Is Patient‐Specific Instrumentation Accurate and Necessary for Open‐Wedge High Tibial Osteotomy? A Meta‐Analysis

Abstract

The purpose of this meta‐analysis was to identify if patient‐specific instrumentation (PSI) could increase the accuracy of the correction in high tibial osteotomy (HTO) and to explore the assessment indices and the necessity of using a PSI in HTO. A systematic search was carried out using online databases. A total of 466 patients were included in 11 papers that matched the inclusion criteria. To evaluate the accuracy of PSI‐assisted HTO, the weight bearing line ratio (WBL%), hip‐knee‐ankle angle (HKA), mechanical medial proximal tibial angle (mMPTA), and posterior tibial slope angle (PTSA) were measured preoperatively and postoperatively and compared to the designed target values. Statistical analysis was performed after strict data extraction with Review Manager (version 5.4). Significant differences were detected in WBL% (MD = −36.41; 95% CI: −42.30 to −30.53; p < 0.00001), HKA (MD = −9.95; 95% CI: –11.65 to –8.25; p < 0.00001), and mMPTA (MD = –8.40; 95% CI:−10.27 to −6.53; p < 0.00001) but not in PTSA (MD = 0.34; 95% CI: −0.59 to 1.27; p = 0.47) between preoperative and postoperative measurements. There was no significant difference between the designed target values and the postoperative correction values of HKA (MD = 0.14; 95% CI: −0.19 to 0.47; p = 0.41) or mMPTA (MD = 0.11; 95% CI −0.34 to 0.55; p = 0.64). The data show that 3D‐based planning of PSI for HTO is both accurate and safe. WBL%, HKA, and mMPTA were the optimal evaluation indicators of coronal plane correction. Sagittal correction is best evaluated by the PTSA. The present study reports that PSI is accurate but not necessary in typical HTO.

Intraoperative Angle Measurement of Anatomical Structures: A Systematic Review

“…Nevertheless, the use of tracking systems together with 3D representations of the segments could have a deep impact on both the surgical team and the patient, as it can result in a reduction of the operation time and radiation exposure, two of the major limitations of this technology [ 119 ]. Moreover, in the scope of implementing image-based technologies, despite requiring a considerable investment of resources, the capabilities they offer justify their use primarily for complex operations that depend on those capabilities [ 44 ].…”

“…In clinical practice, ensuring intraoperative precision in measuring osteotomy angles is of paramount importance [ 43 , 44 ]. Orthopedic surgeons are mostly acquainted with the use of manual devices that are inexpensive and easy to use; however, their accuracy is still far from precise.…”

“…However, that planning, on its own, does not guarantee the ideal outcome, as several studies have reported differences between the preoperative target correction and the postoperative outcome [ 41 , 42 ]. This highlights the value that intraoperative angle adjustments can have in order to achieve the postoperative angle desired, assisting the surgeons in maintaining a correction angle in line with the preoperative target [ 43 , 44 ].…”

“…Currently, there are some limitations associated with intraoperative angle adjustments, as most systems imply an increase in complexity and invasiveness, prolonged intervention time, special equipment, exposure to radiation, increased cost, a learning curve, and may be unavailable in some hospitals [ 43 , 44 , 45 ]. Moreover, there is difficulty in using the same system for different types of osteotomies and different places, as these conditions may imply a higher degree of difficulty in obtaining angle measurements [ 20 , 21 , 22 , 44 ].…”

“…Currently, there are some limitations associated with intraoperative angle adjustments, as most systems imply an increase in complexity and invasiveness, prolonged intervention time, special equipment, exposure to radiation, increased cost, a learning curve, and may be unavailable in some hospitals [ 43 , 44 , 45 ]. Moreover, there is difficulty in using the same system for different types of osteotomies and different places, as these conditions may imply a higher degree of difficulty in obtaining angle measurements [ 20 , 21 , 22 , 44 ]. These limitations create a problem for a surgeon performing an osteotomy, as the intraoperative adjustments will frequently have to rely on the surgeon’s best estimate of the angles [ 46 , 47 ] since the drawbacks of the available systems render them unusable for most situations.…”