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J Knee Surg 2021; 34(14): 1560-1569
DOI: 10.1055/s-0040-1710379
Original Article

Feasibility and 3D Planning of a Novel Patient-Specific Instrumentation Technique in Medial Opening-Wedge High Tibial Osteotomy

Wouter Van Genechten
1   Faculty of Medicine, Antwerp University, Antwerp, Belgium
2   More Foundation, AZ Monica, Antwerp, Belgium
,
Wouter Van Tilborg
1   Faculty of Medicine, Antwerp University, Antwerp, Belgium
,
Maxim Van den Bempt
1   Faculty of Medicine, Antwerp University, Antwerp, Belgium
,
Annemieke Van Haver
2   More Foundation, AZ Monica, Antwerp, Belgium
,
Peter Verdonk
1   Faculty of Medicine, Antwerp University, Antwerp, Belgium
2   More Foundation, AZ Monica, Antwerp, Belgium
3   ORTHOCA, Antwerp, Belgium
› Author Affiliations Funding None.
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Abstract

A novel approach for opening-wedge high tibial osteotomy (OWHTO) with patient-specific instrumentation (PSI) was evaluated for its safety, feasibility, and accuracy. Next, the mechanical medial proximal tibial angle (mMPTA) was assessed as a potential planning angle by investigating the relation with the mechanical femorotibial angle (mFTA). Ten OWHTO cases were 3D planned using the mMPTA and operated with a customized 3D-printed wedge and cast which resembled the intended osteotomy opening. Patients were closely monitored for intraoperative and postoperative complications up to 1 year after surgery. Radiological assessment was conducted on full leg standing radiographs and supine lower limb computed tomography-scans preoperatively and 3 months after surgery. No intraoperative complications or logistical issues during PSI processing were observed. Absolute accuracy outcomes showed a correction error of 1.3° ± 1.1 mMPTA and 0.9° ± 0.6 mFTA with all osteotomies falling in (−2°; + 2°) mFTA around the target. The mMPTA and mFTA were found to have a strong correlation in both 3D (r = 0.842, p = 0.002) and 2D (r = 0.766, p = 0.01) imaging for effective correction. The study confirmed the development of a safe and feasible PSI technique in OWHTO with excellent accuracy outcomes. The strong correlation between the mMPTA and mFTA indicated that soft tissue changes after OWHTO are of minor significance to the final alignment in ligament-stable patients. Finally, the mMPTA was found to be a reliable planning angle in 3D software for obtaining the intended lower limb realignment and its use can therefore be recommended in modern OWHTO planning.

