computer software and the image fitting method, to visually assess the hip deformity, locate the true socket, and predict prosthesis size prior to surgery. The study further employed a custom surgical guide plate, designed and printed to conform to the acetabular surface, which resulted in a shorter operation time (85.85\u0026thinsp;\u0026plusmn;\u0026thinsp;16.44 minutes vs. 122.46\u0026thinsp;\u0026plusmn;\u0026thinsp;53.86 minutes, P\u0026thinsp;=\u0026thinsp;0.028), reduced bleeding (248.08\u0026thinsp;\u0026plusmn;\u0026thinsp;73.50 ml vs. 430.77\u0026thinsp;\u0026plusmn;\u0026thinsp;215.58 ml, P\u0026thinsp;=\u0026thinsp;0.008), and enhanced the safety and surgical precision.\u003c/p\u003e \u003cp\u003eCAS has significantly evolved in orthopedic surgery, primarily by enabling real-time, computer-assisted guidance for minimally invasive, accurate, and personalized procedures through virtual imaging. While 3D printing technology, capable of converting virtual images into physical models, has yet to be fully harnessed in surgical support, its current focus lies in the use of 3D-printed surgical guide plates and pelvic replicas for surgical planning and intraoperative guidance(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTu(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) et al. conducted a study using 3D-printed guide plates in a single-group crowe type IV DDH treated with THA, which corrected the patient's unequal legs in a timely manner and also resulted in a favourable prognosis.\u003c/p\u003e \u003cp\u003eXu et al. reported a discrepancy of no more than 2 sizes in the predicted prosthetic fit when utilizing a 3D-printed pelvic model to facilitate THA for osteoarthritis resulting from DDH(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur study employed geometric mapping techniques to establish reference lines, such as the line connecting the centers of both femoral heads and the lowest point of the ischial tuberosities, for pelvic alignment. By securing the implant angle and designing custom positioning templates and grinding guides, the plates were sterilized and used intraoperatively to enhance the accuracy of THA acetabular component placement in DDH patients. In the guide plate group, the difference between the anterior inclination of the acetabular prosthesis and the design angle was 2.25\u0026thinsp;\u0026plusmn;\u0026thinsp;1.71\u0026deg;,1.85 (1.22, 3.28), whereas in the conventional group, it was 5.28\u0026thinsp;\u0026plusmn;\u0026thinsp;2.42\u0026deg;(P\u0026thinsp;=\u0026thinsp;0.001). Similarly, the difference between the acetabular abduction angle and the predicted angle in the guide plate group was 4.28\u0026thinsp;\u0026plusmn;\u0026thinsp;4.28\u0026deg;, compared to 8.66\u0026thinsp;\u0026plusmn;\u0026thinsp;5.20\u0026deg; 8.51(5.51, 11.80) in the conventional group (P\u0026thinsp;=\u0026thinsp;0.013). Additionally, the intervention aimed to address hip joint deformities and restore hip joint muscle strength, as evidenced by V-COR measurements in the guide group (48.80\u0026thinsp;\u0026plusmn;\u0026thinsp;17.72mm) versus the conventional group (173.01\u0026thinsp;\u0026plusmn;\u0026thinsp;38.08mm) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and H-COR in the guide group (60.53\u0026thinsp;\u0026plusmn;\u0026thinsp;19.28mm) versus the conventional group (267.45\u0026thinsp;\u0026plusmn;\u0026thinsp;56.16mm) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This finding is consistent with the results of several preceding studies(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e), indicating that 3D-printed guides indeed play a guiding role in hip arthroplasty for adult DDH patients.\u003c/p\u003e \u003cp\u003eFurthermore, the subsequent follow-up revealed that the utilization of 3D printed guides also contributed to patients' postoperative rehabilitation. Our study's findings demonstrated a notable enhancement in postoperative joint function recovery attributed to precise acetabular positioning. Specifically, the Harris scores at the 3rd and 6th postoperative months were markedly higher in the guide plate group (91.46\u0026thinsp;\u0026plusmn;\u0026thinsp;2.47 and 94.69\u0026thinsp;\u0026plusmn;\u0026thinsp;2.66) compared to the conventional group (87.77\u0026thinsp;\u0026plusmn;\u0026thinsp;3.70 and 91.15\u0026thinsp;\u0026plusmn;\u0026thinsp;3.74). This underscores the pivotal role of accurate acetabular prosthesis placement in facilitating patients' postoperative functional recovery and overall quality of life.\u003c/p\u003e \u003cp\u003eHowever, it is essential to acknowledge the limitations of this study. Firstly, the sample size is relatively small, and it is a single-center study, potentially introducing selection and geographical biases. Thus, expanding the sample size and conducting multicenter studies are imperative to validate the stability and reliability of the findings. Secondly, the follow-up period was relatively short, precluding a comprehensive assessment of the long-term efficacy and safety of 3D-printed guides. Subsequent research endeavors should focus on extending the observation duration to better evaluate long-term postoperative outcomes and enhance understanding of their clinical value.\u003c/p\u003e \u003cp\u003eIn conclusion, this study affirms the efficacy of 3D-printed guides in adult DDH total hip replacement, which can enhance accuracy, safety, and postoperative recovery. It introduces novel ideas and methods for clinical practice, offering a more effective treatment option for adult DDH. Future investigations should prioritize optimizing guide plate design and preparation techniques, as well as exploring personalized treatment strategies to achieve superior clinical outcomes and enhance patient satisfaction.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eApplication of three-dimensional printing guides in THA for correcting DDH can decrease surgical duration and blood loss. Additionally, it aids in reestablishing the hip joint's center of rotation, expediting joint function recovery, and enhancing the prognosis for adults undergoing DDH THA.