Improved Accuracy of Coronal Alignment Can Be Attained Using 3D-Printed Patient-Specific Instrumentation for Knee Osteotomies: A Systematic Review of Level III and IV Studies

Aman, Zachary S.; DePhillipo, Nicholas N.; Peebles, Liam A.; Familiari, Filippo; LaPrade, Robert F.; Dekker, Maj. Travis J.

doi:10.1016/j.arthro.2022.02.023

Cited by 23 publications

(26 citation statements)

References 53 publications

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“…Examples of these methods are navigation systems, 3D-printing techniques, aligning with electrocautery cables, and fluoroscopy. [4][5][6][7] In addition, there have been some reports that emphasize the softtissue factor for the accurate correction. Kim et al 8 proposed the intraoperative cable technique while applying valgus stress to the knee joint.…”

Section: See Related Article On Page 2741mentioning

confidence: 99%

“…Recently, the simulation of a real-sized model or cutting guide using 3D printing has been reported. 7,9 Patient-specific instrumentation (PSI) or guiding template reported promising outcome in accuracy, reducing operation time, hemorrhage, and radiation exposure. Future of 3D printing is expected to expand beyond the intraoperative application.…”

Section: See Related Article On Page 2741mentioning

confidence: 99%

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Editorial Commentary: Patient-Specific Instrumentation for Knee High Tibial Osteotomy Addresses the Bony but Not the Soft-Tissue Aspect of Deformity Correction

Lee¹

2022

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Section: See Related Article On Page 2741mentioning

confidence: 99%

Section: See Related Article On Page 2741mentioning

confidence: 99%

Editorial Commentary: Patient-Specific Instrumentation for Knee High Tibial Osteotomy Addresses the Bony but Not the Soft-Tissue Aspect of Deformity Correction

Lee¹

2022

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…Currently, there is initial but converging evidence that VSP and 3D-printing result in highly accurate correction following femoral and tibial osteotomies in adults. In a recent systematic review, Aman et al [6] reported that five comparative studies out of six demonstrated that, compared to conventional osteotomies, PS knee osteotomies had significantly more accurate correction, shorter operative times, decreased intraoperative fluoroscopy and low rates of complications. Additionally, Raza et al [10] confirmed this trend in pediatric osteotomies.…”

Section: Discussionmentioning

confidence: 99%

“…The advent of virtual surgical planning (VSP) and 3D-printing has revolutionized the approach to the diagnosis and treatment of several diseases in all fields of surgery [2,3]. Bony surgery represents the main field of application of these technologies, having demonstrated shorter surgery time, less intraoperative blood loss, fewer intraoperative fluoroscopies and a higher rate of excellent outcomes compared with conventional surgery [4][5][6]. Currently, the main advancement of VSP and 3D-printing regards the possibility to customize and personalize bone implants and devices for reconstructive surgery, especially in the presence of severe bone loss and large bone defects [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

“…Currently, the main advancement of VSP and 3D-printing regards the possibility to customize and personalize bone implants and devices for reconstructive surgery, especially in the presence of severe bone loss and large bone defects [7][8][9]. Another application of VSP is the acute correction of bony deformities through osteotomies, especially when multi-segmental, multifocal and multiplanar corrections are required [6,10]. In both these conditions the use of structural allografts is often required [11][12][13] and shape-matching is the primary criterion for selection of an allograft [14].…”

Section: Introductionmentioning

confidence: 99%

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Virtual Surgical Planning, 3D-Printing and Customized Bone Allograft for Acute Correction of Severe Genu Varum in Children

Alessandri

Frizziero

Santi

et al. 2022

JPM

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Complex deformities of lower limbs are frequent in children with genetic or metabolic skeletal disorders. Early correction is frequently required, but it is technically difficult and burdened by complications and recurrence. Herein, we described the case of a 7-year-old girl affected by severe bilateral genu varum due to spondyloepiphyseal dysplasia. The patient was treated by patient-specific osteotomies and customized structural wedge allograft using Virtual Surgical Planning (VSP) and 3D-printed patient-specific instrumentation (PSI). The entire process was performed through an in-hospital 3D-printing Point-of-Care (POC). VSP and 3D-printing applied to pediatric orthopedic surgery may allow personalization of corrective osteotomies and customization of structural allografts by using low-cost in-hospital POC. However, optimal and definitive alignment is rarely achieved in such severe deformities in growing skeleton through a single operation.

