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

Abstract

A novel approach for opening-wedge high tibial osteotomy (OWHTO) with patient-specific instrumentation (PSI) was evaluated for its safety, feasibility, and accuracy. Next, the mechanical medial proximal tibial angle (mMPTA) was assessed as a potential planning angle by investigating the relation with the mechanical femorotibial angle (mFTA). Ten OWHTO cases were 3D planned using the mMPTA and operated with a customized 3D-printed wedge and cast which resembled the intended osteotomy opening. Patients were closely monitored for intraoperative and postoperative complications up to 1 year after surgery. Radiological assessment was conducted on full leg standing radiographs and supine lower limb computed tomography-scans preoperatively and 3 months after surgery. No intraoperative complications or logistical issues during PSI processing were observed. Absolute accuracy outcomes showed a correction error of 1.3° ± 1.1 mMPTA and 0.9° ± 0.6 mFTA with all osteotomies falling in (−2°; + 2°) mFTA around the target. The mMPTA and mFTA were found to have a strong correlation in both 3D (r = 0.842, p = 0.002) and 2D (r = 0.766, p = 0.01) imaging for effective correction. The study confirmed the development of a safe and feasible PSI technique in OWHTO with excellent accuracy outcomes. The strong correlation between the mMPTA and mFTA indicated that soft tissue changes after OWHTO are of minor significance to the final alignment in ligament-stable patients. Finally, the mMPTA was found to be a reliable planning angle in 3D software for obtaining the intended lower limb realignment and its use can therefore be recommended in modern OWHTO planning.

3D-Printed Patient-Specific Instrumentation Technique Vs. Conventional Technique in Medial Open Wedge High Tibial Osteotomy: A Prospective Comparative Study

“…In the study by Van Genechten et al [5], similar competent postoperative overall results were achieved by MOWHTO with the assistance of the 3D-printed PSI. Moreover, with a safer and faster osteotomy, it allows orthopedists to perform more concomitant surgeries at one time, such as meniscectomy and anterior cruciate ligament reconstruction (ACLR) [18][19][20].…”

“…To our knowledge, only a few studies have been reporting feasibility and accuracy outcomes about the clinical use of PSI in BioMed Research International osteotomy around the knee [5,15,17,19,20,22]. In the study by Van Genechten et al [5], the two planar MOWHTOs were performed in a relatively conventional manner (freehand), while a PSI 3D-printed wedge and cast were adopted instead of the HTO plate. Interestingly, they also got excellent corrections outcomes; this precision was achieved by the patient-specific wedge model fixation rather than the osteotomy procedure itself.…”

“…Medial open wedge high tibial osteotomy (MOWHTO) is a well-established surgical procedure in dealing with early or mild stage of knee osteoarthritis (OA), and this native knee-preserving surgery could ensure long-lasting clinical success (>10 years) in the overall treatments of knee OA [1,2]. MOWHTO is typically applied for the correction of varus malalignment of the lower extremities in isolated medial compartment arthritis of the knee [3][4][5]. If accurately performed, MOWHTO has the potential to delay or even possibly prevent the development of end-stage OA, by shifting the weight-bearing axis toward the lateral compartment [3,6]; the loading is redistributed, and knee function is thereby restored and could avert total knee arthroplasty (TKA).…”

“…However, the newly developed ancillary technology in the modality of 3D-printed patient-specific instrumentation (PSI) may be a solution to the accuracy requirements of HTO planning and execution [13]. This technique was initially carried out in maxillofacial surgery [14]; however, its practicability was more adequately embodied in the later orthopedic studies [5,[15][16][17]. The feasibility and proof-ofconcept study by Victor and Premanathan [17] reported PSI for 14 cases of osteotomy around the knee yielded satisfactory outcomes, suggesting it to be a prospective solution.…”

Preoperative Planning Using 3D Printing Technology in Orthopedic Surgery

“…These features allow the surgeon to decide on all these surgical considerations preoperatively with the aid of 3D printing technology. The application of 3D printing technology gives the advantage to reduce surgical time, limit fluoroscopy frequency, decrease the risk of infection and implant mal-positioning, decrease intraoperative blood loss, and other postoperative complications [1,[4][5][6][7][8]. Thus, 3D printing improves the surgeon's 3D orientation of the anatomy that is very essential for the smooth flow of the surgical procedure and improves the standard of care.…”