Patient-specific high tibial osteotomy for varus malalignment: 3D-printed plating technique and review of the literature

Jeong, Stacy; Samuel, Linsen T.; Acuña, Alexander J.; Kamath, Atul F.

doi:10.1007/s00590-021-03043-8

Cited by 15 publications

(21 citation statements)

References 28 publications

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“…When comparing the postoperative MPTA with the planned MPTA, no significant difference was found, indicating that the degree of force line correction by the PSI was accurate and could achieve the preoperative planned degree of force line correction in the absence of errors in measurement and operation. Different previous studies reported the application of PSI for HTO with a mean difference between the preoperative planned and postoperative MPTA of approximately 0.1° ~ 1.9° [ 13 , 14 ]. The mean difference between the postoperative MPTA and preoperative planned value in this study was 0.72°, which was similar to the results reported in the previous literature.…”

Section: Discussionmentioning

confidence: 99%

The validity and accuracy of 3D-printed patient-specific instruments for high tibial osteotomy: a cadaveric study

Miao

Luo

et al. 2022

J Orthop Surg Res

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Objective High tibial osteotomy (HTO) has been used for the treatment of patients with knee osteoarthritis. However, the successful implementation of HTO requires precise intraoperative positioning, which places greater requirements on the surgeon. In this study, we aimed to design a new kind of 3D-printed patient-specific instrument (PSI) for HTO, including a positioning device and an angle bracing spacer, and verify its effectiveness using cadaveric specimens. Methods This study included ten fresh human lower-limb cadaveric specimens. Computed tomography (CT) and X-ray examinations were performed to make preoperative plans. PSI was designed and 3D-printed according to the preoperative plan. Then, the PSI was used to guide HTO. Finally, we performed X-ray and CT after the operation to verify its validity and accuracy. Results The PSI using process was adjusted according to the pre-experimental procedure in 1 case. Hinge fracture occurred in 1 case. According to X-rays of the remaining eight cadaveric specimens, no statistically significant difference was noted between the preoperative planning medial proximal tibial angle (MPTA) and postoperative MPTA (P > 0.05) or the preoperative and postoperative posterior slope angle (PSA) (P > 0.05). According to the CT of 10 cadaveric specimens, no statistically significant difference was noted between the design angle and actual angle, which was measured according to the angle between the osteotomized line and the cross section (P > 0.05). The gap between the designed osteotomy line and the actual osteotomy line was 2.09 (0.8 ~ 3.44) mm in the coronal plane and 1.58 (0.7 ~ 2.85) mm in the sagittal plane. Conclusion This 3D-printed PSI of HTO accurately achieves the angle and position of the preoperative plan without increasing the stripping area. However, its use still requires a certain degree of proficiency to avoid complications, such as hinge fracture.

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Section: Discussionmentioning

confidence: 99%

The validity and accuracy of 3D-printed patient-specific instruments for high tibial osteotomy: a cadaveric study

Miao

Luo

et al. 2022

J Orthop Surg Res

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“…An additional study was excluded because it investigated the osteotomy procedure to correct tibial plateau fractures’ non-union [ 12 ]. A total of 28 articles [ 6 , 7 , 8 , 9 , 10 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ] were included in this systematic review ( Figure 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…All the included studies used preoperative CT scan to obtain patient-specific 3D geometry for planning. The majority of patient-specific devices used in the literature for HTO were the customized osteotomy guides, described in 25 out of 28 studies included ( Table 1 ), with only two studies using a custom-made plate [ 21 , 31 ].…”

Section: Resultsmentioning

confidence: 99%

“…Five studies [ 8 , 20 , 28 , 29 , 35 ] reported the duration of the surgery, revealing an average surgical time between 26.3 and 61 min. Seven studies [ 8 , 20 , 21 , 28 , 29 , 32 , 35 ] reported the mean intraoperative fluoroscopy shoots, showing an average of figures between 1.3 and 18.8. Four studies reported the hinge fracture frequency, indicating a range from 0 to 24% [ 10 , 29 , 32 , 34 ].…”

Section: Resultsmentioning

confidence: 99%

“…A recent systematic review reported that conventional HTO procedures can delay the onset of knee arthroplasty by more than 15 years [ 1 ]. However, this procedure presents several pitfalls, including generalized and specific surgical complications such as deep vein thrombosis, nerve injury, and intra-operative fractures [ 21 ]. Furthermore, postoperative under- and over-correction regularly occurs, affecting the long-term outcomes of HTO, which depend on the accuracy of the correction [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

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Custom-Made Devices Represent a Promising Tool to Increase Correction Accuracy of High Tibial Osteotomy: A Systematic Review of the Literature and Presentation of Pilot Cases with a New 3D-Printed System

Zaffagnini

Fabbro

Belvedere

et al. 2022

JCM

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Background: The accuracy of the coronal alignment corrections using conventional high tibial osteotomy (HTO) falls short, and multiplanar deformities of the tibia require consideration of both the coronal and sagittal planes. Patient-specific instrumentations have been introduced to improve the control of the correction. Clear evidence about customized devices for HTO and their correction accuracy lacks. Methods: The databases PUBMED and EMBASE were systematically screened for human and cadaveric studies about the use of customized devices for high tibial osteotomy and their outcomes concerning correction accuracy. Furthermore, a 3D-printed customized system for valgus HTO with three pilot cases at one-year follow-up was presented. Results: 28 studies were included. The most commonly used custom-made devices for HTO were found to be cutting guides. Reported differences between the achieved and targeted correction of hip-knee-ankle angle and the posterior tibial slope were 3° or under. The three pilot cases that underwent personalized HTO with a new 3D-printed device presented satisfactory alignment and clinical outcomes at one-year follow-up. Conclusion: The available patient-specific devices described in the literature, including the one used in the preliminary cases of the current study, showed promising results in increasing the accuracy of correction in HTO procedure.

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Design considerations for patient-specific bone fixation plates: a literature review

Brouwer de Koning,

de Winter,

Moosabeiki

et al. 2023

Med Biol Eng Comput

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Patient-specific high tibial osteotomy for varus malalignment: 3D-printed plating technique and review of the literature

Cited by 15 publications

References 28 publications

The validity and accuracy of 3D-printed patient-specific instruments for high tibial osteotomy: a cadaveric study

The validity and accuracy of 3D-printed patient-specific instruments for high tibial osteotomy: a cadaveric study

Custom-Made Devices Represent a Promising Tool to Increase Correction Accuracy of High Tibial Osteotomy: A Systematic Review of the Literature and Presentation of Pilot Cases with a New 3D-Printed System

Design considerations for patient-specific bone fixation plates: a literature review

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