Are three-dimensional patient-specific cutting guides for open wedge high tibial osteotomy accurate? An in vitro study
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RESEARCH ARTICLE
Open Access
Are three-dimensional patient-specific cutting guides for open wedge high tibial osteotomy accurate? An in vitro study Mathias Donnez1,2,3* , Matthieu Ollivier1,2, Maxime Munier2, Philippe Berton3, Jean-Pierre Podgorski3, Patrick Chabrand1,2 and Sébastien Parratte1,2
Abstract Background: The 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. Methods: Ten 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 preOWHTO reference planes and axis. Pearson’s and Lin’s correlation tests were performed to assess precision and accuracy of patient-specific cutting guides. Results: The 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. Conclusions: 3D 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. Keywords: Knee surgery, Osteoarthrosis, Medial gonarthrosis, Osteotomy, Open wedge high tibial osteotomy, Patientspecific, Accuracy, Tibial slope correction
Background Open wedge high tibial osteotomy (OWHTO) has been described as an efficient conservative surgical treatment preserving the bone stock for patients with moderate medial gonarthrosis and lower leg malalignment [1, 2]. * Correspondence: [email protected] 1 Aix Marseille Univ, CNRS, ISM, Marseille, France 2 Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopaedics and Traumatology, Marseille, France Full list of author information is available at the end of the article
The objective of the OWHTO is to correct lower leg malalignment in both the frontal and sagittal tibial planes to limit the overload of the medial compartment. Accurate correctio
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