3D planning and custom prosthesis in hip surgery
This video discusses the benefits of 3D planning in hip surgery, particularly for the selection and customization of implants. Through precise anatomy analysis, implants can be better adapted to patients, improving functionality, recovery, and post-operative satisfaction.
Doctors
Topics
Treatments
Advice
- Dr. Jacques Vallotton; Jérémy Gozzo
- Hip prosthesis
- 2D vs 3D Planning
- Femoral offset
- Acetabulum
- Clinical case
- Custom-made prosthesis
- Modular prosthesis
- Planning represents 50 % of the surgeon's work
- anticipate anatomical variations of the femur and pelvis
- adapt the implant as best as possible to avoid pain and imbalances
Role of 3D planning in hip prosthesis
Preoperative planning determines the precision of the prosthetic procedure. It aims to restore the anatomy of the hip as closely as possible to the native morphology: center of rotation, limb length, gluteal lever arm and stability. In this context, the 3D approach provides a detailed reading of bone volumes and the relationships between the proximal femur and pelvis, whereas 2D captures neither the torsions nor the actual orientation in space.
The goal is twofold: to anticipate challenges (anatomical variations, deformities, bone quality) and to choose the implant that will replicate the expected biomechanics. This anticipation, which represents "half the work" for the surgeon, reduces length or offset bias and decreases the risk of instability or postoperative lameness. Finally, it helps align the patient's expectations with a lasting functional outcome.
Understanding three-dimensional anatomy
3D analysis allows us to objectify decisive parameters that are impossible to estimate correctly in 2D: femoral ante/retrotorsion, neck orientation, femoral offset and acetabular coverage. This data guides the virtual positioning of the cup and stem, then the fine adjustment of the version and inclination to optimize stability and range of motion.
The restoration of the center of rotation and leg length is then done with limited margins of error. The planning also highlights the implant-bone contact zones, useful for anticipating the primary hold, and indicates situations where medialization or lateralization would be necessary. Overall, the three-dimensional reading secures the operative strategy and reduces technical uncertainty.
Planning and preparation involves determining the choice of implants to restore the patient's original anatomy.
Choosing the implant: modular or custom-made
3D planning helps compare several families of stems and cups to select the most suitable combination. In many cases, standard modular hardware, properly planned, allows for faithful reconstruction without the need for a custom-made prosthesis. When the anatomy presents marked singularities (short/wide neck, extreme torsions, narrow canal), the use of custom-made prostheses becomes relevant again to precisely restore orientation and offset.
This graduated approach combines biomechanical efficiency, safety, and economic constraints. The final choice is based on the superposition of the native and prosthetic centers of rotation, the quality of the metaphyseal supports, and the possibility of facilitated future revision.
Prevent length and offset errors
Excessive lengthening leads to pain and muscle stiffness; shortening or medialization compromises the gluteal lever arm and promotes lameness. 3D planning allows these parameters to be balanced by precisely adjusting the stem size, neck, head, and cup position. It also provides insight into the optimal orientation to limit the risk of dislocation due to poor version or inclination.
In practice, simulation guides resection height, implantation depth, and final adjustment to the operating room, with reproducible landmarks. This level of preparation results in a more predictable aftercare and smoother recovery.
3D planning allows us to restore the functionality of the hip and to best satisfy the patient.
Imaging and surgical landmarks
Standard radiography remains informative for an initial assessment, but does not capture rotational components. 3D digital planning is based on a volume model that allows virtual positioning of implants in all planes, with measurements of acetabular coverage and constraints in the femoral shaft.
In the operating room, simple landmarks (lesser trochanter, inter-ischial line, neck orientation, height markers) are linked to the preoperative project. This continuity between simulation and execution promotes stable, functional and durable implantation.
Message to the patient: precision in the service of function
The goal of planning is not to achieve a "beautiful x-ray," but to restore a stable, painless, and effective hip for active life. By anticipating the three-dimensional geometry, surgery gains in precision and safety, while adapting to the profile of each patient.
This upfront investment contributes to faster recovery, symmetrical walking, and a return to activities in a reassuring environment. 3D planning is therefore a major component of quality in total hip replacement.
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