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Surgical Technique of the 3-Dimensional-printed Personalized Hip Implant for the Treatment of Canine Hip Dysplasia

Hip dysplasia causes major disability in dogs. Treatment options are limited to palliative treatment (e.g., pain relief, physical exercise, lifestyle ...

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Surgical Technique for the Implantation of a Biomimetic Artificial Intervertebral Disc in a Goat Animal Model

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Utrecht University

Kasetsart University

Hip dysplasia (HD) is a common orthopedic problem in young dogs. To decrease the laxity of the hip joint related to HD, the surgical treatments are recommended to increase femoral head coverage. ACEtabular rim eXtension (ACE-X) using a personalized 3-dimensional printed titanium shelf implant is a new surgical treatment to increase femoral head coverage and decrease laxity of the dysplastic hip joint, however, the efficacy is less know. Client-owned dogs older than 6 months with clinical signs of coxofemoral joint subluxation and radiographic evidence of HD with no or mild osteoarthritis (OA) were included. The Norberg angle (NA), linear percentage of femoral head overlap (LFO), and percentage of femoral head coverage (PC) were investigated radiographically and with computed tomography (CT) before and after surgery. OA was graded (scores 0-3) according to the maximum osteophyte size measured on CT. In addition, joint laxity (Ortolani) test results, gait analysis, and the Helsinki chronic pain index (HCPI) questionnaire were obtained at preoperative, immediately postoperative and at 1.5- and 3-month evaluations. Acetabular rim extension was performed in 61 hips of 34 dogs; NA, LFO, and PC were significantly higher immediately postoperatively and at the 1.5- and 3-month follow-up examinations compared with preoperative values ( < 0.05). Osteophyte size gradually increased over time ( < 0.05). The OA score significantly increased between preoperatively and directly postoperatively, and between preoperatively and at 3-month follow-up ( < 0.05). The laxity test normalized in 59 out of 61 hips after surgery, and the HCPI questionnaire showed that the pain score decreased significantly at 1.5 and 3 months, postoperatively. The force plate showed no significant improvement during the 3 months follow-up. Although pain reduction by the implant was unclear in short-term results, a personalized shelf implant significantly increased femoral head coverage and eliminated subluxation of the dysplastic hip joint. Further studies are required to study the long-term efficacy of gait, chronic pain, and progression of osteoarthritis.

Acetabular rim extension using a personalized titanium implant for treatment of hip dysplasia in dogs: short-term results.

The acetabular rim extension (ACE-X) implant is a custom-made three-dimensionally printed titanium device designed for the treatment of canine hip dysplasia. In this study, 34 dogs (61 hips) underwent ACE-X implantation, and assessments were conducted using computed tomography, force plate analysis, Ortolani's test, and the Helsinki chronic pain index (HCPI) questionnaires at five intervals: the pre-operative day, the surgery day, and the 1.5-month, 3-month, and 12-month follow-ups. Statistically significant increases in femoral head coverage with a negative Ortolani subluxation test were observed immediately after surgery and persisted throughout the study. Osteoarthritis (OA) scores remained stable, but osteophyte size significantly increased between the surgery day and the 12-month follow-up, especially in hips with a baseline OA score of 2 compared to those with a score of 1. The force plate data showed no significant changes during the study. The HCPI demonstrated a significant decrease in pain score from pre-operative value to six-week follow-up and gradually decreased over time. Major complications were identified in six hips (9.8%) of four dogs. In conclusion, the ACE-X implant effectively increased femoral head coverage, eliminated subluxation, and provided long-term pain relief with minimal complications, benefiting over 90% of the study population. The study supports the ACE-X implant as a valuable alternative treatment for canine hip dysplasia.

Outcome One Year after Acetabular Rim Extension Using a Customized Titanium Implant for Treating Hip Dysplasia in Dogs.

Hip dysplasia (HD) is one of the most prevalent orthopedic issues in dogs. Generic shelf implants are 3D-printed devices designed to address HD in dogs of varying sizes and hip laxity scores. This pilot study evaluated the feasibility and effectiveness of generic shelf implants in six dogs diagnosed with bilateral HD. Each dog underwent bilateral hip surgery in a single session followed by a 12-month monitoring period. Post-operative CT scans revealed increased femoral head coverage in all 12 hips, resulting in reversed hip laxity. However, implants exhibited positional deviations from optimal congruency for 5.1 ± 1.7 mm. Mild to moderate osteoarthritis (OA) progression was observed during the lead times and post-operatively. Although force plate analysis showed no significant changes, functional outcomes improved, as demonstrated by reduced owner questionnaire scores at 12 months post-surgery. Post-operative internal rotation and abduction angles were reduced compared to pre-operative values, suggesting potential impingement due to implant positioning. Complications were observed in one dog (two hips). Another dog died nine months post-surgery due to unrelated causes. Post-mortem histology and micro-CT analysis of these hip joints revealed localized cartilage depletion around the implant's rim extension area. However, no lameness or hip discomfort was reported by the owner before the dog's death. The generic shelf implant effectively enhances hip stability and alleviates pain-related behaviors by improving femoral head coverage. Suboptimal placement was associated with reduced range of motion and OA progression in this study. Refinements to the implant design and adjusting sizing protocols to better match acetabular morphology are necessary.

ArticleTotal : 2	Year
Publication title Cited by 2	2024
Publication title	2025

Article	Year
Acetabular rim extension using a personalized titanium implant for treatment of hip dysplasia in dogs: short-term results. Frontiers in veterinary science\| PubMed ID: 37152693	2023
Outcome One Year after Acetabular Rim Extension Using a Customized Titanium Implant for Treating Hip Dysplasia in Dogs. Animals : an open access journal from MDPI\| PubMed ID: 39199919	2024
Pilot study on the use of an off-the-shelf 3D-printed titanium acetabular rim extension implant for treating canine hip dysplasia. Research in veterinary science\| PubMed ID: 40328200	2025

Irin Kwananocha

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