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Chen KJ, Hsiung W, Wang CY, Lee OKS, Huang KK, Huang Y, Yang JCS. Comparison of double chevron-cut and biplanar distal femoral osteotomy techniques: A biomechanical study. PLoS One 2024; 19:e0296300. [PMID: 38635518 PMCID: PMC11025861 DOI: 10.1371/journal.pone.0296300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/10/2023] [Indexed: 04/20/2024] Open
Abstract
OBJECTIVE This study aimed to compare the stability and mechanical properties of the double chevron-cut (DCC) and biplanar (BP) distal femoral osteotomy (DFO) techniques, along with analyzing their respective contact surface areas. METHODS Biomechanical testing was performed using sawbone and 3D modeling techniques to assess axial and torsional stability, torsional stiffness, and maximum torque of both osteotomy configurations. Additionally, 3D models of the sawbone femur were created to calculate and compare the contact surface area of the DCC, BP, and conventional single-plane DFO techniques. RESULTS Axial stiffness and maximum strength did not significantly differ between the two osteotomy techniques. However, in terms of torsional properties, the DCC technique exhibited superior torsional stiffness compared to the BP group (27 ± 7.7 Nm/° vs. 4.5 ± 1.5 Nm/°, p = 0.008). Although the difference in maximum torque did not reach statistical significance (63 ± 10.6 vs. 56 ± 12.1, p = 0.87), it is noteworthy that the DCC group sawbone model exhibited fracture in the shaft region instead of at the osteotomy site. Therefore, the actual maximum torque of the DCC construct may not be accurately reflected by the numerical values obtained in this study. The contact surface area analysis revealed that the BP configuration had the largest contact surface area, 111% larger than that of the single-plane configuration. but 60% of it relied on the less reliable axial cut. Conversely, the DCC osteotomy offered a 31% larger contact surface area than the single-plane configuration, with both surfaces being weight-bearing. CONCLUSION The DCC osteotomy exhibited superior mechanical stability, showing improved rotational stiffness and maximum torque when compared to the BP osteotomy. Although the BP osteotomy resulted in a larger contact surface area than the DCC osteotomy, both were larger than the conventional single-plane configuration. In clinical practice, both the DCC and BP techniques should be evaluated based on patient-specific characteristics and surgical goals.
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Affiliation(s)
- Kuan-Jung Chen
- Department of Orthopaedics, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei Hsiung
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Orthopaedics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chien-Yuan Wang
- Department of Orthopaedics, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
- Department of Orthopaedics, College of Medicine, China Medical University, Taichung, Taiwan
| | - Oscar Kuang-Sheng Lee
- Department of Orthopaedics, College of Medicine, China Medical University, Taichung, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Center for Translational Genomics and Regenerative Medicine, China Medical University Hospital, Taichung, Taiwan
- Stem Cell Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kuo-Kuang Huang
- Department of Information Science, National Penghu University of Science and Technology, Penghu, Taiwan
| | - Ye Huang
- Department of Orthopedics, Knee Preservation Clinical and Research Center, Beijing Jishuitan Hospital, Beijing, China
| | - Jesse Chieh-Szu Yang
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
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Zaffagnini S, Dal Fabbro G, Lucidi GA, Agostinone P, Belvedere C, Leardini A, Grassi A. Personalised opening wedge high tibial osteotomy with patient-specific plates and instrumentation accurately controls coronal correction and posterior slope: Results from a prospective first case series. Knee 2023; 44:89-99. [PMID: 37562120 DOI: 10.1016/j.knee.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/08/2023] [Accepted: 07/24/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Patient specific devices represent a promising tool to improve accuracy and simplify high tibial osteotomy (HTO) procedures. The current study aims to assess accuracy of the correction of alignment and posterior tibial slope (PTS), and provide patient reported outcomes (PROMs) of a new personalised cutting guide and fixation plate (TOKA) system for HTO in patients with medial osteoarthritis (OA) and varus knee. METHODS 25 patients (mean age 54.4 years) with medial OA and varus knee malalignment who underwent HTO with the TOKA system were prospectively evaluated pre-operatively, 1, 3, 6 and 12-months follow-up. Standing long-leg and lateral radiographs of the knee were used to assess the hip-knee-ankle (HKA) angle and the PTS, respectively. Accuracy was defined as the difference in planned minus achieved correction. The patient reported outcomes collected were the KOOS score, EQ5D, KSS score, and VAS pain scores. All statistical analyses were performed using IBM SPSS Statistics for Windows. RESULTS The mean preoperative HKA was 170.7° (SD ± 3.2°); the mean postoperative HKA was 177.4° (SD ± 2.9°). The overall mean difference between planned and achieved correction in terms of HKA was 2.1° (SD ± 2.0°). The mean difference between planned and achieved PTS was 0.2° (SD ± 0.4°). All the assessed PROMs had a significant (p < 0.001) increase from the pre-operative value to postoperative evaluation and showed a significant (p < 0.001) improvement with follow-up time. CONCLUSIONS TOKA personalised HTO system showed accurate correction in terms of both coronal and sagittal alignment, and excellent patient reported outcomes. LEVEL OF EVIDENCE 4, prospective case series. Registration in public trial registry: registered at ClinicalTrial.gov [NCT04574570].
