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Mabrouk A, Monda M, Bell L, Broderick J, Dawson M. Superior accuracy in knee double level osteotomy using a novel hybrid fixation technique compared to conventional double plating. J Exp Orthop 2024; 11:e12081. [PMID: 39015342 PMCID: PMC11249844 DOI: 10.1002/jeo2.12081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 06/21/2024] [Accepted: 06/25/2024] [Indexed: 07/18/2024] Open
Abstract
Purpose This 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. Methods A 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. Results A 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). Conclusion Superior 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 Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Ahmed Mabrouk
- Trauma & Orthopaedics DepartmentLeeds Teaching HospitalsLeedsUK
| | - Maureen Monda
- Trauma & Orthopaedics DepartmentNorth Cumbria NHS TrustNorth CumbriaUK
| | - Lucy Bell
- Trauma & Orthopaedics DepartmentNorth Cumbria NHS TrustNorth CumbriaUK
| | - James Broderick
- Trauma & Orthopaedics DepartmentNorth Cumbria NHS TrustNorth CumbriaUK
| | - Matthew Dawson
- Trauma & Orthopaedics DepartmentNorth Cumbria NHS TrustNorth CumbriaUK
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Schneble CA, Yu K, Venkadesan M, Cooperman D, Beitler B, Sieberer J, Fulkerson J. Three-Dimensional Imaging of the Patellofemoral Joint Improves Understanding of Trochlear Anatomy and Pathology and Planning of Realignment. Arthroscopy 2024:S0749-8063(24)00305-0. [PMID: 38697330 DOI: 10.1016/j.arthro.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 04/07/2024] [Accepted: 04/09/2024] [Indexed: 05/04/2024]
Abstract
Three-dimensional (3D) modeling using digital or printed models provides a unique perspective that caters to cognitive spatial ability in a way that can add to our understanding and mental representations of human anatomy. This is particularly useful in the setting of trochlear dysplasia, where the morphology of the groove can exhibit substantial variability and complexity. Using 3D reformatted images and models, a pragmatic understanding of how morphology influences patellofemoral pathology can be gleaned. Further, this perspective facilitates cognition of what patellar tracking may look like after realignment procedures. Using 3D modeling, concepts such as patella alta, trochlear depth, lateralization of the patellar entry point, trochlear curvature, and the presence of a proximal trochlear spur can help afford a better understanding of how trochlear anatomy may influence tracking while also providing insight as to the ideal tracking path. The use of 3D has recently emerged as a useful tool in multiple surgical subspecialties, particularly in situations involving surgical planning or complex anatomy. Given the complexity and variation in trochlear morphology in patients with trochlear dysplasia who develop either patellar instability or focal overloading, 3D modeling is well-suited to provide a perspective that can add to our understanding of trochlear dysplasia, and potentially even how we diagnose and treat it. LEVEL OF EVIDENCE: Level V, expert opinion.
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Affiliation(s)
- Christopher A Schneble
- Orthopedic Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - Kristin Yu
- Orthopaedic Surgery, Mayo Clinic Foundation, Rochester, Minnesota, U.S.A
| | - Madhusudhan Venkadesan
- Department of Mechanical Engineering and Materials Science, Yale University, New Haven, Connecticut, U.S.A
| | - Daniel Cooperman
- Department of Orthopaedic Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - Brian Beitler
- Orthopaedic Surgery, Mount Sinai Hospital, New York, New York, U.S.A
| | - Johannes Sieberer
- Department of Mechanical Engineering and Materials Science, Yale University, New Haven, Connecticut, U.S.A
| | - John Fulkerson
- Department of Orthopaedic Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A..
