ORIGINAL RESEARCH article
Front. Bioeng. Biotechnol.
Sec. Biomechanics
Volume 13 - 2025 | doi: 10.3389/fbioe.2025.1604285
An Innovative Three-Dimensional Evaluation Protocol for Assessing the Consistency of Critical Screw Angles in 3D-Printed Patient-Specific Acetabular Revision Prostheses with Preoperative Planning
Provisionally accepted
- Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Background: Screw fixation is pivotal for prosthetic stability. For 3D-printed customized acetabular revision prostheses designed for complex, large-scale bone defects, precise adherence to preoperative screw trajectory planning is critical. However, there remains a lack of standardized three-dimensional (3D) evaluation protocols to quantify intraoperative screw angular alignment fidelity relative to preoperative digital plans, hindering universal validation criteria. Methods: A total of 11 patients were stratified into two groups based on postoperative Harris Hip Scores and severe complication rates: the better outcome group and the regular outcome group. A 3D pelvic coordinate system was established using anatomical landmarks. Two biomechanically critical screws per prosthesis were selected to quantify 3D angular deviations between postoperative and preoperative plans. The efficacy of this method was compared with simulated anteroposterior radiograph-based 2D measurements. Inter-and intra-observer consistency (kappa statistics) were evaluated to assess reproducibility. Results: High inter-observer (κ=0.88) and intra-observer (κ=0.87, 0.75) agreement confirmed method reliability. While individual critical screw deviations showed no significant intergroup differences, the cumulative angular deviation of critical screws was significantly lower in the better outcome group (p=0.0147). In contrast, 2D radiographic analysis failed to distinguish intergroup differences in cumulative deviations (p=0.1489), demonstrating reduced clinical relevance. Conclusions: This 3D assessment protocol robustly correlates with clinical outcomes, providing a validated tool for evaluating preoperative-to-postoperative fidelity in customized acetabular revision prostheses. To our knowledge, this is the first CT-based 3D coordinate system study quantifying critical screw alignment accuracy in patient-specific prostheses, with clinical validation.
Keywords: 3D pelvic coordinate system, acetabular revision prosthesis, 3D printing, customization, critical screws
Received: 01 Apr 2025; Accepted: 14 Jul 2025.
Copyright: © 2025 Luo, Wu, Ran, Wu, Wang, Xie and Hao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Dinghao Luo, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
Kai Xie, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
Yongqiang Hao, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.