Using a Patient-Specific 3D-Printed Surgical Guide for High Tibial Osteotomy: A Technical Note

doi:10.1007/s12204-021-2302-8

J Shanghai Jiaotong Univ Sci ›› 2021, Vol. 26 ›› Issue (3): 339-345.doi: 10.1007/s12204-021-2302-8

• Medical 3D Printing and Personalised Medicine • Previous Articles Next Articles

Using a Patient-Specific 3D-Printed Surgical Guide for High Tibial Osteotomy: A Technical Note

JIANG Xu1,2 (江旭), XIE Kai1 (谢凯), LI Bo2 (李波), HU Xumin2 (胡旭民), WU Haishan1 (吴海山), GAO Liangbin2 (高梁斌), WANG Liao1 (王燎), YAN Mengning1 (严孟宁)

(1. Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People’s
Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; 2. Department of Orthopaedic
Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China)
(1. Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People’s
Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; 2. Department of Orthopaedic
Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China)

Online:2021-06-28 Published:2021-06-02
Contact: YAN Mengning(严孟宁) E-mail:yanmengning@163.com
Supported by:
the National Key Research and Development
Program of China (No. 2017YFB1104104), the
Clinical Research Program of Ninth People’s Hospital
Affiliated to Shanghai Jiao Tong University School
of Medicine (No. JYLJ025), the Project of the Shanghai
Collaborative Innovation Center for Translational
Medicine (No. TM201814), the Technology and Innovation
Fund (Chuang Ke) of the Ninth People’s
Hospital Affiliated to Shanghai Jiao Tong University
School of Medicine (No. CK2018011), the 3D Snowball
Project of Shanghai Jiao Tong University School
of Medicine (No. GXQ202007), the National Natural
Science Foundation of China (No. 81772425), the Science
and Technology Commission of Shanghai Municipality
(No. 16441908700), Shanghai Jiao Tong University
(No. YG2016MS11), and the Science and Technology
Project of Guangdong Province (No. 201707010089)

Abstract

Abstract: Patient-specific instrumentation (PSI) enables a more accurate alignment of the lower limbs in a high tibial osteotomy (HTO) than in traditional surgery; however, the current design of commercial PSIs is not perfect. Therefore, we designed a new patient-specific surgical guide to improve the accuracy of the osteotomy and verified its reliability through a clinical operation. Here, we describe a patient with isolated medial-compartment bilateral knee osteoarthritis, accompanied by a varus deformity of the proximal tibia. The patient was treated with HTO using a patient-specific 3D-printed surgical guide. We concluded that the patient-specific 3D-printed surgical guide improved the accuracy of the osteotomy and the alignment of the lower limb.

摘要： Patient-specific instrumentation (PSI) enables a more accurate alignment of the lower limbs in a high tibial osteotomy (HTO) than in traditional surgery; however, the current design of commercial PSIs is not perfect. Therefore, we designed a new patient-specific surgical guide to improve the accuracy of the osteotomy and verified its reliability through a clinical operation. Here, we describe a patient with isolated medial-compartment bilateral knee osteoarthritis, accompanied by a varus deformity of the proximal tibia. The patient was treated with HTO using a patient-specific 3D-printed surgical guide. We concluded that the patient-specific 3D-printed surgical guide improved the accuracy of the osteotomy and the alignment of the lower limb.

关键词: high tibial osteotomy (HTO), 3D printing, patient-specific instrumentation (PSI), wedge augment

CLC Number:

R 684

JIANG Xu, (江旭), XIE Kai (谢凯), LI Bo (李波), HU Xumin (胡旭民), WU Haishan (吴海山), GAO Liangbin (高梁斌), WANG Liao (王燎), YAN Mengning (严孟宁). Using a Patient-Specific 3D-Printed Surgical Guide for High Tibial Osteotomy: A Technical Note[J]. J Shanghai Jiaotong Univ Sci, 2021, 26(3): 339-345.