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Harrer J, Lutter C, Hüttner F, Petersen W, Fürmetz J, Ferner F. [Patient-specific cutting guides in corrective osteotomy near to the knee joint]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2024; 36:105-116. [PMID: 38573503 DOI: 10.1007/s00064-024-00842-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/16/2023] [Accepted: 12/18/2023] [Indexed: 04/05/2024]
Abstract
OBJECTIVE Patient-specific cutting guides (PSCG) are used in osteotomy near to the knee joint to simplify the operative technique, shorten the duration of surgery, reduce radiation exposure and to exactly realize the preoperative planning during surgery, especially when complex deformities are corrected simultaneously in multiple planes. INDICATIONS The application of PSCG is in principle possible in all osteotomies near to the knee joint but is especially useful in multidimensional, complex osteotomy. CONTRAINDICATIONS No specific contraindications. SURGICAL TECHNIQUE After multidimensional 3D analysis and planning using a preoperative computed tomography (CT) protocol, a 3D-printed patient-specific cutting guide is produced. This PSCG is used during standard osteotomy near to the knee. Using this PSCG the guided sawcut and predrilling of the screw positions inside the bone for the screws of the planned angle stable osteotomy plate are performed. The amount of the deformity correction needed is "stored" in the PSCG and is converted to the bony geometry during placement of the screws in the predrilled holes through the plate after opening or closing the osteotomy. Apart from that, the surgical approach and technique are equivalent to the standard osteotomy types near to the knee. POSTOPERATIVE MANAGEMENT The application of PSCG in osteotomy near to the knee does not change the postoperative management of the specific osteotomy. RESULTS The use of patient-specific cutting guides leads to a higher accuracy in the implementation of the preoperative planning and the desired target axis is achieved with greater accuracy. Multidimensional complex corrections can also be exactly planned and implemented. In addition, the intraoperative radiation exposure for the operation team can possibly be reduced.
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Affiliation(s)
- Jörg Harrer
- Klinik für Orthopädie und Unfallchirurgie, Helmut-G.-Walther-REGIOMED-Klinikum Lichtenfels, Prof.-Arneth-Str. 2b, 96215, Lichtenfels, Deutschland.
- Komitee Osteotomie der Deutschen Kniegesellschaft (DKG), Schwarzenbek, Deutschland.
| | - Christoph Lutter
- Komitee Osteotomie der Deutschen Kniegesellschaft (DKG), Schwarzenbek, Deutschland
- Department of Orthopaedic Surgery, Rostock University Medical Center, Rostock, Deutschland
| | - Felix Hüttner
- Klinik für Orthopädie und Unfallchirurgie, Helmut-G.-Walther-REGIOMED-Klinikum Lichtenfels, Prof.-Arneth-Str. 2b, 96215, Lichtenfels, Deutschland
| | - Wolf Petersen
- Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Berlin, Deutschland
| | - Julian Fürmetz
- Komitee Osteotomie der Deutschen Kniegesellschaft (DKG), Schwarzenbek, Deutschland
- Abteilung für Sporttraumatologie, BG Unfallklinik Murnau, Murnau, Deutschland
| | - Felix Ferner
- Klinik für Orthopädie und Unfallchirurgie, Helmut-G.-Walther-REGIOMED-Klinikum Lichtenfels, Prof.-Arneth-Str. 2b, 96215, Lichtenfels, Deutschland
- Komitee Osteotomie der Deutschen Kniegesellschaft (DKG), Schwarzenbek, Deutschland
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Anzillotti G, Guazzoni E, Conte P, Di Matteo V, Kon E, Grappiolo G, Loppini M. Using Three-Dimensional Printing Technology to Solve Complex Primary Total Hip Arthroplasty Cases: Do We Really Need Custom-Made Guides and Templates? A Critical Systematic Review on the Available Evidence. J Clin Med 2024; 13:474. [PMID: 38256607 PMCID: PMC10816635 DOI: 10.3390/jcm13020474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/06/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
The burden of osteoarthritis (OA) is around 300 million people affected worldwide, with the hip representing a commonly affected joint. Total hip arthroplasty (THA) has been used with notable success as a definitive treatment to improve pain and function in hip OA patients. The recent advent of new technologies, such as 3D printing, has pushed the application of these new concepts toward applications for the well-known THA. Currently, the evidence on the use of 3D printing to aid complex primary THA cases is still scarce. METHODS An extensive literature review was conducted to retrieve all articles centered on the use of 3D printing in the setting of primary THA. RESULTS A total of seven studies were included in the present systematic review. Four studies investigated the use of 3D-printed surgical guides to be used during surgery. The remaining three studies investigated the benefit of the use of 3D-printed templates of the pelvis to simulate the surgery. CONCLUSIONS The use of 3D printing could be a promising aid to solve difficult primary total hip arthroplasty cases. However, the general enthusiasm in the field is not supported by high-quality studies, hence preventing us from currently recommending its application in everyday practice.
