Journal of Clinical Medicine 11-05717
Summary of the study:
This article discusses the use of patient-specific devices for high tibial osteotomy (HTO), a joint-preserving procedure for patients with compartmental osteoarthritis of the knee. Conventional HTO has limitations in achieving accurate coronal alignment corrections, particularly in cases with multiplanar deformities of the tibia that require consideration of both the coronal and sagittal planes. Patient-specific instruments have been introduced to improve the control of the correction and achieve better long-term outcomes. This study systematically reviews the literature on the use of customized devices for HTO and their accuracy in achieving correction. The authors also present their experience using a 3D-printed customized system for valgus HTO in three pilot cases.
The systematic review included 28 studies, and the most commonly used custom-made devices for HTO were found to be cutting guides. The reported differences between the achieved and targeted correction of hip-knee-ankle angle and the posterior tibial slope were 3 degrees or less. The available patient-specific devices described in the literature, including the one used in the authors’ preliminary cases, showed promising results in increasing the accuracy of correction in HTO procedures.
The article also discusses the research strategy used to identify relevant studies, the selection criteria used to include or exclude studies, and the data extraction and synthesis process used to compare and summarize the results of the included studies. The authors note that the included studies were highly heterogeneous, which made it challenging to perform a quantitative analysis of the radiological and clinical data abstracted. However, the results were qualitatively compared and summarized, providing valuable insights into the use of patient-specific devices for HTO.
Abstract:
Background: The accuracy of the coronal alignment corrections using conventional high tibial osteotomy (HTO) falls short, and multiplanar deformities of the tibia require consideration of both the coronal and sagittal planes. Patient-specific instrumentations have been introduced to improve the control of the correction. Clear evidence about customized devices for HTO and their correction accuracy lacks.
Methods:
The databases PUBMED and EMBASE were systematically screened for human and cadaveric studies about the use of customised devices for high tibial osteotomy and their outcomes concerning correction accuracy. Furthermore, a 3D-printed customised system for valgus HTO with three pilot cases at one-year follow-up was presented.
Results:
28 studies were included. The most commonly used custom-made devices for HTO were found to be cutting guides. Reported differences between the achieved and targeted correction of hip-knee-ankle angle and the posterior tibial slope were 3 or under. The three pilot cases that underwent personalized HTO with a new 3D-printed device presented satisfactory alignment and clinical outcomes at one-year follow-up. Conclusion: The available patient-specific devices described in the literature, including the one used in the preliminary cases of the current study, showed promising results in increasing the accuracy of correction in HTO procedure.