{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:10:53Z","timestamp":1760130653851,"version":"build-2065373602"},"reference-count":32,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,9,18]],"date-time":"2023-09-18T00:00:00Z","timestamp":1694995200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Hungarian Ministry of Finance and the European Union","award":["GINOP 2.3.2-15-2016-00022","GINOP-2.2.1-15-2017-00055"],"award-info":[{"award-number":["GINOP 2.3.2-15-2016-00022","GINOP-2.2.1-15-2017-00055"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>Background: Surgeries of severe periacetabular bone defects (Paprosky \u2265 2B) are a major challenge in current practice. Although solutions are available for this serious clinical problem, they all have their disadvantages as well as their advantages. An alternative method of reconstructing such extensive defects was the use of a cup with a stem to solve these revision situations. As the instrumentation offered is typically designed for scenarios where a significant bone defect is not present, our unique technique has been developed for implantation in cases where reference points are missing. Our hypothesis was that a targeting device designed based on the CT scan of a patient\u2019s pelvis could facilitate the safe insertion of the guiding wire. Methods: Briefly, our surgical solution consists of a two-step operation. If periacetabular bone loss was found to be more significant during revision surgery, all implants were removed, and two titanium marker screws in the anterior iliac crest were percutaneously inserted. Next, by applying the metal artifact removal (MAR) algorithm, a CT scan of the pelvis was performed. Based on that, the dimensions and positioning of the cup to be inserted were determined, and a patient-specific 3D printed targeting device made of biocompatible material was created to safely insert the guidewire, which is essential to the implantation process. Results: In this study, medical, engineering, and technical tasks related to the design, the surgical technique, and experiences from 17 surgical cases between February 2018 and July 2021 are reported. There were no surgical complications in any cases. The implant had to be removed due to septic reasons (independently from the technique) in a single case, consistent with the septic statistics for this type of surgery. There was not any perforation of the linea terminalis of the pelvis due to the guiding method. The wound healing of patients was uneventful, and the implant was fixed securely. Following rehabilitation, the joints were able to bear weight again. After one to four years of follow-up, the patient satisfaction level was high, and the gait function of the patients improved a lot in all cases. Conclusions: Our results show that CT-based virtual surgical planning and, based on it, the use of a patient-specific 3D printed aiming device is a reliable method for major hip surgeries with significant bone loss. This technique has also made it possible to perform these operations with minimal X-ray exposure.<\/jats:p>","DOI":"10.3390\/bioengineering10091095","type":"journal-article","created":{"date-parts":[[2023,9,19]],"date-time":"2023-09-19T02:26:17Z","timestamp":1695090377000},"page":"1095","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Acetabular Revision with McMinn Cup: Development and Application of a Patient-Specific Targeting Device"],"prefix":"10.3390","volume":"10","author":[{"given":"Zolt\u00e1n","family":"Csern\u00e1tony","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary"},{"name":"Laboratory of Biomechanics, Department of Orthopaedics and Traumatology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2108-2685","authenticated-orcid":false,"given":"S\u00e1ndor","family":"Man\u00f3","sequence":"additional","affiliation":[{"name":"Laboratory of Biomechanics, Department of Orthopaedics and Traumatology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D\u00e1niel","family":"Szab\u00f3","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hajnalka","family":"So\u00f3sn\u00e9 Horv\u00e1th","sequence":"additional","affiliation":[{"name":"Laboratory of Biomechanics, Department of Orthopaedics and Traumatology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00c1gnes \u00c9va","family":"Kov\u00e1cs","sequence":"additional","affiliation":[{"name":"Laboratory of Biomechanics, Department of Orthopaedics and Traumatology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5023-3617","authenticated-orcid":false,"given":"Lor\u00e1nd","family":"Cs\u00e1mer","sequence":"additional","affiliation":[{"name":"Laboratory of Biomechanics, Department of Orthopaedics and Traumatology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1302\/0301-620X.50B4.720","article-title":"Complete replacement arthroplasty of the hip by the ring prosthesis","volume":"50","author":"Ring","year":"1968","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1302\/0301-620X.69B3.3584187","article-title":"Ring uncemented hip replacements","volume":"69","author":"Patterson","year":"1987","journal-title":"The results of revision. J. Bone Jt. Surg. Br. Vol."