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Affiliation(s)
- Giuseppe Anzillotti
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.A.); (E.G.); (P.C.); (V.D.M.); (E.K.); (G.G.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
| | - Edoardo Guazzoni
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.A.); (E.G.); (P.C.); (V.D.M.); (E.K.); (G.G.)
- Fondazione Livio Sciutto Onlus, Campus Savona, Università Degli Studi di Genova, 17100 Savona, Italy
| | - Pietro Conte
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.A.); (E.G.); (P.C.); (V.D.M.); (E.K.); (G.G.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
| | - Vincenzo Di Matteo
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.A.); (E.G.); (P.C.); (V.D.M.); (E.K.); (G.G.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Faculty of Medicine and Surgery, Catholic University of Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Elizaveta Kon
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.A.); (E.G.); (P.C.); (V.D.M.); (E.K.); (G.G.)
- Department of Traumatology, Orthopaedics and Disaster Surgery, Sechenov University, Moscow 119991, Russia
| | - Guido Grappiolo
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.A.); (E.G.); (P.C.); (V.D.M.); (E.K.); (G.G.)
- Fondazione Livio Sciutto Onlus, Campus Savona, Università Degli Studi di Genova, 17100 Savona, Italy
| | - Mattia Loppini
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.A.); (E.G.); (P.C.); (V.D.M.); (E.K.); (G.G.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Fondazione Livio Sciutto Onlus, Campus Savona, Università Degli Studi di Genova, 17100 Savona, Italy
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Burssens A, Devos Bevernage B, Buedts K. Supramalleolar Osteotomies in Cavovarus Foot Deformity: Why Patient-Specific Instruments Make a Difference. Foot Ankle Clin 2023; 28:843-856. [PMID: 37863539 DOI: 10.1016/j.fcl.2023.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
Supramalleolar osteotomy enables correction of the ankle varus deformity and is associated with improvement of pain and function in the short term and long term. Despite these beneficial results, the amount of surgical correction is challenging to titrate and the procedure remains technically demanding. Most supramalleolar osteotomies are currently planned preoperatively on 2-dimensional weight-bearing radiographs and executed peroperatively using free-hand techniques. This article encompasses 3-dimensional planning and printing techniques based on weight-bearing computed tomography images and patient-specific instruments to correct ankle varus deformities.
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Affiliation(s)
- Arne Burssens
- Department of Orthopaedics, Ghent University Hospital, Corneel Heymanslaan 10, Ghent 9000, Belgium.
| | - Bernhard Devos Bevernage
- Department of Orthopaedics, Ghent University Hospital, Corneel Heymanslaan 10, Ghent 9000, Belgium; Department of Orthopaedics, Foot and Ankle Institute, Avenue Ariane 5, Brussels 1000, Belgium
| | - Kristian Buedts
- Department of Orthopaedics, ZNA Middelheim, Lindendreef 1, Antwerp 2020, Belgium
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Menozzi GC, Depaoli A, Ramella M, Alessandri G, Frizziero L, Liverani A, Rocca G, Trisolino G. Side-to-Side Flipping Wedge Osteotomy: Virtual Surgical Planning Suggested an Innovative One-Stage Procedure for Aligning Both Knees in "Windswept Deformity". J Pers Med 2023; 13:1538. [PMID: 38003853 PMCID: PMC10671880 DOI: 10.3390/jpm13111538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/11/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023] Open
Abstract
(1) Background: The adoption of Virtual Surgical Planning (VSP) and 3D technologies is rapidly growing within the field of orthopedic surgery, opening the door to highly innovative and individually tailored surgical techniques. We present an innovative correction approach successfully used in a child affected by "windswept deformity" of the knees. (2) Methods: We report a case involving a child diagnosed with "windswept deformity" of the knees. This condition was successfully addressed through a one-stage bilateral osteotomy of the distal femur. Notably, the wedge removed from the valgus side was flipped and employed on the varus side to achieve the correction of both knees simultaneously. The surgical technique was entirely conceptualized, simulated, and planned in a virtual environment. Customized cutting guides and bony models were produced at an in-hospital 3D printing point of care and used during the operation. (3) Results: The surgery was carried out according to the VSP, resulting in favorable outcomes. We achieved good corrections of the angular deformity with an absolute difference from the planned correction of 2° on the right side and 1° on the left side. Moreover, this precision not only improved surgical outcomes but also reduced the procedure's duration and overall cost, highlighting the efficiency of our approach. (4) Conclusions: The integration of VSP and 3D printing into the surgical treatment of rare limb anomalies not only deepens our understanding of these deformities but also opens the door to the development of innovative, personalized, and adaptable approaches for addressing these unique conditions.
