Patient specific surgical guide design and application in preoperative planning for femoral head necrosis using computer aided design

Fibular Grafting and Impaction Bone Grafting (FAIBG) is a type of minimally invasive hip preserving procedure with stable clinical curative effects and a standard operation procedure. However, FAIBG requires a difficult technique and a series of complex procedures. Therefore, the discovery of a new methodology for surgical guidance that could lead to accurate, safe, easily performed surgeries will play a crucial role in the promotion and application of FAIBG. From September 2013 to July 2014, one surgeon performed FAIBG on 10 patients (4 males and 6 females) with an average age of 40 years (range, 35-50 years) using patient-specific surgical guides. All patients underwent preoperative X-ray examinations and CT and MRI scans. Before surgery, we performed preoperative planning with patient-specific surgical guides by Computer Aided Design (CAD), and the length of the bone tunnel; bone mass, percentage by volume, and percentage by surface area were measured. After surgery, ten fibular allografts and screws were placed in 10 patients diagnosed with ARCO II FHN. All implants were successfully placed using patient-specific surgical guides. After the application of the patient-specific surgical guide, the operating times were 53-75 min (average: 68.6 min), the blood loss volumes were 90-150 ml (average 120 ml), the operative incision sizes were 5-7 cm (average 6.4 cm), and the mean hospital stay was 13.2 d. All cases were followed up for 12 to 30 months (average: 20.4 months). In conclusions, patient-specific surgical guidance may enable more intuitive and precise preoperative planning for hip-preserving procedures.