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International Orthopaedics

, Volume 43, Issue 3, pp 619–624 | Cite as

Three dimensional patient-specific printed cutting guides for closing-wedge distal femoral osteotomy

  • JianHui ShiEmail author
  • Wei Lv
  • Yan Wang
  • Ben Ma
  • Wei Cui
  • ZhenZhong Liu
  • KeCheng Han
Original Paper

Abstract

Purpose

Medial closing-wedge distal femoral osteotomy (MCWDFO) was used to treat valgus knee malalignment combined with lateral compartment disease. The clinical outcome of the osteotomy depends on the accurate correction of valgus malalignment. The aim of this study was to evaluate the accuracy of a MCWDFO assisted by three-dimensional (3D)-printed cutting guides and locking guides.

Patients and methods

Thirty-three consecutive patients (33 knees) were operated on using the same MCWDFO. 3D-printed cutting guides and locking guides were used to locate the osteotomy cut plane and to facilitate closing the wedge in 12 patients (3D-guide group). Another 21 patients (conventional group) underwent MCWDFO following the conventional technique. The desired correction was defined as a weight-bearing line (WBL) coordinate 50% of the width of the tibial plateau from the medial tibial margin. The deviation between the planned and executed WBL coordinate, surgical time and fluoroscopic time were compared.

Results

The mean deviation between the planned and executed WBL coordinate was 4.9% in the 3D-guide group and 7.6% in the conventional group (P = 0.024). Shorter surgical time was found in the 3D-guide group (mean, 77.7 minutes vs. mean, 96.5 minutes; P < 0.001), while the mean number of intra-operative fluoroscopic images was 6.1, compared with 34.7 in the conventional group (P < 0.001).

Conclusion

The use of 3D-printed cutting guides and locking guides can increase the precision of the MCWDFO in patients with lateral compartment disease and valgus deformity, making our surgery more efficiency and occupying less fluoroscopic time.

Keywords

Lateral compartment knee osteoarthritis Valgus knee Medial closing-wedge distal femoral osteotomy Patient-specific surgical guides 3D printing 

Notes

Compliance with ethical standards

Ethical approval

This retrospective comparative study was approved by our Institutional Review Board.

