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International Orthopaedics

, Volume 43, Issue 10, pp 2285–2291 | Cite as

“More accurate correction using “patient-specific” cutting guides in opening wedge distal femur varization osteotomies

  • Christophe Jacquet
  • Johanna Chan-Yu-Kin
  • Akash Sharma
  • Jean-Noël Argenson
  • Sébastien Parratte
  • Matthieu OllivierEmail author
Original Paper

Abstract

Purpose

The distal femoral varization osteotomy (DFVO) by a lateral opening wedge osteotomy is an established intervention for patients suffering from lateral femoro-tibial osteoarthritis on a genu valgum deformity. In order to improve the accuracy of this correction, the use of a customized cutting guide (PSI) has been proposed as an alternative to conventional technique. The objective of our study was to compare the accuracy of post-operative alignment following DFVO in the coronal and sagittal plane using either a conventional abacus technique or PSI guide.

Method

Twenty-one patients that underwent lateral opening wedge osteotomy from a technique using PSI based on 3D CT-scans were matched 1:1 to 21 patients operated on using a conventional technique (pre-operative planning performed on standard radiographs). The accuracy of the correction was analyzed, comparing coronal and sagittal mechanical post-operative angles with pre-operative planning.

Results

With regard to alignment in the coronal plane (HKA correction), our study demonstrated a significant improvement in the accuracy of the correction obtained in the PSI group compared to the conventional group (0.43 ± 0.50 vs 3.95 ± 1.64 p < 0.001). In the sagittal plane (PDFA correction), we also found a significant improvement in correction accuracy in the PSI group (0.52 ± 0.60 vs 3.10 ± 1.83 p < 0.001).

There was a significant decrease in operating time (delta 7.7 ± 3.07 (1.5–13.9) (p = 0.0.161) and fluoroscopic images taken (6.9 ± 0.54 (5.8–8) p < 0.001).

Conclusion

Our results suggest that the use of PSI in DFVO improves the accuracy of correction in both the coronal and sagittal planes compared to conventional techniques.

Keywords

Femoral Osteotomy External-opening Accuracy Customized Cutting-guide 

Abbreviations

DFVO

Distal femoral varization osteotomy

PSI

Personal-specific implant

HTO

High tibial osteotomy

HKA

Hip knee angle (coronal alignment of the limb)

PDFA

Posterior distal femoral angle (sagittal alignment of the femur)

IKS

International Knee Society Score with a Global evaluation (IKSG) and Function evaluation (IKSF)

Notes

Author contributions statement

MO and SP designed the protocol.

MO and CJ performed database analysis.

CJ, MO, and AS wrote the initial draft.

MO, SP, and JNA edited the different version of the draft.

CJ, MO, SP, AS, and JNA approved of the submitted and final versions.

Compliance with ethical standards

Conflict of interest

MO is educational consultant for New-Clip, Stryker and Arthrex.

SP is educational consultant for New-Clip, Zimmer and Arthrex.

JNA receives royalties from Zimmer.

CJ and AS have nothing to disclose.

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Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Christophe Jacquet
    • 1
    • 2
  • Johanna Chan-Yu-Kin
    • 1
    • 2
  • Akash Sharma
    • 1
    • 2
  • Jean-Noël Argenson
    • 1
    • 2
  • Sébastien Parratte
    • 1
    • 2
  • Matthieu Ollivier
    • 1
    • 2
    Email author
  1. 1.Aix-Marseille UniversitéMarseille cedex 09France
  2. 2.Department of Orthopedics and Traumatology, Institute of Movement and LocomotionSt. Marguerite HospitalMarseilleFrance

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