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Affiliation(s)
- Stefano Zaffagnini
- IRCCS Istituto Ortopedico Rizzoli, 2nd Orthopedics and Trauma Unit, Bologna, Italy; Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, University of Bologna, Italy
| | - Giacomo Dal Fabbro
- IRCCS Istituto Ortopedico Rizzoli, 2nd Orthopedics and Trauma Unit, Bologna, Italy.
| | - Gian Andrea Lucidi
- IRCCS Istituto Ortopedico Rizzoli, 2nd Orthopedics and Trauma Unit, Bologna, Italy; Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, University of Bologna, Italy
| | - Piero Agostinone
- IRCCS Istituto Ortopedico Rizzoli, 2nd Orthopedics and Trauma Unit, Bologna, Italy
| | - Claudio Belvedere
- IRCCS Istituto Ortopedico Rizzoli, Laboratory of Movement Analysis and Functional Evaluation of Prosthesis, Bologna, Italy
| | - Alberto Leardini
- IRCCS Istituto Ortopedico Rizzoli, Laboratory of Movement Analysis and Functional Evaluation of Prosthesis, Bologna, Italy
| | - Alberto Grassi
- IRCCS Istituto Ortopedico Rizzoli, 2nd Orthopedics and Trauma Unit, Bologna, Italy; Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, University of Bologna, Italy
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No benefits of knee osteotomy patient's specific instrumentation in experienced surgeon hands. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07288-6. [PMID: 36538058 DOI: 10.1007/s00167-022-07288-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To compare the clinical and radiological outcomes of patient-specific instrumentation (PSI) with the conventional free hand (FH) technique in performing coronal plane corrective knee osteotomies in terms of limb alignment and functional scores. The hypothesis is that conventional FH technique in experienced hands with proper pre-operative planning is as precise as PSI. METHODS Patients who underwent coronal plane corrective knee osteotomies with either PSI or FH technique between 2017 and 2019 by the same senior surgeon and have a minimum of 2 years follow-up period were included in this study. A total of 91 knees (84 patients) with mean age of 42.9 ± 12.5 years who had a pre- and post-operative complete weight-bearing radiographic work-up (50 of them were performed with the FH technique and 41 by means of PSI) were included for comparison. The data were retrospectively reviewed both radiologically and clinically using the Knee Injury and Osteoarthritis Outcome Score (KOOS) sub-scores. All cases in both groups were evaluated for the following measurements: hip-knee-ankle (HKA), medial proximal tibial angle (MPTA), mechanical lateral distal femoral angle (mLDFA), and joint line convergence angle (JLCA) both preoperatively and postoperatively. In addition, FH and PSI osteotomy cases were also compared for their precision in achieving the target correction that was planned preoperatively. All cases were also evaluated clinically preoperatively and at 2-year follow-up using KOOS sub-scores and the two groups were compared. RESULTS The mean HKA precision was 1.5 ± 0.9 in FH group and 1.3 ± 0.7 in PSI (P value = n.s.), the mean MPTA precision was 1.6 ± 1.6 in FH group and 2.1 ± 1.2 in PSI (P value = n.s.), the mean m-LDFA precision was 1.9 ± 1.7 in FH group and 1.4 ± 1.3 in PSI (P value = n.s.), and the mean JLCA precision in the FH group was 1.5 ± 1.2 and 1.7 ± 1.2 in PSI (P value = n.s.). For all the radiographic parameters, there were no statistically significant differences between the target correction and the obtained correction in both groups. Moreover, PSI and FH techniques were comparable in terms of clinical outcomes and no significant difference was found between the two groups in any of the 2-year follow-up KOOS sub-scores. CONCLUSION Conventional FH method in the hands of experienced surgeons is as precise as PSI in reliably achieving the planned correction in different coronal plane knee corrective osteotomies. Moreover, there was also no difference between both methods in the 2-year clinical outcome scores.
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Zaffagnini S, Dal Fabbro G, Belvedere C, Leardini A, Caravelli S, Lucidi GA, Agostinone P, Mosca M, Neri MP, Grassi A. 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. J Clin Med 2022; 11:jcm11195717. [PMID: 36233583 PMCID: PMC9571741 DOI: 10.3390/jcm11195717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 11/17/2022] Open
Abstract
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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Affiliation(s)
- Stefano Zaffagnini
- 2nd Orthopedics and Trauma Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), University of Bologna, 40126 Bologna, Italy
| | - Giacomo Dal Fabbro
- 2nd Orthopedics and Trauma Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Correspondence: ; Tel.: +39-051-636-6075
| | - Claudio Belvedere
- Laboratory of Movement Analysis and Functional Evaluation of Prosthesis, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Alberto Leardini
- Laboratory of Movement Analysis and Functional Evaluation of Prosthesis, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Silvio Caravelli
- 2nd Orthopedics and Trauma Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Gian Andrea Lucidi
- 2nd Orthopedics and Trauma Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), University of Bologna, 40126 Bologna, Italy
| | - Piero Agostinone
- 2nd Orthopedics and Trauma Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Massimiliano Mosca
- 2nd Orthopedics and Trauma Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Maria Pia Neri
- 2nd Orthopedics and Trauma Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Alberto Grassi
- 2nd Orthopedics and Trauma Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), University of Bologna, 40126 Bologna, Italy
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