Keywords

knee - osteoarthritis - osteotomy - 3D planning - accuracy


Publication History

Received: 11 December 2019

Accepted: 28 March 2020

Article published online:
22 May 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Van den Bempt M, Van Genechten W, Claes T, Claes S. How accurately does high tibial osteotomy correct the mechanical axis of an arthritic varus knee? A systematic review. Knee 2016; 23 (06) 925-935
    CrossrefPubMedGoogle Scholar
  • 2 Martay JL, Palmer AJ, Bangerter NK. et al. A preliminary modeling investigation into the safe correction zone for high tibial osteotomy. Knee 2018; 25 (02) 286-295
    CrossrefPubMedGoogle Scholar
  • 3 Niinimäki TT, Eskelinen A, Ohtonen P, Junnila M, Leppilahti J. Incidence of osteotomies around the knee for the treatment of knee osteoarthritis: a 22-year population-based study. Int Orthop 2012; 36 (07) 1399-1402
    CrossrefPubMedGoogle Scholar
  • 4 Nwachukwu BU, McCormick FM, Schairer WW, Frank RM, Provencher MT, Roche MW. Unicompartmental knee arthroplasty versus high tibial osteotomy: United States practice patterns for the surgical treatment of unicompartmental arthritis. J Arthroplasty 2014; 29 (08) 1586-1589
    CrossrefPubMedGoogle Scholar
  • 5 National Joint Registry for England, Wales and Northern Ireland. 13th Annual Report. Published 2016. Accessed August 27, 2019 at: http://www.njrcentre.org.uk/njrcentre/Portals/0/Documents/England/Reports/13thAnnualReport/07950NJRAnnualReport2016ONLINEREPORT.pdf
  • 6 Darees M, Putman S, Brosset T, Roumazeille T, Pasquier G, Migaud H. Opening-wedge high tibial osteotomy performed with locking plate fixation (TomoFix) and early weight-bearing but without filling the defect. A concise follow-up note of 48 cases at 10 years' follow-up. Orthop Traumatol Surg Res 2018; 104 (04) 477-480
    CrossrefPubMedGoogle Scholar
  • 7 Hantes ME, Natsaridis P, Koutalos AA, Ono Y, Doxariotis N, Malizos KN. Satisfactory functional and radiological outcomes can be expected in young patients under 45 years old after open wedge high tibial osteotomy in a long-term follow-up. Knee Surg Sports Traumatol Arthrosc 2018; 26 (11) 3199-3205
    CrossrefPubMedGoogle Scholar
  • 8 Rodriguez-Merchan EC. Does a previous high tibial osteotomy (HTO) influence the long-term function or survival of a total knee arthroplasty (TKA)?. Arch Bone Jt Surg 2018; 6 (01) 19-22
    PubMedGoogle Scholar
  • 9 Pérez-Mañanes R, Burró JA, Manaute JR, Rodriguez FC, Martín JV. 3D surgical printing cutting guides for open-wedge high tibial osteotomy: do it yourself. J Knee Surg 2016; 29 (08) 690-695
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Hankemeier S, Mommsen P, Krettek C. et al. Accuracy of high tibial osteotomy: comparison between open- and closed-wedge technique. Knee Surg Sports Traumatol Arthrosc 2010; 18 (10) 1328-1333
    CrossrefPubMedGoogle Scholar
  • 11 Wu Z-P, Zhang P, Bai J-Z. et al. Comparison of navigated and conventional high tibial osteotomy for the treatment of osteoarthritic knees with varus deformity: a meta-analysis. Int J Surg 2018; 55: 211-219
    CrossrefPubMedGoogle Scholar
  • 12 Elson DW. The surgical accuracy of knee osteotomy. Knee 2017; 24 (02) 167-169
    CrossrefPubMedGoogle Scholar
  • 13 Victor J, Premanathan A. Virtual 3D planning and patient specific surgical guides for osteotomies around the knee: a feasibility and proof-of-concept study. Bone Joint J 2013; 95-B (Suppl 11A(: 153-158
    CrossrefPubMedGoogle Scholar
  • 14 Lee DH, Nha KW, Park SJ, Han SB. Preoperative and postoperative comparisons of navigation and radiologic limb alignment measurements after high tibial osteotomy. Arthroscopy 2012; 28 (12) 1842-1850
    CrossrefPubMedGoogle Scholar
  • 15 Saragaglia D, Roberts J. Navigated osteotomies around the knee in 170 patients with osteoarthritis secondary to genu varum. Orthopedics 2005; 28 (Suppl. 10) s1269-s1274
    PubMedGoogle Scholar
  • 16 Iorio R, Pagnottelli M, Vadalà A. et al. Open-wedge high tibial osteotomy: comparison between manual and computer-assisted techniques. Knee Surg Sports Traumatol Arthrosc 2013; 21 (01) 113-119
    CrossrefPubMedGoogle Scholar
  • 17 Sarment DP, Al-Shammari K, Kazor CE. Stereolithographic surgical templates for placement of dental implants in complex cases. Int J Periodontics Restorative Dent 2003; 23 (03) 287-295
    PubMedGoogle Scholar
  • 18 Lu S, Zhang YZ, Wang Z. et al. Accuracy and efficacy of thoracic pedicle screws in scoliosis with patient-specific drill template. Med Biol Eng Comput 2012; 50 (07) 751-758
    CrossrefPubMedGoogle Scholar
  • 19 Byrne A-M, Impelmans B, Bertrand V, Van Haver A, Verstreken F. Corrective osteotomy for malunited diaphyseal forearm fractures using preoperative 3-dimensional planning and patient-specific surgical guides and implants. J Hand Surg Am 2017; 42 (10) 836.e1-836.e12
    CrossrefPubMedGoogle Scholar
  • 20 Munier M, Donnez M, Ollivier M. et al. Can three-dimensional patient-specific cutting guides be used to achieve optimal correction for high tibial osteotomy? Pilot study. Orthop Traumatol Surg Res 2017; 103 (02) 245-250
    CrossrefPubMedGoogle Scholar
  • 21 Donnez M, Ollivier M, Munier M. et al. Are three-dimensional patient-specific cutting guides for open wedge high tibial osteotomy accurate? An in vitro study. J Orthop Surg Res 2018; 13 (01) 171
