Zhengzhou Orthopedic Hospital in Zhengzhou City successfully completed a challenging knee joint revision surgery using a 'Rotating Hinge Knee Prosthesis' with the assistance of 3D printing and digital technology. This remarkable procedure involved the use of 3D-printed custom Cone implants to repair a significant femoral bone defect. It marks the debut of this precise digital technology in aiding hinge knee joint revisions.

Case sharing

The surgical patient is a 60-year-old middle-aged woman. Preoperative imaging revealed a significant bone defect on the femoral side of the knee joint, making repair extremely challenging.

Historically, treatment options involved complete removal of the distal portion of the femur, followed by the use of a tumor-type knee joint for revision. This method led to the loss of more normal bone and had limited long-term durability, making it less than the optimal choice.

After extensive discussion and analysis, the surgical team decided to employ a 3D printing approach. This approach aims to maximize the preservation of the patient's healthy bone tissue, with the goal of achieving a longer-lasting, long-term outcome.

Pre-operation

Through a CT scan, the patient's knee joint CT data was input into a computer for preoperative planning. Leveraging a 3D printing digital orthopedic system, the precise measurements of intraoperative bone defect size, prosthesis type, and placement were calculated. A suitably sized metal femoral distal Cone prosthesis was 3D printed. This enabled the creation of a tailored surgical plan for the patient. The decision was made to perform the first-ever "3D printing custom (Cone) digital technology-assisted hinged knee joint revision surgery" under combined lumbar and rigid anesthesia.

Customization

During operation

During the surgery, it was discovered that the structures of the patient's knee joint, including the distal femur and proximal tibia, were severely compromised. After multiple tests for skeletal integrity and joint space, a team led by Deputy Chief Physician Wang Jinliang precisely performed bone resection, balancing of soft tissues on the medial and lateral sides, and trial fitting of the 3D-printed custom Cone prosthesis into the distal femur. A hinged artificial prosthesis was securely fixed at the femur and tibia resection sites. Intraoperative examination revealed knee joint flexion-extension ranging from 0 to 120 degrees, with excellent joint stability.

The surgery lasted for one and a half hours, and the 3D-printed femoral distal Cone prosthesis was implanted as planned, successfully completing the revision surgery

Postoperation

Postoperatively, with meticulous care from the Joint Disease Department II medical team, the patient healed well and was able to walk smoothly.