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFull name\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbbreviations\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eDevelopmental dysplasia of the hip\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eDDH\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eTotal hip arthroplasty\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eTHA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003ecenter-edge angle\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eCEA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003evertical centre of rotation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eV-COR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003ehorizontal centre of rotation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eH-COR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003ecomputer-assisted surgery\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eCAS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003ethree-dimensional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e3D\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eInformed consent:\u003c/h2\u003e \u003cp\u003e Informed consent was obtained from all individual participants included in the study, This retrospective study involving human participants adhered to the ethical standards set by the Institutional and National Research Councils, as well as the 1964 Helsinki Protocol and its subsequent amendments or any other comparable ethical standards. The study was also approved by the First People's Hospital of Guangzhou (K-2018-137-01).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConflict of Interest:\u003c/strong\u003e \u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThis study was supported by the Science and Technology Program Fund of Guangdong Provincial Department of Science and Technology (2023A03J0957); the Featured Project of Guangzhou Municipal Family Planning and Health Commission of Guangdong Province (2023C-TS20); the Natural Science Foundation of Guangdong Province (2023A1515010557, 2021A1515012564), the Science and Technology Program Fund of Guangdong Province ( 2017B090911008) grants,The data materials in the study are available, and the software used in the study is open freeware.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to the conceptualization and design of the study. Huanwen Ding, Han Yan, Haotian Zhu, Kai Cheng, and Yuanhao Peng were responsible for program implementation, data collection, and analysis. Kang Liu and Yuning Wang designed and optimized the surgical protocol. Haotian Zhu initially drafted the manuscript, which was subsequently reviewed and revised by all authors to produce the final draft. All authors acknowledge their responsibility for all aspects of the manuscript and the study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAll data generated or analysed during this study are included in this published article and specific detailed data are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMulpuri K, Schaeffer EK, Price CT. Global Collaborations in Developmental Dysplasia of the Hip. Indian J Orthop. 2020;55(6):1357\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTian FD, Zhao DW, Wang W, Guo L, Tian SM, Feng A, et al. Prevalence of Developmental Dysplasia of the Hip in Chinese Adults: A Cross-sectional Survey. Chin Med J (Engl). 2017;130(11):1261\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGanz R, Parvizi J, Beck M, Leunig M, N\u0026ouml;tzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003(417):112\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi Y, Guo Y, Li M, Zhou Q, Liu Y, Chen W, et al. Acetabular index is the best predictor of late residual acetabular dysplasia after closed reduction in developmental dysplasia of the hip. Int Orthop. 2018;42(3):631\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNovais EN, Hill MK, Carry PM, Heyn PC. Is Age or Surgical Approach Associated With Osteonecrosis in Patients With Developmental Dysplasia of the Hip? A Meta-analysis. Clin Orthop Relat Res. 2016;474(5):1166\u0026ndash;77.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVallamshetla VR, Mughal E, O'Hara JN. Congenital dislocation of the hip. A re-appraisal of the upper age limit for treatment. J Bone Joint Surg Br. 2006;88(8):1076\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCherney DL, Westin GW. Acetabular development in the infant's dislocated hips. Clin Orthop Relat Res. 1989(242):98\u0026ndash;103.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShen B. Hip preservation and replacement surgery for developmental hip dysplasia - a standardised stepwise treatment from childhood, adolescence to adulthood. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2021;35(12):1509\u0026ndash;12. Chinese.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFahlbusch H, Budin M, Volk A, von Rehlingen Prinz F, Linke P, Citak M, et al. Long-term outcomes of total hip arthroplasty in patients with developmental dysplasia of the hip: a minimum 21-year follow-up. Arch Orthop Trauma Surg. 2023;143(11):6609\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLevesque JN, Shah A, Ekhtiari S, Yan JR, Thornley P, Williams DS. Three-dimensional printing in orthopaedic surgery: a scoping review. EFORT Open Rev. 2020;5(7):430\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWong RMY, Wong PY, Liu C, Chung YL, Wong KC, Tso CY, et al. 3D printing in orthopaedic surgery: a scoping review of randomized controlled trials. Bone Joint Res. 2021;10(12):807\u0026ndash;19.