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

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

We report our experience with a 3D patient-specific instrument (PSI) in an opening-wedge tibial osteotomy for the correction of varus malalignment in a patient with prior anterior cruciate ligament reconstruction. Previous studies have not reported the use of 3D PSI in patients with prior knee surgeries.

Methods

A pre-operative CT was used to create a 3D model of the lower extremity using Bodycad Imager. The pre-operative medial proximal tibial angle (MPTA), lateral distal femoral ankle, hip-knee-ankle (HKA), and tibial slope were calculated. The Bodycad Osteotomy software package was used to create a simulated osteotomy and correction. The resulting 3D patient-specific surgical guide and plate were used to conduct the high tibial osteotomy. Radiographic measurements and range of motion were evaluated at 6-week follow-up.

Results

The arthroscopy and open portions of the procedure were performed in 65 min, with only three fluoroscopy shots taken intraoperatively. At 6-week follow-up, the patient had 125° of flexion and minimal pain. The angular correction of the bone was achieved within 1.9° (planned MPTA 91.9° vs. actual 90°); the HKA angle was achieved with an error of 0.7° (planned 2.4° vs. actual 1.7°); and there was no change in the posterior tibial slope (planned 13.5° vs 13.8° actual).

Conclusion

Three-dimensional PSI can be successfully used for the accurate and efficient correction of varus malalignment while accommodating pre-existing hardware, with good short-term clinical outcomes.

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Center for Hip Preservation, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

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

Authors
  1. Stacy H. Jeong
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  2. Linsen T. Samuel
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  3. Alexander J. Acuña
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  4. Atul F. Kamath
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Corresponding author

Correspondence to Atul F. Kamath.

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Ethical declaration

We certify that our analysis complies with the ethical standards of our institution as well as laws related to research conducted in the USA.

Conflict of interest

A.F.K. reports the following disclosures: research support (Signature Orthopaedics), paid presenter or speaker (DePuy Synthes and Zimmer Biomet), paid consultant (DePuy Synthes and Zimmer Biomet), stock or stock options (Zimmer Biomet, Johnson & Johnson, and Procter & Gamble), IP royalties (Innomed), and board or committee member (AAOS, AAHKS, and Anterior Hip Foundation). L.T.S., A.J.A., J.M.K., and A.E. have nothing to disclose.

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Jeong, S.H., Samuel, L.T., Acuña, A.J. et al. Patient-specific high tibial osteotomy for varus malalignment: 3D-printed plating technique and review of the literature. Eur J Orthop Surg Traumatol 32, 845–855 (2022). https://doi.org/10.1007/s00590-021-03043-8

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  • DOI: https://doi.org/10.1007/s00590-021-03043-8

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