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Affiliation(s)
- Grazia Chiara Menozzi
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.C.M.); (A.D.); (M.R.); (G.R.)
| | - Alessandro Depaoli
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.C.M.); (A.D.); (M.R.); (G.R.)
| | - Marco Ramella
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.C.M.); (A.D.); (M.R.); (G.R.)
| | - Giulia Alessandri
- Department of Industrial Engineering, Alma Mater Studiorum University of Bologna, 40136 Bologna, Italy; (G.A.); (L.F.); (A.L.)
| | - Leonardo Frizziero
- Department of Industrial Engineering, Alma Mater Studiorum University of Bologna, 40136 Bologna, Italy; (G.A.); (L.F.); (A.L.)
| | - Alfredo Liverani
- Department of Industrial Engineering, Alma Mater Studiorum University of Bologna, 40136 Bologna, Italy; (G.A.); (L.F.); (A.L.)
| | - Gino Rocca
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.C.M.); (A.D.); (M.R.); (G.R.)
| | - Giovanni Trisolino
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.C.M.); (A.D.); (M.R.); (G.R.)
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Vlachopoulos L, Fucentese SF. [Osteotomies around the knee: preoperative planning using CT-based three-dimensional analysis, patient-specific cutting and reduction guides]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2023; 35:225-238. [PMID: 37316574 PMCID: PMC10520128 DOI: 10.1007/s00064-023-00814-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The goal of osteotomy is either to restore pretraumatic anatomic conditions or to shift the load to less affected compartments. INDICATIONS Indications for computer-assisted 3D analysis and the use of patient-specific osteotomy and reduction guides include "simple" deformities and, in particular, multidimensional complex (especially posttraumatic) deformities. CONTRAINDICATIONS General contraindications for performing a computed tomography (CT) scan or for an open approach for performing the surgery. SURGICAL TECHNIQUE Based on CT examinations of the affected and, if necessary, the contralateral healthy extremity as a healthy template (including hip, knee, and ankle joints), 3D computer models are generated, which are used for 3D analysis of the deformity as well as for calculation of the correction parameters. For the exact and simplified intraoperative implementation of the preoperative plan, individualized guides for the osteotomy and the reduction are produced by 3D printing. POSTOPERATIVE MANAGEMENT Partial weight-bearing from the first postoperative day. Increasing load after the first x‑ray control 6 weeks postoperatively. No limitation of the range of motion. RESULTS There are several studies that have analyzed the accuracy of the implementation of the planned correction for corrective osteotomies around the knee joint with the use of patient-specific instruments with promising results.