},{"key":"ref_3","first-page":"174","article-title":"700 Total Hip Replacements Experience With 6 Types","volume":"95","author":"Leinbach","year":"1973","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1677","DOI":"10.2106\/00004623-197254080-00007","article-title":"The Ring total hip prosthesis. Comparison of results at one and three years","volume":"54","author":"Evarts","year":"1972","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_5","first-page":"44","article-title":"Total replacement of the hip joint. A review of a thousand operations","volume":"56","author":"Ring","year":"1974","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1302\/0301-620X.98B6.36469","article-title":"Review of the outcomes of complex acetabular reconstructions using a stemmed acetabular pedestal component","volume":"98","author":"Stihsen","year":"2016","journal-title":"Bone Jt. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1007\/s11639-009-0033-y","article-title":"La nuova coppa a stelo iliaco nelle revisioni acetabolari","volume":"23","author":"Santori","year":"2009","journal-title":"Lo Scalpello\u2014Otodi Educ."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"266","DOI":"10.5301\/hipint.5000561","article-title":"Preliminary results of a 3D-printed acetabular component in the management of extensive defects","volume":"28","author":"Citak","year":"2018","journal-title":"HIP Int."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Marinescu, R., and Popescu, D. (2020, January 29\u201330). 3D Prints are not a Panacea, but Definitely Support Orthopedic Surgery. Proceedings of the 2020 International Conference on e-Health and Bioengineering (EHB), Iasi, Romania.","DOI":"10.1109\/EHB50910.2020.9280113"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.12968\/hmed.2020.0596","article-title":"The impact of medical device regulation on hospital doctors who prescribe and manufacture custom-made devices","volume":"81","author":"Green","year":"2020","journal-title":"Br. J. Hosp. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1007\/s43465-019-00013-5","article-title":"Changing Device Regulations in the European Union: Impact on Research, Innovation and Clinical Practice","volume":"54","author":"Vasiljeva","year":"2020","journal-title":"Indian J. Orthop."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1611","DOI":"10.1302\/0301-620X.87B12.16402","article-title":"A stemmed acetabular component in the management of severe acetabular deficiency","volume":"87","author":"Badhe","year":"2005","journal-title":"J. Bone Jt. Surg. Br. Vol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1302\/0301-620X.93B5.25608","article-title":"Ice-cream cone reconstruction of the pelvis: A new type of pelvic replacement","volume":"93","author":"Fisher","year":"2011","journal-title":"J. Bone Jt. Surg. Br. Vol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1706","DOI":"10.1302\/0301-620X.96B12.34622","article-title":"Clinical outcome of pedestal cup endoprosthetic reconstruction after resection of a peri-acetabular tumour","volume":"96","author":"Bus","year":"2014","journal-title":"Bone Jt. J."},{"key":"ref_15","first-page":"58","article-title":"Clinical and radiological results of the stemmed Mc Minn cup in hip revision surgery","volume":"76","author":"Willemse","year":"2010","journal-title":"Acta Orthop. Belg."},{"key":"ref_16","first-page":"680","article-title":"Severe pelvic bone loss treated using a coned acetabular prosthesis with a stem extension inside the ilium","volume":"79","author":"Matharu","year":"2013","journal-title":"Acta Orthop. Belg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"101493","DOI":"10.1016\/j.jcot.2021.101493","article-title":"Methods to address metal artifacts in post-processed CT images\u2014A do-it-yourself guide for orthopedic surgeons","volume":"20","author":"Sharma","year":"2021","journal-title":"J. Clin. Orthop. Trauma"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1016\/j.otsr.2012.01.006","article-title":"Total hip revision using a cup design with a peg to treat severe pelvic bone defects","volume":"98","author":"Desbonnet","year":"2012","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1111\/clr.40_13644","article-title":"Evaluation of volumetric changes of 3D printed implant surgical guides after sterilization process","volume":"31","author":"Tachmatzidis","year":"2020","journal-title":"Clin. Oral Implant. Res."