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiaw CK, Hou SM, Yang RS, Wu TY, Fuh CS. A new tool for measuring cup orientation in total hip arthroplasties from plain radiographs. Clin Orthop Relat Res. 2006;451:134\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCheng Feng. Evaluation of the efficacy of rotary centre upstaged total hip arthroplasty for Crowe's type. II and III DDH [Masters]; 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStans AA, Pagnano MW, Shaughnessy WJ, Hanssen AD. Results of total hip arthroplasty for Crowe Type III developmental hip dysplasia. Clin Orthop Relat Res. 1998(348):149\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOndeck NT, Borsinger TM, Chalmers BP, Blevins JL. Correcting Hip Dysplasia in Young Adults: Intraoperative Navigation and Outcomes. Hss j. 2023;19(4):501\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDargel J, Oppermann J, Br\u0026uuml;ggemann GP, Eysel P. Dislocation following total hip replacement. Dtsch Arztebl Int. 2014;111(51\u0026ndash;52):884\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNyirjesy SC, Heller M, von Windheim N, Gingras A, Kang SY, Ozer E, et al. The role of computer aided design/computer assisted manufacturing (CAD/CAM) and 3- dimensional printing in head and neck oncologic surgery: A review and future directions. Oral Oncol. 2022;132:105976.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGebhard F, Krettek C, H\u0026uuml;fner T. Computer aided orthopedic surgery (CAOS) -- a rapidly evolving technology. Injury. 2004;35(Suppl 1):S\u0026ndash;a1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJoskowicz L, Hazan EJ. Computer Aided Orthopaedic Surgery: Incremental shift or paradigm change? Med Image Anal. 2016;33:84\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLaCour M, Ta M, Nachtrab J, Nguyen T, Komistek R. Determination of optimal component positioning in THA using 3D preoperative planning. J Orthop Res. 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang R, Lin J, Chen F, Liu W, Chen M. Clinical and radiological outcomes in three-dimensional printing assisted revision total hip and knee arthroplasty: a systematic review. J Orthop Surg Res. 2021;16(1):495.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSavov P, Budde S, Tsamassiotis S, Windhagen H, Klintschar M, Ettinger M. Three-dimensional templating in hip arthroplasty: the basis for template-directed instrumentation? Arch Orthop Trauma Surg. 2020;140(6):827\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnzillotti G, Guazzoni E, Conte P, Di Matteo V, Kon E, Grappiolo G et al. Using Three-Dimensional Printing Technology to Solve Complex Primary Total Hip Arthroplasty Cases: Do We Really Need Custom-Made Guides and Templates? A Critical Systematic Review on the Available Evidence. J Clin Med. 2024;13(2).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTu Q, Ding HW, Chen H, Shen JJ, Miao QJ, Liu B, et al. Preliminary application of 3D-printed individualised guiding templates for total hip arthroplasty in Crowe type IV developmental dysplasia of the hip. Hip Int. 2022;32(3):334\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu J, Li D, Ma RF, Barden B, Ding Y. Application of Rapid Prototyping Pelvic Model for Patients with DDH to Facilitate Arthroplasty Planning: A Pilot Study. J Arthroplasty. 2015;30(11):1963\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiaw CY, Guvendiren M. Current and emerging applications of 3D printing in medicine. Biofabrication. 2017;9(2):024102.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYan L, Wang P, Zhou H. 3D Printing Navigation Template Used in Total Hip Arthroplasty for Developmental Dysplasia of the Hip. Indian J Orthop. 2020;54(6):856\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Total hip arthroplasty, Developmental Dysplasia of the Hip, 3D printing, Osteoarthritis","lastPublishedDoi":"10.21203/rs.3.rs-4543432/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4543432/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003eTotal hip arthroplasty effectively treats developmental dysplasia of the hip. Severe acetabular deformities present challenges for accurate positioning and prosthetic placement. The advent of three-dimensional printing offers a solution.The aim of this study was to investigate the clinical efficacy of 3D printed surgical guides in total hip arthroplasty for hip dysplasia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatients and Methods:\u003c/strong\u003e A retrospective case-control study was conducted on total hip arthroplasty for hip dysplasia patients treated between 2020 and 2023. Prosthetic implantation outcomes and prognostic indicators were assessed in 26 patients (13 guided procedures, 13 conventional procedures) utilizing customized surgical guides or conventional total hip arthroplasty.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eNo significant differences were observed between the groups regarding gender, age, affected hip side, Crowe grading, and central rim angle(P\u0026gt;0.05). However, significant disparities were noted in operative time, blood loss, acetabular prosthesis angle and horizontal and vertical distance from the centre of rotation(P\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e3D-printed guides significantly reduce operative time, diminish blood loss, restore the hip joint's center of rotation, and enhance the prognosis of total hip arthroplasty in adults with hip dysplasia.\u003c/p\u003e","manuscriptTitle":"Conventional versus guide plate-assisted total hip arthroplasty for congenital hip dysplasia: a case-control study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-10 02:35:26","doi":"10.21203/rs.3.rs-4543432/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"609b7dcf-618a-420c-b60e-3da39454ce59","owner":[],"postedDate":"July 10th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-03T09:09:29+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-10 02:35:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4543432","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4543432","identity":"rs-4543432","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}