Conflict of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Julin J, Jämsen E, Puolakka T, Konttinen YT, Moilanen T (2010) Younger age increases the risk of early prosthesis failure following primary total knee replacement for osteoarthritis. A follow-up study of 32,019 total knee replacements in the Finnish Arthroplasty Register. Acta Orthop 81(4):413–419CrossRefGoogle Scholar
  2. 2.
    Hui C, Salmon LJ, Kok A, Williams HA, Hockers N, van der Tempel WM et al (2011) Long-termsurvival of high tibial osteotomy for medial compartment osteoarthritis of the knee. Am J Sports Med 39(1):64–70CrossRefGoogle Scholar
  3. 3.
    Coventry MB (1987) Proximal tibial varus osteotomy for osteoarthritis of the lateral compartment of the knee. J Bone Joint Surg Am 69:32–38CrossRefGoogle Scholar
  4. 4.
    Shoji H, Insall J (1973) High tibial osteotomy for osteoarthritis of the knee with valgus deformity. J Bone Joint Surg Am 55:963–973CrossRefGoogle Scholar
  5. 5.
    Cameron JI, McCauley JC, Kermanshahi AY, Bugbee WD (2015) Lateral opening-wedge distal femoral osteotomy: pain relief, functional improvement, and survivorship at 5 years. Clin Orthop Relat Res 473(6):2009–2015CrossRefGoogle Scholar
  6. 6.
    Ekeland A, Nerhus TK, Dimmen S, Heir S (2016) Good functional results of distal femoral opening-wedge osteotomy of knees with lateral osteoarthritis. Knee Surg Sports Traumatol Arthrosc 24(5):1702–1709CrossRefGoogle Scholar
  7. 7.
    Puddu G, Cipolla M, Cerullo G, Franco V, Giannì E (2010) Which osteotomy for a valgus knee? Int Orthop 34(2):239–247CrossRefGoogle Scholar
  8. 8.
    Ribeiro CH, Severino NR, Fucs PM (2013) Preoperative surgical planning versus navigation system in valgus tibial osteotomy: a cross-sectional study. Int Orthop 37(8):1483–1486CrossRefGoogle Scholar
  9. 9.
    Wagner JD, Baack B, Brown GA, Kelly J (2004) Rapid 3-dimensional prototyping for surgical repair of maxillofacial fractures: a technical note. J Oral Maxillofac Surg 62:898–901CrossRefGoogle Scholar
  10. 10.
    Arnal-Burro J, Perez-Mananes R, Gallo-Del-Valle E, Igualada-Blazquez C, Cuervas-Mons M, Vaquero-Martin J (2017) Three dimensional-printed patient-specific cutting guides for femoral varization osteotomy: do it yourself. Knee 24(6):1359–1368CrossRefGoogle Scholar
  11. 11.
    Perez-Mananes R, Burro JA, Manaute JR, Rodriguez FC, Martin JV (2016) 3D surgical printing cutting guides for open-wedge high tibial osteotomy: do it yourself. J Knee Surg 29(8):690–695CrossRefGoogle Scholar
  12. 12.
    Saragaglia D, Roberts J (2005) Navigated osteotomies around the knee in 170 patients with osteoarthritis secondary to genu varum. Orthopedics 28(10 Suppl):s1269–s1274Google Scholar
  13. 13.
    Puddu G, Cipolla M, Cerullo G, Franco V, Gianni E (2007) Osteotomies: the surgical treatment of the valgus knee. Sports Med Arthrosc Rev 15:15–22CrossRefGoogle Scholar
  14. 14.
    Stahelin T, Hardegger F, Ward JC (2000) Supracondylar osteotomy of the femur with use of compression–osteosynthesis with a malleable implant. J Bone Joint Surg Am 82:712–722CrossRefGoogle Scholar
  15. 15.
    Lützner J, Gross AF, Günther KP, Kirschner S (2009) Reliability of limb alignment measurement for high tibial osteotomy with a navigation system. Eur J Med Res 14(10):447–450CrossRefGoogle Scholar
  16. 16.
    Saragaglia D, Chedal-Bornu B (2014) Computer-assisted osteotomy for valgus knees: medium-term results of 29 cases. Orthop Traumatol Surg Res 100(5):527–530CrossRefGoogle Scholar
  17. 17.
    Munier M, Donnez M, Ollivier M, Flecher X, Chabrand P, Argenson JN, Parratte S (2017) Can three-dimensional patient-specific cutting guides be used to achieve optimal correction for high tibial osteotomy? Pilot study. Orthop Traumatol Surg Res 103(2):245–250CrossRefGoogle Scholar
  18. 18.
    Hoekstra H, Rosseels W, Sermon A, Nijs S (2016) Corrective limb osteotomy using patient specific 3D-printed guides: a technical note. Injury 47(10):2375–2380CrossRefGoogle Scholar
  19. 19.
    Victor J, Premanathan A (2013) Virtual 3D planning and patient specific surgical guides for osteotomies around the knee: a feasibility and proof-of-concept study. Bone Joint J 95-B(11 Suppl A):153–158CrossRefGoogle Scholar
  20. 20.
    Çalbıyık M (2017) Clinical outcome of total knee arthroplasty performed using patient-specific cutting guides. Med Sci Monit 23:6168–6173CrossRefGoogle Scholar
  21. 21.
    Radtke K, Becher C, Noll Y, Ostermeier S (2010) Effect of limb rotation on radiographic alignment in total knee arthroplasties. Arch Orthop Trauma Surg 130:451–457CrossRefGoogle Scholar
  22. 22.
    Swanson KE, Stocks GW, Warren PD, Hazel MR, Janssen HF (2000) Does axial limb rotation affect the alignment measurements in deformed limbs? Clin Orthop Relat Res:246–252Google Scholar
  23. 23.
    Lee YS, Park SJ, Shin VI, Lee JH, Kim YH, Song EK (2010) Achievement of targeted posterior slope in the medial opening wedge high tibial osteotomy: a mathematical approach. Ann Biomed Eng 38:583–593CrossRefGoogle Scholar
  24. 24.
    Subburaj K, Ravi B, Agarwal M (2010) Computer-aided methods for assessing lower limb deformities in orthopaedic surgery planning. Comput Med Imaging Graph 34:277–288CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Department of OrthopaedicsHeilongjiang Provincial HospitalHarbinChina
  2. 2.Department of OrthopaedicsHarbin City Fifth HospitalHarbinChina

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