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Affiliation(s)
- Lazaros Vlachopoulos
- Klinik für Orthopädie, Universitätsklinik Balgrist, Universität Zürich, Forchstr. 340, 8008, Zürich, Schweiz.
| | - Sandro F Fucentese
- Klinik für Orthopädie, Universitätsklinik Balgrist, Universität Zürich, Forchstr. 340, 8008, Zürich, Schweiz
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Liles JL, Vopat ML, Ganokroj P, Mologne MS, Fossum BW, Peebles AM, Provencher MT. Patient-Specific Instrumentation for Medial Closing Wedge Distal Femoral Osteotomy With Patellar Osteochondral Allograft. Arthrosc Tech 2023; 12:e1203-e1209. [PMID: 37533923 PMCID: PMC10391343 DOI: 10.1016/j.eats.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/16/2023] [Indexed: 08/04/2023] Open
Abstract
The primary indications for performing a medial closing wedge distal femoral osteotomy are valgus knee malalignment, lateral knee compartment overload, lateral meniscus insufficiency, and/or lateral compartment osteoarthritis or cartilage damage. Without correction of this malalignment, there is an increased risk for chondral damage in the lateral and patellofemoral compartment of the knee. The optimal candidates for this procedure are young, active individuals with moderate to severe arthritis in the lateral compartment. Recently, preoperative planning for high tibial and distal femoral osteotomies (HTOs and DFOs) using 3-dimensional (3D) patient-specific instrumentation (PSI) has increased in popularity. Successful patient outcomes have been reported using this technique. This Technical Note illustrates our preferred technique that uses 3D PSI in addition to a patellar OCA transplant when treating a symptomatic cartilage lesion associated with genu valgum.
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Affiliation(s)
- Jordan L. Liles
- Steadman Clinic, Vail, Colorado, U.S.A
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Matthew L. Vopat
- Steadman Clinic, Vail, Colorado, U.S.A
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Phob Ganokroj
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | | | | | | | - Matthew T. Provencher
- Steadman Clinic, Vail, Colorado, U.S.A
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
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Dasari SP, Hevesi M, Mameri E, Ferrer-Rivero R, Fortier LM, Jackson GR, Warrier AA, Maheshwer B, Jawanda H, Khan ZA, Kerzner B, Browning RB, Gursoy S, Chahla J. Patient-specific instrumentation for medial opening wedge high tibial osteotomies in the management of medial compartment osteoarthritis yields high accuracy and low complication rates: A systematic review. J ISAKOS 2023; 8:163-176. [PMID: 36931505 DOI: 10.1016/j.jisako.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 01/15/2023] [Accepted: 02/25/2023] [Indexed: 03/17/2023]
Abstract
IMPORTANCE There has been growing interest in the use of patient-specific instrumentation (PSI) to maximise accuracy and minimise the risk of major complications for medial opening-wedge high tibial osteotomies (MOW-HTOs). Numerous studies have reported the efficacy and safety of implementing this technology into clinical practice, yet no systematic review summarising the clinical literature on PSI for MOW-HTOs has been performed to date. AIM The aim of this investigation was to perform a systematic review summarising the evidence surrounding the use of PSI for MOW-HTOs in the management of medial compartment osteoarthritis. EVIDENCE REVIEW PubMed, Scopus, and the Cochrane Library were queried in October 2021 for studies that used PSI for MOW-HTOs when managing medial compartment knee osteoarthritis. Primary outcomes included accuracy in coronal plane correction (mechanical medial proximal tibial angle), sagittal plane correction (posterior tibial slope), and mechanical axis correction (hip-knee-ankle angle [HKA], mechanical femorotibial angle, and weight-bearing line). Accuracy was defined as error between post-operative measurements relative to the planned pre-operative correction. A secondary outcome was the incidence of major complications. FINDINGS This review included eight different techniques among the 14 included studies. There was a weighted mean error of 0.5° (range: 0.1°-1.3°) for the mechanical medial proximal tibial angle, 0.6° (range: 0.3°-2.7°) for the posterior tibial slope, and 0.8° (range: 0.1°-1.0°) for the hip-knee-ankle angle. Four studies compared the correctional error of the mechanical axis between conventional techniques and PSI techniques. The comparative difference between the two techniques favoured the use of PSI for MOW-HTOs (standardised mean difference = 0.52; 95% confidence interval, 0.16 to 0.87; p = 0.004). Among the 14 studies evaluated, four studies explicitly reported no major complications, while five studies reported a non-zero incidence of major complications. Among these nine studies, the weighted mean major complication rate was 7.1% (range: 0.0-13.0%). CONCLUSIONS AND RELEVANCE The findings of this present systematic review suggest that the use of PSI for MOW-HTOs leads to high accuracy relative to the planned corrections in the coronal plane, sagittal plane, and mechanical axis. Furthermore, these findings would suggest there is a low risk of major complications when implementing PSI for MOW-HTOs. LEVEL OF EVIDENCE Systematic review; IV.