},{"key":"ref_20","first-page":"179","article-title":"Causes of revision after total hip arthroplasty in an orthopedics and traumatology regional center","volume":"95","author":"Apostu","year":"2022","journal-title":"Med. Pharm. Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1740","DOI":"10.1016\/j.arth.2020.12.033","article-title":"Trabecular Metal Augments for Severe Acetabular Defects in Revision Hip Arthroplasty: A Long-Term Follow-Up","volume":"36","author":"Russell","year":"2021","journal-title":"J. Arthroplast."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"De la Torre-Escuredo, B., G\u00f3mez-Garc\u00eda, E., \u00c1lvarez-Villar, S., Bujan, J., and Ortega, M.A. (2020). Bone impaction grafting with trabecular metal augments in large defects in young patients: Unravelling a new perspective in surgical technique. BMC Musculoskelet. Disord., 21.","DOI":"10.1186\/s12891-020-03591-w"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1177\/11207000221099817","article-title":"The modern Burch-Schneider antiprotrusio cage for the treatment of acetabular defects: Is it still an option? A systematic review","volume":"33","author":"Malahias","year":"2023","journal-title":"HIP Int."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1016\/j.arth.2020.08.050","article-title":"Survival Analysis of Allografting and Antiprotrusio Cage in Treating Massive Acetabular Bone Defects","volume":"36","author":"Chang","year":"2021","journal-title":"J. Arthroplast."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"102361","DOI":"10.1016\/j.media.2022.102361","article-title":"Utility of optical see-through head mounted displays in augmented reality-assisted surgery: A systematic review","volume":"77","author":"Birlo","year":"2022","journal-title":"Med. Image Anal."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1016\/j.spinee.2019.10.012","article-title":"Augmented reality navigation for spinal pedicle screw instrumentation using intraoperative 3D imaging","volume":"20","author":"Roner","year":"2020","journal-title":"Spine J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1595","DOI":"10.1007\/s10439-018-2055-1","article-title":"Augmented Reality Based Navigation for Computer Assisted Hip Resurfacing: A Proof of Concept Study","volume":"46","author":"Liu","year":"2018","journal-title":"Ann. Biomed. Eng."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1049\/htl.2018.5072","article-title":"Augmented reality in computer-assisted interventions based on patient-specific 3D printed reference","volume":"5","author":"Pascau","year":"2018","journal-title":"Healthc. Technol. Lett."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1007\/s11548-020-02302-z","article-title":"Mixed reality as a novel tool for diagnostic and surgical navigation in orthopaedics","volume":"16","author":"Teatini","year":"2021","journal-title":"Int. J. Comput. Assist. Radiol. Surg."},{"key":"ref_30","unstructured":"Liebmann, F., Roner, S., von Atzigen, M., Wanivenhaus, F., Neuhaus, C., Spirig, J., Scaramuzza, D., Sutter, R., Snedeker, J., and Farshed, M. (2020). Registration made easy\u2014Standalone orthopedic navigation with HoloLens. arXiv."},{"key":"ref_31","first-page":"4900214","article-title":"Registration Techniques for Clinical Applications of Three-Dimensional Augmented Reality Devices","volume":"9","author":"Andrews","year":"2020","journal-title":"IEEE J. Transl. Eng. Health Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.culher.2018.07.013","article-title":"Automated markerless registration of point clouds from TLS and structured light scanner for heritage documentation","volume":"35","author":"Shao","year":"2019","journal-title":"J. Cult. Herit."}],"container-title":["Bioengineering"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2306-5354\/10\/9\/1095\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:53:01Z","timestamp":1760129581000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2306-5354\/10\/9\/1095"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,18]]},"references-count":32,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,9]]}},"alternative-id":["bioengineering10091095"],"URL":"https:\/\/doi.org\/10.3390\/bioengineering10091095","relation":{},"ISSN":["2306-5354"],"issn-type":[{"type":"electronic","value":"2306-5354"}],"subject":[],"published":{"date-parts":[[2023,9,18]]}}}