References 30

	[1]
	BONASIA D E, DETTONI F, SITO G, et al. Medial opening wedge high tibial
	osteotomy for medial compartment overload/arthritis in the varus knee:
	Prognostic factors [J]. The American Journal of Sports Medicine, 2014, 42(3):
69	0-698.
	[2]
	AMENDOLA A, BONASIA D E. Results of high tibial osteotomy: Review of the
	literature [J]. International Orthopaedics, 2010, 34(2): 155-160.
	[3]
	FLOERKEMEIER S, STAUBLI A E, SCHROETER S, et al. Outcome after high tibial
	open-wedge osteotomy: A retrospective evaluation of 533 patients [J]. Knee
	Surgery, Sports Traumatology, Arthroscopy, 2013, 21(1): 170-180.
	[4]
	BOUGUENNEC N, MERGENTHALER G, GICQUEL T, et al. Medium-term survival and clinical
	and radiological results in high tibial osteotomy: Factors for failure and
	comparison with unicompartmental arthroplasty [J]. Orthopaedics & Traumatology:
	Surgery & Research, 2020, 106(8): S223-S230.
	[5]
	SMITH W B, STEINBERG J, SCHOLTES S, et al. Medial compartment knee
	osteoarthritis: Agestratified cost-effectiveness of total knee arthroplasty, unicompartmental
	knee arthroplasty, and high tibial osteotomy [J]. Knee Surgery, Sports
	Traumatology, Arthroscopy, 2017, 25(3): 924-933.
	[6]
	TAKEUCHI R, UMEMOTO Y, ARATAKE M, et al. A mid term comparison of open wedge
	high tibial osteotomy vs unicompartmental knee arthroplasty for medial
	compartment osteoarthritis of the knee [J]. Journal of Orthopaedic Surgery and
	Research, 2010, 5(1): 65. [7] HERNIGOU P, MEDEVIELLE D, DEBEYRE J, et al.
	Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to
	thirteen-year follow-up study [J]. The Journal of Bone and Joint Surgery
	-American Volume, 1987, 69(3): 332-354.
	[8]
	DUGDALE T W, NOYES F R, STYER D. Preoperative planning for high tibial
	osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral
	length [J]. Clinical Orthopaedics and Related Research, 1992 (274): 248-264.
[9]	BODE
	G, VON HEYDEN J, PESTKA J, et al. Prospective 5-year survival rate data
	following openwedge valgus high tibial osteotomy [J]. Knee Surgery, Sports
	Traumatology, Arthroscopy, 2015, 23(7): 1949- 1955.
	[10]
	ELSON D W, PETHERAM T G, DAWSON M J. High reliability in digital planning of
	medial opening wedge high tibial osteotomy, using Miniaci’s method [J]. Knee
	Surgery, Sports Traumatology, Arthroscopy, 2015, 23(7): 2041-2048.
	[11]
	MINIACI A, BALLMER F T, BALLMER P M, et al. Proximal tibial osteotomy. A new
	fixation device [J]. Clinical Orthopaedics and Related Research, 1989 (246):
25	0-259.
	[12]
	FUJISAWA Y, MASUHARA K, SHIOMI S. The effect of high tibial osteotomy on
	osteoarthritis of the knee: An arthroscopic study of 54 knee joints [J].
	Orthopedic Clinics of North America, 1979, 10(3): 585-608.
[13]	YIN
	Y C, LI S L, ZHANG R P, et al. What is the relationship between the “Fujisawa
	point” and postoperative knee valgus angle? A theoretical, computer-based study
[J]	The Knee, 2020, 27(1): 183-191.
	[14]
	JONES L D, BROWN C P, JACKSON W, et al. Assessing accuracy requirements in high
	tibial osteotomy: A theoretical, computer-based model using AP radiographs [J].
	Knee Surgery, Sports Traumatology, Arthroscopy, 2017, 25(9): 2952-2956.
	[15]
	MOORE J, MYCHALTCHOUK L, LAVOIE F. Applicability of a modified angular
	correction measurement method for open-wedge high tibial osteotomy [J]. Knee
	Surgery, Sports Traumatology, Arthroscopy, 2017, 25(3): 846-852.
[16]	KIM
	H J, PARK J, SHIN J Y, et al. More accurate correction can be obtained using a
	three-dimensional printed model in open-wedge high tibial osteotomy [J]. Knee
	Surgery, Sports Traumatology, Arthroscopy, 2018, 26(11): 3452-3458.
	[17]
	JACQUET C, SHARMA A, FABRE M, et al. Patientspecific high-tibial osteotomy’s
	‘cutting-guides’ decrease operating time and the number of fluoroscopic images
	taken after a Brief Learning Curve [J]. Knee Surgery, Sports Traumatology,
	Arthroscopy, 2020, 28(9): 2854-2862.
	[18]
	CHAOUCHE S, JACQUET C, FABRE-AUBRESPY M, et al. Patient-specific cutting guides
	for open-wedge high tibial osteotomy: Safety and accuracy analysis of a hundred
	patients continuous cohort [J]. International Orthopaedics, 2019, 43(12):
27	57-2765.
[19]	JUD
	L, F¨URNSTAHL P, VLACHOPOULOS L, et al. Malpositioning of patient-specific
	instruments within the possible degrees of freedom in high-tibial osteotomy has
	no considerable influence on mechanical leg axis correction [J]. Knee Surgery,
	Sports Traumatology, Arthroscopy, 2020, 28(5): 1356-1364.
[20]	MAO
	Y H, XIONG Y, LI Q, et al. 3D-printed patientspecific instrumentation technique
	vs. conventional technique in medial open wedge high tibial osteotomy: A
	prospective comparative study [J]. BioMed Research International, 2020, 2020:
	1-10.
	[21]
	FUCENTESE S F, MEIER P, JUD L, et al. Accuracy of 3D-planned patient specific
	instrumentation in high tibial open wedge valgisation osteotomy [J]. Journal of
	Experimental Orthopaedics, 2020, 7(1): 7.
	[22]
	YANG J C S, CHEN C F, LUO C, et al. Clinical experience using a 3D-printed
	patient-specific instrument for medial opening wedge high tibial osteotomy [J].
	BioMed Research International, 2018, 2018: 9246529.
	[23]
	CERCIELLO S, OLLIVIER M, CORONA K, et al. CAS and PSI increase coronal
	alignment accuracy and reduce outliers when compared to traditional technique of
	medial open wedge high tibial osteotomy: A meta-analysis [J]. Knee Surgery, Sports
	Traumatology, Arthroscopy, 2020. https://doi.org/10.1007/s00167- 020-06253-5
	(published online).
	[24]
	AKAMATSU Y, KOBAYASHI H, KUSAYAMA Y, et al. Comparative study of opening-wedge
	high tibial osteotomy with and without a combined computed tomography-based and
	image-free navigation system [J]. Arthroscopy, 2016, 32(10): 2072-2081.
	[25]
	SASAKI E, AKIMOTO H, IIO K, et al. Longterm survival rate of closing wedge high
	tibial osteotomy with high valgus correction: A 15-year followup study [J].
	Knee Surgery, Sports Traumatology, Arthroscopy, 2020.
	https://doi.org/10.1007/s00167- 020-06128-9 (published online).
	[26]
	DUIVENVOORDEN T, VAN DIGGELE P, REIJMAN M, et al. Adverse events and survival after
	closing- and opening-wedge high tibial osteotomy: A comparative study of 412
	patients [J]. Knee Surgery, Sports Traumatology, Arthroscopy, 2017, 25(3):
89	5-901.
	[27]
	DUIVENVOORDEN T, BROUWER R W, BAAN A, et al. Comparison of closing-wedge and
	openingwedge high tibial osteotomy for medial compartment osteoarthritis of the
	knee: A randomized controlled trial with a six-year follow-up [J]. The Journal
	of Bone and Joint Surgery -American Volume, 2014, 96(17): 1425-1432.
	[28]
	MARKELJ P, TOMAˇZEVIˇC D, LIKARB, et al. A review of 3D/2D registration methods
	for image-guided interventions [J]. Medical Image Analysis, 2012, 16(3): 642-661.
	[29]
	SALEH M, HARRIMAN P, EDWARDS D J. A radiological method for producing precise
	limb alignment [J]. The Journal of Bone and Joint Surgery-British Volume, 1991,
73	(3): 515-516.
[30]	JIANG X, XIE K, HAN X Q, et al. HKA angle — A reliable planning parameter for high tibial osteotomy: A
	theoretical analysis using standing wholeleg radiographs [J]. The Journal of
	Knee Surgery, 2020. https://doi.org/10.1055/s-0040-1712945 (published online).

