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

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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.

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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)

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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.

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Authors and Affiliations

  1. Aix-Marseille Université, CNRS, ISM UMR 7287, 13288, Marseille cedex 09, France

    Christophe Jacquet, Johanna Chan-Yu-Kin, Akash Sharma, Jean-Noël Argenson, Sébastien Parratte & Matthieu Ollivier

  2. Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite BP 29, 13274, Marseille, France

    Christophe Jacquet, Johanna Chan-Yu-Kin, Akash Sharma, Jean-Noël Argenson, Sébastien Parratte & Matthieu Ollivier

Authors
  1. Christophe Jacquet
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  2. Johanna Chan-Yu-Kin
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  3. Akash Sharma
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  6. Matthieu Ollivier
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Corresponding author

Correspondence to Matthieu Ollivier.

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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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Jacquet, C., Chan-Yu-Kin, J., Sharma, A. et al. “More accurate correction using “patient-specific” cutting guides in opening wedge distal femur varization osteotomies. International Orthopaedics (SICOT) 43, 2285–2291 (2019). https://doi.org/10.1007/s00264-018-4207-1

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  • DOI: https://doi.org/10.1007/s00264-018-4207-1

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