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Affiliation(s)
- Suhas P Dasari
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Mario Hevesi
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Enzo Mameri
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Robert Ferrer-Rivero
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Luc M Fortier
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Garrett R Jackson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Alec A Warrier
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Bhargavi Maheshwer
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Harkirat Jawanda
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Zeeshan A Khan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Benjamin Kerzner
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Robert B Browning
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Safa Gursoy
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
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Benignus C, Buschner P, Meier MK, Wilken F, Rieger J, Beckmann J. Patient Specific Instruments and Patient Individual Implants—A Narrative Review. J Pers Med 2023; 13:jpm13030426. [PMID: 36983609 PMCID: PMC10051718 DOI: 10.3390/jpm13030426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/20/2023] [Accepted: 02/25/2023] [Indexed: 03/02/2023] Open
Abstract
Joint arthroplasties are one of the most frequently performed standard operations worldwide. Patient individual instruments and patient individual implants represent an innovation that must prove its usefulness in further studies. However, promising results are emerging. Those implants seem to be a benefit especially in revision situations. Most experience is available in the field of knee and hip arthroplasty. Patient-specific instruments for the shoulder and upper ankle are much less common. Patient individual implants combine individual cutting blocks and implants, while patient individual instruments solely use individual cutting blocks in combination with off-the-shelf implants. This review summarizes the current data regarding the implantation of individual implants and the use of individual instruments.
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Affiliation(s)
- Christian Benignus
- Department of Traumatology and Orthopedic Surgery, Hospital Ludwigsburg, Posilipostr. 4, 71640 Ludwigsburg, Germany
| | - Peter Buschner
- Department of Orthopedic Surgery and Traumatology, Hospital Barmherzige Brüder Munich, Romanstr. 93, 80639 Munich, Germany
| | - Malin Kristin Meier
- Department of Orthopedic Surgery and Traumatology, Inselspital, University Hospital Bern, University of Bern, Freiburgstr. 4, 3010 Bern, Switzerland
| | - Frauke Wilken
- Department of Orthopedic Surgery and Traumatology, Hospital Barmherzige Brüder Munich, Romanstr. 93, 80639 Munich, Germany
| | - Johannes Rieger
- Department of Orthopedic Surgery and Traumatology, Hospital Barmherzige Brüder Munich, Romanstr. 93, 80639 Munich, Germany
| | - Johannes Beckmann
- Department of Orthopedic Surgery and Traumatology, Hospital Barmherzige Brüder Munich, Romanstr. 93, 80639 Munich, Germany
- Correspondence:
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Attention to Detail: The Effect of Fluoroscopic Parallax on Limb Alignment Assessment During Corrective Osteotomy. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202302000-00008. [PMID: 36787194 PMCID: PMC9928831 DOI: 10.5435/jaaosglobal-d-22-00289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/06/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND The accuracy of a corrective osteotomy is dependent on many factors. One error rarely considered is using noncentered fluoroscopic imaging to assess intraoperative alignment. This study quantified the coronal alignment error produced by visual parallax per interval changes in vertical and horizontal positioning of the C-arm and alignment rod during intraoperative evaluation. METHODS Unilateral hip, ankle, and knee fluoroscopic images were obtained from a single intact cadaveric specimen. A center-center fluoroscopic image was obtained by moving the C-arm appeared in the center square of the nine-box grid. With the base of the C-arm stationary, the radiograph generator/intensifier portion of the C-arm was translated medially until the target bone appeared on the edge of the fluoroscopic image. RESULTS One hundred eight images were obtained. Measurement error increased by an average of 14% per 10 mm of horizontal C-arm offset. Minimal effect was seen if the obtained image was within 5 mm of the true center; however, once 55 mm of offset was reached, all experimental conditions resulted in at least 10 mm of parallax error. CONCLUSION Our results demonstrate that small variations in C-arm positioning can create statistically significant inaccuracies when assessing limb alignment using intraoperative fluoroscopy.