Using a Patient-Specific 3D-Printed Surgical Guide for High Tibial Osteotomy: A Technical Note

Using a Patient-Specific 3D-Printed Surgical Guide for High Tibial Osteotomy: A Technical Note

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

References 30

Related Articles 3

Recommended Articles

Metrics

Comments

[1]	KAN Tianyou(阚天佑), XIE Kai(谢凯), QU Yang(曲扬), AI Songtao (艾松涛), JIANG Wenbo (姜闻博), WU Haishan (吴海山), WANG Liao(王燎), YAN Mengning(严孟宁). 3D-Printed Porous Titanium Augments for Reconstruction of Massive Bone Defect in Complex Revision Total Knee Arthroplasty: Implant Design and Surgical Technique [J]. J Shanghai Jiaotong Univ Sci, 2021, 26(3): 334-338.
[2]	YAO Xiangyun (姚湘云), GAN Yaokai (干耀恺), SHI Dingwei(史定伟), XU Chen (徐辰), ZHAO Jie(赵杰), DAI Kerong(戴尅戎). 3D-Printed Guide Plate Assisted Osteochondral Transplantation for the Treatment of Large Talar Defect:#br# Case Report and Literature Analysis [J]. J Shanghai Jiaotong Univ Sci, 2021, 26(3): 346-351.
[3]	DONG Yue-fu (董跃福), HU Guang-hong (胡广洪), ZHANG Luo-lian (张罗莲), HU Yang (胡杨) DONG Ying-hai (董英海), XU Qing-rong . Accurate 3D Reconstruction of Subject-Specific Knee Finite Element Model to Simulate the Articular Cartilage Defects [J]. Journal of shanghai Jiaotong University (Science), 2011, 16(5): 620-627.