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Superior accuracy in knee double level osteotomy using a novel hybrid fixation technique compared to conventional double plating

Mabrouk,

Monda,

Bell

et al. 2024

J. exp. orthop.

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PurposeThis study aimed to compare two different double‐level knee osteotomy (DLO) fixation techniques. The primary outcome reported the radiological coronal plane correction and its accuracy. The secondary outcomes reported the correction outliers, the clinical outcomes, the 5‐year postoperative satisfaction and the complications.MethodsA retrospective review of a single surgeon osteotomy database identified 52 cases of DLO between 2011 and 2019, of which 24 cases met the inclusion criteria. Patients were categorised into two groups: the nail‐plate (NP) group fixed with a magnetic extendable intramedullary tibial nail and femoral conventional plate, and the double‐plate (DP) group fixed with conventional plates (tibia and femur). Radiographic parameters were recorded, including the mechanical femorotibial angle (mFTA), medial proximal tibial angle (MPTA), mechanical lateral distal femoral angle (mLDFA), joint line convergence angle (JLCA) and weight‐bearing line ratio (Mikulicz %). Surgical accuracy was calculated as the difference between the achieved and the planned correction. Outliers were defined as those with a greater than 10% difference from the planned correction. Simple knee value scores and visual analogue scale for pain were recorded preoperatively and postoperatively at 2 and 5 years. Five‐year patient satisfaction was recorded.ResultsA total of 24 patients were included: the NP group (n = 12) and the DP group (n = 12). Significant coronal plane corrections were achieved in the NP group for the mean mFTA (preoperative 167.9° ± 3.4° to postoperative 182.1° ± 1.4°), the mean MPTA (preoperative 83.5° ± 2.9° to postoperative 91.3° ± 2.8°) and the mean mLDFA (preoperative 89.8° ± 3.4° to postoperative 85.9° ± 4.4°). Similarly, significant coronal plane corrections were achieved in the DP group for the mean mFTA (preoperative 168.6° ± 4.4° to postoperative 182.2° ± 2°), the mean MPTA (preoperative 84.2° ± 2° to postoperative 88.3° ± 4.1°) and the mean mLDFA (preoperative 90.7° ± 2.9° to postoperative 83.9° ± 1.7°) (all p < 0.05). The mean correction accuracy was higher for the NP versus DP group at 3.4 ± 3.4% versus 7.1 ± 3.9% (intergroup p < 0.05). There were no outliers in the NP group versus two outliers (overcorrected) (16.7%) in the DP group. Significant clinical improvement was reported in both groups at 2 and 5 years postoperatively (all p < 0.05).ConclusionSuperior correction accuracy and no outliers were achieved in hybrid fixation double‐level knee osteotomy compared to the conventional double‐plating technique. The magnetic extendable nail offers the advantage of fine‐tuning the correction postoperatively and could be a potential research template for future designs of postoperative correction implants.Level of EvidenceLevel III, retrospective cohort study.

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Improved Accuracy of Coronal Alignment Can Be Attained Using 3D-Printed Patient-Specific Instrumentation for Knee Osteotomies: A Systematic Review of Level III and IV Studies

Cited by 23 publications

References 53 publications

Editorial Commentary: Patient-Specific Instrumentation for Knee High Tibial Osteotomy Addresses the Bony but Not the Soft-Tissue Aspect of Deformity Correction

Editorial Commentary: Patient-Specific Instrumentation for Knee High Tibial Osteotomy Addresses the Bony but Not the Soft-Tissue Aspect of Deformity Correction

Virtual Surgical Planning, 3D-Printing and Customized Bone Allograft for Acute Correction of Severe Genu Varum in Children

Superior accuracy in knee double level osteotomy using a novel hybrid fixation technique compared to conventional double plating

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