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3D osteotomies-improved accuracy with patient-specific instruments (PSI).

Maximilian Jörgens1, Alexander M Keppler2, Philipp Ahrens3

  • 1Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany. maximilian.joergens@med.uni-muenchen.de.

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Summary

Three-dimensional (3D) printed patient-specific instruments (PSI) enable precise high tibial osteotomies (HTO). This study validates 3D planning and custom cutting blocks, showing minimal deviations in joint angles and good surface agreement.

Keywords:
3D-planningHTOOpen-wedge tibial osteotomyPSIPatient-specific instrumentsSpacer

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Area of Science:

  • Orthopedic Surgery
  • Biomedical Engineering
  • Medical Imaging

Background:

  • Patient-specific instruments (PSI) are increasingly used in orthopedic surgery to enhance precision.
  • Three-dimensional (3D) printing offers potential for creating custom surgical tools.
  • Validation of 3D planning and manufacturing for high tibial osteotomy (HTO) is needed.

Purpose of the Study:

  • To evaluate the accuracy of 3D planning and patient-specific cutting blocks for high tibial osteotomy (HTO).
  • To assess the deviations in joint angles and surface accuracy after using 3D printed instruments in HTO.

Main Methods:

  • 3D digital planning of HTO with a medial opening of 8 mm was performed using segmented CT data from 13 human tibiae.
  • Patient-specific cutting blocks and spacers were designed and fabricated based on the 3D models.
  • Surgical accuracy was evaluated by measuring 3D joint angles and surface deviations post-operatively.

Main Results:

  • The mean deviation for the medial proximal tibial angle (MPTA) was 0.57°.
  • Tibial slope and torsion showed average deviations of 0.98° and 1.26°, and 5.74°, respectively.
  • Color analysis indicated excellent or good agreement in surface deviations for 7 out of 13 tibiae.

Conclusions:

  • 3D printed cutting blocks and spacers allow for accurate translation of 3D HTO plans into surgical reality.
  • The study critically evaluates the individual steps and outcomes of this patient-specific HTO method.
  • Results demonstrate the potential of 3D printed PSI for precise and reliable HTO procedures.