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Wang J, Wang X, Sun B, Yuan L, Zhang K, Yang B. 3D-printed patient-specific instrumentation decreases the variability of patellar height in total knee arthroplasty. Front Surg 2023; 9:954517. [PMID: 36704513 PMCID: PMC9871753 DOI: 10.3389/fsurg.2022.954517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Abstract
Objective Three-dimensionally (3D) printed patient-specific instrumentation (PSI) might help in this regard with individual design and more accurate osteotomy, but whether the utility of such instrumentations minimizes the variability of patellar height in total knee arthroplasty (TKA) and the reasons for this effect are unknown. Our aim is to compare and analyze the variability of patellar height with PSI and conventional instrumentation (CI) in TKA. Methods Between March 2018 and November 2021, 215 patients with severe knee osteoarthritis who were treated with primary unilateral TKA were identified for this observational study. The patients were divided into the CI-TKA group and PSI-TKA group according to the osteotomy tools used in TKA. Preoperative and postoperative radiographic parameters including hip-knee-ankle angle (HKA), posterior tibial slope (PTS), Insall-Salvati ratio, modified Caton-Deschamps (mCD) ratio, anterior condylar offset (ACO), and posterior condylar offset (PCO) were evaluated. Results The groups were similar in patients' demographic data, clinical scores, and radiographic parameters preoperatively. Overall, according to the results of the Insall-Salvati ratio, postoperative patellar height reduction was noted in 140 patients (65.1%). Interestingly, the variability of patellar height was smaller in the PSI-TKA group. Radiographic evaluation revealed that the Insall-Salvati ratio after TKA had a minor change in the PSI-TKA group (p = 0.005). Similarly, the mCD ratio after TKA also had a minor change in the PSI-TKA group (p < 0.001). Compared to those in the CI-TKA group, the ACO (p < 0.001) and PCO (p = 0.011) after TKA had a minor change in the PSI-TKA group, but no minor PTS change (p = 0.951) was achieved in the PSI-TKA group after TKA. However, even with 3D-printed patient-specific instrumentation, there were still significant reductions in patellar height, ACO, PCO, and PTS after TKA (p < 0.001). Conclusion The variability of patellar height was sufficiently minimized with more accurate anterior and posterior femoral condyle osteotomy when 3D printed PSI was used. Furthermore, there was a trend in over-resection of the femoral anterior and posterior condyle and a marked reduction in PTS during TKA, which could lead to a change in patellar height and might result in more patellofemoral complications following TKA. Level of evidence Level II.
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Virtual Surgical Planning, 3D-Printing and Customized Bone Allograft for Acute Correction of Severe Genu Varum in Children. J Pers Med 2022; 12:jpm12122051. [PMID: 36556271 PMCID: PMC9783361 DOI: 10.3390/jpm12122051] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/07/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022] Open
Abstract
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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Lee YS. Editorial Commentary: Patient-Specific Instrumentation for Knee High Tibial Osteotomy Addresses the Bony but Not the Soft-Tissue Aspect of Deformity Correction. Arthroscopy 2022; 38:2759-2760. [PMID: 36064281 DOI: 10.1016/j.arthro.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 02/02/2023]
Abstract
Both bony and soft-tissue components should be considered during preoperative planning and intraoperative performance of knee high tibial osteotomy to achieve accurate correction. 3D-printed patient-specific instrumentation may aid in addressing the bony component. Even with appropriate preoperative planning for bony and soft-tissue correction, appropriate adjustments must be made intraoperatively to achieve successful outcomes, and accurate correction is impossible unless the soft-tissue component is considered.
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Affiliation(s)
- Yong Seuk Lee
- Seoul National University College of Medicine, Seoul National University Bundang Hospital
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