This diagnostic image is an anteroposterior (AP) pelvic X-ray demonstrating bilateral total hip arthroplasty in an 85-year-old female patient with osteoarthritis. The image shows sequential implantation of cemented A2 femoral stems. Both the left and right femurs exhibit radiopaque stainless-steel implants consisting of a femoral head articulating with an acetabular component and a calcar-guided stem extending into the femoral canal. A visible cement mantle surrounds both stems, appearing as a moderately radiopaque layer between the dense metal implant and the cortical bone. On the right side (labeled 'R'), the cement stopper is positioned immediately distal to the stem tip. On the left side, there is evidence of slight distalization of the cement stopper. The pelvic bone quality shows signs of reduced density consistent with age-related changes (Dorr Type B-C femora) and heterogeneity suggesting bone remodeling. This image illustrates postoperative orthopedic positioning and the use of cemented backups in patients with poor bone quality.

This four-panel series of intraoperative clinical photographs details the surgical technique for structural bone grafting and socket implantation during a cemented total hip arthroplasty (cTHA) for acetabular dysplasia. Panel (a) demonstrates a roughly hemispherical femoral head autograft being positioned into the superior acetabular defect, secured temporarily with thin metallic Kirschner wires (K-wires). Panel (b) shows the definitive fixation of the graft using bioabsorbable screws (Superfixorb) with white washers, positioned superiorly to allow for subsequent acetabular reaming. A screw insertion tool is visible. In panel (c), the acetabular bed is re-reamed to create a spherical cavity involving both the native bone and the graft. Panel (d) displays the final implantation of a white highly cross-linked polyethylene (HXLPE) non-flanged socket. The socket is fixed with polymethylmethacrylate (PMMA) bone cement and is being seated with a gold-headed tamping instrument. The bone graft provides structural augmentation to the superior acetabular roof, increasing the contact surface for the cemented implant.

A multi-panel figure illustrating the computer-aided design (CAD) and 3D-printing workflow for complex revision hip arthroplasty. (a) Pre-operative X-ray of the hip showing a temporary antibiotic-loaded cement spacer (SPACER) in situ following primary implant removal. (b) 3D volumetric reconstruction of the pelvis and proximal femur derived from CT data, with a red bounding box indicating the region of interest for surgical planning. (c) Digital segmentation and isolation of the hip endoprosthesis components, including the femoral stem and head. (d) A refined 3D digital model of the hemi-pelvis showing significant acetabular bone loss. (e) A tangible 1:1 scale 3D-printed physical model of the pelvis used for intraoperative orientation and pre-fitting the acetabular cup and fixation screws. (f) Post-operative diagnostic radiograph showing the successful implantation of the revision prosthesis, including an acetabular cup stabilized with multiple screws and a long-stem femoral component. The sequence demonstrates the integration of reverse engineering and additive manufacturing to manage complex anatomical defects and improve surgical precision in orthopedic surgery.