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Learning curves for high tibial osteotomy using patient-specific instrumentation: a case control study.

Davide Stimolo1,2, Filippo Leggieri1, Fabrizio Matassi1

  • 1Department of Orthopaedics, AOU Careggi Florence, University of Florence, Florence, Italy.

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Summary

Patient-Specific Instrumentation (PSI) with 3D planning significantly improves accuracy and reduces surgical time and fluoroscopy use in Medial Opening Wedge High Tibial Osteotomy (mOW-HTO). This technique enhances surgical outcomes and efficiency from the initial cases.

Keywords:
3D planningHTOPSIcustom-madehigh tibial osteotomypersonalized instrumentation

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Area of Science:

  • Orthopedic surgery
  • Biomedical engineering
  • Surgical planning

Background:

  • Conventional Medial Opening Wedge High Tibial Osteotomy (mOW-HTO) techniques can have variable outcomes.
  • Three-dimensional (3D) planning and Patient-Specific Instrumentation (PSI) offer potential for improved predictability in mOW-HTO.

Purpose of the Study:

  • To compare the accuracy and learning curve of PSI with standard techniques for mOW-HTO.
  • To evaluate the impact of PSI on surgery time, fluoroscopic shots, and postoperative alignment.

Main Methods:

  • A comparative study included 12 consecutive mOW-HTO cases using 3D planning and PSI, and 12 cases using standard techniques.
  • Surgery time, fluoroscopic shots, and variations in Hip Knee Ankle Angle (HKA), mechanical medial Proximal Tibia Angle (MPTA), Joint Line Convergence Angle (JLCA), and tibial slope (TS) were recorded.
  • Cumulative Sum (CUSUM) analysis was used to assess learning curves.

Main Results:

  • The PSI group demonstrated significantly lower mean surgical time (48.58±7.87 min vs. 58.75±6.86 min) and fewer fluoroscopic shots (10.75±3.93 vs. 18.16±4.93).
  • Postoperative accuracy was superior in the PSI group, with smaller deviations for HKA (0.42±0.51° vs. 1.25±0.87°), MPTA (0.50±0.67° vs. 3.75±1.48°), TS (1.00±0.82° vs. 3.50±1.57°), and JLCA (1.83±1.11° vs. 4±1.41°).
  • CUSUM analysis favored the PSI group for surgery time and fluoroscopic shots, indicating a reduced learning curve.

Conclusions:

  • PSI and 3D planning effectively reduce learning curves for operation time and fluoroscopic shots in mOW-HTO.
  • The accuracy of the mOW-HTO procedure is enhanced with PSI and 3D planning, showing improvement from the initial cases.