    CrossrefPubMedGoogle Scholar
  • 22 Sheehy L, Cooke TDV. Radiographic assessment of leg alignment and grading of knee osteoarthritis: a critical review. World J Rheumatol 2015; 5 (02) 69-82
    CrossrefPubMedGoogle Scholar
  • 23 Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957; 16 (04) 494-502
    CrossrefPubMedGoogle Scholar
  • 24 Takeuchi R, Ishikawa H, Kumagai K. et al. Fractures around the lateral cortical hinge after a medial opening-wedge high tibial osteotomy: a new classification of lateral hinge fracture. Arthroscopy 2012; 28 (01) 85-94
    CrossrefPubMedGoogle Scholar
  • 25 Kim H-J, Park J, Shin J-Y, Park I-H, Park K-H, Kyung H-S. More accurate correction can be obtained using a three-dimensional printed model in open-wedge high tibial osteotomy. Knee Surg Sport Traumatol Arthrosc 2018; 26 (11) 3452-3458
    CrossrefPubMedGoogle Scholar
  • 26 Yang JCS, Chen CF, Luo CA. et al. Clinical experience using a 3D-printed patient-specific instrument for medial opening wedge high tibial osteotomy. BioMed Res Int 2018; 2018: 9246529
    PubMedGoogle Scholar
  • 27 Brouwer RW, Bierma-Zeinstra SM, van Koeveringe AJ, Verhaar JA. Patellar height and the inclination of the tibial plateau after high tibial osteotomy. The open versus the closed-wedge technique. J Bone Jt Surg 2005; 87 (09) 1227-1232
    CrossrefPubMedGoogle Scholar
  • 28 Kawakami H, Sugano N, Yonenobu K. et al. Effects of rotation on measurement of lower limb alignment for knee osteotomy. J Orthop Res 2004; 22 (06) 1248-1253
    CrossrefPubMedGoogle Scholar
  • 29 Ogawa H, Matsumoto K, Ogawa T, Takeuchi K, Akiyama H. Preoperative varus laxity correlates with overcorrection in medial opening wedge high tibial osteotomy. Arch Orthop Trauma Surg 2016; 136 (10) 1337-1342
    CrossrefPubMedGoogle Scholar
  • 30 Henckel J, Richards R, Lozhkin K. et al. Very low-dose computed tomography for planning and outcome measurement in knee replacement. The imperial knee protocol. J Bone Joint Surg Br 2006; 88 (11) 1513-1518
    CrossrefPubMedGoogle Scholar
  • 31 DePuy Orthopaedics Inc. Radiation Exposure Considerations with the Use of TruMatch Personalized Solutions. 2010. Accessed September 12, 2019
  • 32 Miniaci A, Ballmer FT, Ballmer PM, Jakob RP. Proximal tibial osteotomy. A new fixation device. Clin Orthop Relat Res 1989; (246) 250-259
    PubMedGoogle Scholar
  • 33 Dugdale TW, Noyes FR, Styer D. Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length. Clin Orthop Relat Res 1992; (274) 248-264
    PubMedGoogle Scholar
  • 34 Kubota M, Ohno R, Sato T, Yamaguchi J, Kaneko H, Kaneko K. The medial proximal tibial angle accurately corrects the limb alignment in open-wedge high tibial osteotomy. Knee Surg, Sport Traumatol Arthrosc 2019; 27 (08) 2410-2416
    CrossrefPubMedGoogle Scholar
  • 35 Fujisawa Y, Masuhara K, Shiomi S. The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am. 1979;10(3):585–608
  • 36 van de Pol GJ, Verdonschot N, van Kampen A. The value of the intra-operative clinical mechanical axis measurement in open-wedge valgus high tibial osteotomies. Knee 2012; 19 (06) 933-938
    CrossrefPubMedGoogle Scholar
  • 37 Martay JL, Palmer AJ, Bangerter NK. et al. A preliminary modeling investigation into the safe correction zone for high tibial osteotomy. Knee 2018; 25 (02) 286-295
    CrossrefPubMedGoogle Scholar
  • 38 Stanley JC, Robinson KG, Devitt BM. et al. Computer assisted alignment of opening wedge high tibial osteotomy provides limited improvement of radiographic outcomes compared to flouroscopic alignment. Knee 2016; 23 (02) 289-294
    CrossrefPubMedGoogle Scholar
  • 39 Hohloch L, Kim S, Mehl J. et al. Customized post-operative alignment improves clinical outcome following medial open-wedge osteotomy. Knee Surg Sports Traumatol Arthrosc 2018; 26 (09) 2766-2773
    CrossrefPubMedGoogle Scholar
  • 40 Marti CB, Gautier E, Wachtl SW, Jakob RP. Accuracy of frontal and sagittal plane correction in open-wedge high tibial osteotomy. Arthroscopy 2004; 20 (04) 366-372
    CrossrefPubMedGoogle Scholar
  • 41 Feucht MJ, Minzlaff P, Saier T. et al. Degree of axis correction in valgus high tibial osteotomy: proposal of an individualised approach. Int Orthop 2014; 38 (11) 2273-2280
    CrossrefPubMedGoogle Scholar
  • 42 Victor J, Van Doninck D, Labey L, Innocenti B, Parizel PM, Bellemans J. How precise can bony landmarks be determined on a CT scan of the knee?. Knee 2009; 16 (05) 358-365
    CrossrefPubMedGoogle Scholar
  • 43 Auricchio F, Marconi S. 3D printing: clinical applications in orthopaedics and traumatology. EFORT Open Rev 2017; 1 (05) 121-127
    CrossrefPubMedGoogle Scholar
  • 44 Starosolski ZA, Kan JH, Rosenfeld SD, Krishnamurthy R, Annapragada A. Application of 3-D printing (rapid prototyping) for creating physical models of pediatric orthopedic disorders. Pediatr Radiol 2014; 44 (02) 216-221
    CrossrefPubMedGoogle Scholar
  • 45 Van den Bempt M, Liebregts J, Maal T, Bergé S, Xi T. Toward a higher accuracy in orthognathic surgery by using intraoperative computer navigation, 3D surgical guides, and/or customized osteosynthesis plates: a systematic review. J Craniomaxillofac Surg 2018; 46 (12) 2108-2119
    CrossrefPubMedGoogle Scholar