Impacted bone allograft personalised by a novel 3D printed customization kit produces high surgical accuracy in medial opening wedge high tibial osteotomy: a pilot study
Abstract Purpose Contemporary medial opening wedge high tibial osteotomy (MOWHTO) still seems to struggle with inconsistent accuracy outcomes. Our objective was to assess surgical accuracy and short‐term clinical outcomes when using 3D planning and a patient‐specific instrumentation (PSI) kit to pre...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-01-01
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| Series: | Journal of Experimental Orthopaedics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40634-023-00593-0 |
| _version_ | 1797270743638081536 |
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| author | Wouter Van Genechten Annemieke Van Haver Stijn Bartholomeeusen Toon Claes Nathalie Van Beek Jozef Michielsen Steven Claes Peter Verdonk |
| author_facet | Wouter Van Genechten Annemieke Van Haver Stijn Bartholomeeusen Toon Claes Nathalie Van Beek Jozef Michielsen Steven Claes Peter Verdonk |
| author_sort | Wouter Van Genechten |
| collection | DOAJ |
| description | Abstract Purpose Contemporary medial opening wedge high tibial osteotomy (MOWHTO) still seems to struggle with inconsistent accuracy outcomes. Our objective was to assess surgical accuracy and short‐term clinical outcomes when using 3D planning and a patient‐specific instrumentation (PSI) kit to prepare customized bone allografts. Methods Thirty subjects (age 48y ± 13) were included in a double‐center prospective case series. A low‐dose CT‐scan was performed to generate 3D bone models, a MOWHTO was simulated, and PSI was designed and 3D printed based on the complementary negative of the planned osteotomy gap. Clinical outcome was assessed at two, four, 12 weeks and one year using NRS, KOOS, UCLA activity score, EQ‐5D and anchor questions. A linear‐mixed model approach was implemented for data analysis. Results Preoperative 3D values were 175.0° ± 2.2 mechanical tibiofemoral angle (mTFA), 85.0° ± 3.0 medial proximal tibial angle (MPTA), and 94.1° ± 3.4 medial posterior tibial slope (MPTS). Target planning ranged from slight varus to the lateral tibial spine (slight valgus). Postoperative 3D analysis showed an accuracy of 1.1° ± 0.7 ΔMPTA (p = 0.04) and 1.2° ± 1.2 ΔMPTS (p = 0.11). NRS decreased from baseline 6.1 ± 1.9 to 2.7 ± 1.9 at four weeks (p < 0.001) and 1.7 ± 1.9 at one year (p < 0.001). KOOS increased from 31.4 ± 17.6 to 50.6 ± 20.6 at 12 weeks (p < 0.001) and to 71.8 ± 15.6 at one year (p < 0.001). Conclusion The study suggests that 3D printed instrumentation to personalize structural bone allograft is a viable alternative method in MOWHTO that has the benefit of optimizing surgical accuracy while providing early and consistent pain relief after surgery. |
| first_indexed | 2024-03-08T04:57:08Z |
| format | Article |
| id | doaj.art-150d0be8162b4cc483070bcf24594b82 |
| institution | Directory Open Access Journal |
| issn | 2197-1153 |
| language | English |
| last_indexed | 2024-04-25T02:09:07Z |
| publishDate | 2023-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Experimental Orthopaedics |
| spelling | doaj.art-150d0be8162b4cc483070bcf24594b822024-03-07T12:46:41ZengWileyJournal of Experimental Orthopaedics2197-11532023-01-01101n/an/a10.1186/s40634-023-00593-0Impacted bone allograft personalised by a novel 3D printed customization kit produces high surgical accuracy in medial opening wedge high tibial osteotomy: a pilot studyWouter Van Genechten0Annemieke Van Haver1Stijn Bartholomeeusen2Toon Claes3Nathalie Van Beek4Jozef Michielsen5Steven Claes6Peter Verdonk7Orthopedic DepartmentUniversity Hospital AntwerpAntwerpBelgiumMore InstituteAntwerpBelgiumOrthopedic DepartmentAZ HerentalsHerentalsBelgiumOrthopedic DepartmentAZ HerentalsHerentalsBelgiumOrthopedic DepartmentAZ HerentalsHerentalsBelgiumOrthopedic DepartmentUniversity Hospital AntwerpAntwerpBelgiumMore InstituteAntwerpBelgiumOrthopedic DepartmentUniversity Hospital AntwerpAntwerpBelgiumAbstract Purpose Contemporary medial opening wedge high tibial osteotomy (MOWHTO) still seems to struggle with inconsistent accuracy outcomes. Our objective was to assess surgical accuracy and short‐term clinical outcomes when using 3D planning and a patient‐specific instrumentation (PSI) kit to prepare customized bone allografts. Methods Thirty subjects (age 48y ± 13) were included in a double‐center prospective case series. A low‐dose CT‐scan was performed to generate 3D bone models, a MOWHTO was simulated, and PSI was designed and 3D printed based on the complementary negative of the planned osteotomy gap. Clinical outcome was assessed at two, four, 12 weeks and one year using NRS, KOOS, UCLA activity score, EQ‐5D and anchor questions. A linear‐mixed model approach was implemented for data analysis. Results Preoperative 3D values were 175.0° ± 2.2 mechanical tibiofemoral angle (mTFA), 85.0° ± 3.0 medial proximal tibial angle (MPTA), and 94.1° ± 3.4 medial posterior tibial slope (MPTS). Target planning ranged from slight varus to the lateral tibial spine (slight valgus). Postoperative 3D analysis showed an accuracy of 1.1° ± 0.7 ΔMPTA (p = 0.04) and 1.2° ± 1.2 ΔMPTS (p = 0.11). NRS decreased from baseline 6.1 ± 1.9 to 2.7 ± 1.9 at four weeks (p < 0.001) and 1.7 ± 1.9 at one year (p < 0.001). KOOS increased from 31.4 ± 17.6 to 50.6 ± 20.6 at 12 weeks (p < 0.001) and to 71.8 ± 15.6 at one year (p < 0.001). Conclusion The study suggests that 3D printed instrumentation to personalize structural bone allograft is a viable alternative method in MOWHTO that has the benefit of optimizing surgical accuracy while providing early and consistent pain relief after surgery.https://doi.org/10.1186/s40634-023-00593-0High tibial osteotomy3D planningPatient‐specific instrumentationAccuracyJoint preservation |
| spellingShingle | Wouter Van Genechten Annemieke Van Haver Stijn Bartholomeeusen Toon Claes Nathalie Van Beek Jozef Michielsen Steven Claes Peter Verdonk Impacted bone allograft personalised by a novel 3D printed customization kit produces high surgical accuracy in medial opening wedge high tibial osteotomy: a pilot study Journal of Experimental Orthopaedics High tibial osteotomy 3D planning Patient‐specific instrumentation Accuracy Joint preservation |
| title | Impacted bone allograft personalised by a novel 3D printed customization kit produces high surgical accuracy in medial opening wedge high tibial osteotomy: a pilot study |
| title_full | Impacted bone allograft personalised by a novel 3D printed customization kit produces high surgical accuracy in medial opening wedge high tibial osteotomy: a pilot study |
| title_fullStr | Impacted bone allograft personalised by a novel 3D printed customization kit produces high surgical accuracy in medial opening wedge high tibial osteotomy: a pilot study |
| title_full_unstemmed | Impacted bone allograft personalised by a novel 3D printed customization kit produces high surgical accuracy in medial opening wedge high tibial osteotomy: a pilot study |
| title_short | Impacted bone allograft personalised by a novel 3D printed customization kit produces high surgical accuracy in medial opening wedge high tibial osteotomy: a pilot study |
| title_sort | impacted bone allograft personalised by a novel 3d printed customization kit produces high surgical accuracy in medial opening wedge high tibial osteotomy a pilot study |
| topic | High tibial osteotomy 3D planning Patient‐specific instrumentation Accuracy Joint preservation |
| url | https://doi.org/10.1186/s40634-023-00593-0 |
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