Are three-dimensional patient-specific cutting guides for open wedge high tibial osteotomy accurate? An in vitro study

Abstract

BackgroundThe aim of this in vitro study was to assess the accuracy of three-dimensional patient-specific cutting guides for open wedge high tibial osteotomy (OWHTO) to provide the planned correction in both frontal and sagittal planes.MethodsTen cadaveric tibias underwent OWHTO performed using a patient-specific cutting guide based on 3D preoperative planning. An initial CT scan of the tibias was performed, and after segmentation, 3D geometrical models of the pre-OWHTO tibias were obtained. Reference planes were defined, and OWHTO virtually planned to then design patient-specific cutting guides. OWHTO were performed using the patient-specific cutting guides. The patient-specific cutting guide controls the cut and the correction of the OWHTO in both planes. 3D models of post-OWHTO tibias were created after a postoperative CT scan. Geometrical post-OWHTO 3D models were superimposed on pre-OWHTO 3D models. Mechanical medial proximal tibial angle (mMPTA) in the frontal plane and posterior tibial slope (PTS) in the sagittal plane were compared between planned-OWHTO and post-OWHTO 3D reconstructions relative to the pre-OWHTO reference planes and axis. Pearson’s and Lin’s correlation tests were performed to assess precision and accuracy of patient-specific cutting guides.ResultsThe mean difference between post-OWHTO and planned-OWHTO was 0.2° (max 0.5°, SD 0.3°) in the frontal plane and − 0.1° (max 0.8°, SD 0.5°) in the sagittal plane. Statistically significant correlations were found between the planned-OWHTO and post-OWHTO configurations for the mMPTA (p < 0.0001) and PTS (p < 0.0001) measurements, and the bias correction factor was 0.99 in both planes.Conclusions3D patient-specific cutting guides for OWHTO-based 3D virtual planning is a reliable and accurate method of achieving multiplanar correction in both frontal and sagittal planes.

Feasibility and 3D Planning of a Novel Patient-Specific Instrumentation Technique in Medial Opening-Wedge High Tibial Osteotomy

“…While the mFTA, also known as hip-knee-ankle angle, is the standard measure for overall alignment, the mMPTA is a pure bony angle giving a more correct representation of the OWHTO key principle. 21 A recent study showed that the preoperative mMPTA is the only predictor of the alignment error after OWHTO and concluded that its use is recommended for improving correction accuracy in OWHTO. 34 The strong correlation between effective corrections expressed in mMPTA and mFTA in both 3D and 2D imaging modalities indicates that the overall lower limb correction largely depends on the effective bony correction rather than the effect of weight-bearing and concomitant soft tissue changes after surgery in patients without preoperative signs of collateral laxity.…”

Early Outcomes of Patient-Specific Modular Cones for Substitution of Methaphysial and Diaphysial Bone Defects in Revision Knee Arthroplasty

“…на протяжении последнего десятилетия прослеживается общемировая тенденция роста применения 3D-технологий в ортопедии. наибольшее распространение они получили для создания индивидуальных резекторных блоков при тотальной артропластике коленного сустава, а также направителей для выполнения корригирующих остеотомий костей верхних и нижних конечностей [13][14][15]. лидирующими областями, где 3D-печать служит для компенсации обширных костных дефектов, являются челюстно-лицевая хирургия и костная онкология.…”

Adding a protective screw improves hinge's axial and torsional stability in High Tibial Osteotomy

“…The recent introduction of Patient-Specific Cutting Guides (Donnez et al, 2018;Munier et al, 2017) (PSCGs) using pre-operative CT-scan templating has raised the possibility of making instrumentation specific to each patient. A K-wire (Dessyn et al, 2019) has been incorporated into the design of the bespoke cutting guide, intersecting the cutting plane at the theoretical lateral hinge location.…”