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Patient-specific high-tibial osteotomy's 'cutting-guides' decrease operating time and the number of fluoroscopic
Christophe Jacquet1,2, Akash Sharma1,2, Maxime Fabre1,2
1Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29 13274, Marseille, France.
Summary
Patient-specific cutting guides (PSCGs) for high-tibial osteotomies (HTO) demonstrate a short learning curve for surgeons, improving efficiency without compromising limb alignment accuracy or functional outcomes.
Area of Science:
- Orthopedic surgery
- Biomechanical engineering
- Surgical innovation
Background:
- Patient-specific cutting guides (PSCGs) are increasingly used in orthopedic surgery to enhance surgical precision.
- Opening-wedge high-tibial osteotomy (HTO) is a common procedure for treating knee osteoarthritis, where accurate bone cut is crucial.
- The learning curve associated with adopting new surgical technologies like PSCGs in HTO needs thorough evaluation.
Purpose of the Study:
- To determine the learning curve for surgeons using PSCGs in opening-wedge HTO.
- To assess the impact of PSCG adoption on operating time, surgeon anxiety, and fluoroscopic image usage.
- To evaluate the effect of PSCG experience on the accuracy of postoperative limb alignment and 1-year functional outcomes.
Main Methods:
- Prospective cohort study of 71 consecutive opening-wedge HTO procedures using PSCGs performed by three surgeons.
- Data collected included operative time, surgeon anxiety (STAI), and number of fluoroscopic images.
- Postoperative limb alignment (ΔHKA, ΔMPTA, ΔPPTA) was measured via CT scans; functional outcomes assessed using KOOS at 1 year.
- Cumulative summation (CUSUM) analysis was employed to evaluate learning curves.
Main Results:
- A learning curve of approximately 8-10 cases was observed to optimize operative time, reduce surgeon anxiety, and decrease fluoroscopic imaging.
- PSCG experience did not significantly impact the accuracy of postoperative limb alignment (mean ΔHKA = 1.0° ± 1.0°).
- No correlation was found between the number of PSCG procedures performed and patient functional outcomes at 1 year.
Conclusions:
- The adoption of PSCGs for opening-wedge HTO involves a short learning curve, leading to improved operative efficiency and reduced resource utilization.
- Surgeons can achieve proficiency with PSCGs without compromising the accuracy of limb alignment correction.
- The use of PSCGs in HTO is safe and effective, with no adverse impact on functional outcomes within the first year post-surgery.