Abstract
PurposeCorrection osteotomies around the knee are common methods for the treatment of varus or valgus malalignment of the lower extremity. In recent years, patient specific instrumentation (PSI) guides were introduced in order to enhance the accuracy of these procedures. The purpose of this study was to determine the accuracy of CT based PSI guides for correction osteotomies around the knee of low volume osteotomy surgeons and to evaluate if CT based PSI blocks deliver a high degree of accuracy without using intraoperative fluoroscopy.MethodsTwo study arms with CT based PSI cutting blocks for osteotomies around the knee were conducted. Part one: A retrospective analysis of 19 osteotomies was made in order to evaluate the accuracy in the hands of a low volume surgeon on long-leg radiographs. Part two: A cadaveric study with 8 knees was performed for the purpose of analyzing the accuracy without using intraoperative fluoroscopy on pre- and postoperative CT scans. Hip-Knee-Ankle angle (HKA), lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA) were analyzed. The mean absolute delta (∂) between the planned and postoperative parameters were calculated. The accuracy of both study arms were compared.ResultsPart one: The mean MPTA ∂, LDFA ∂ and HKA ∂ was 0.9°, 1.9° and 1.5°, respectively. Part two: The mean MPTA ∂ and LDFA ∂ was 3.5° and 2.2°, respectively. The mean ∂ of MPTA is significantly different between clinical patients with fluoroscopic control and cadaveric specimens without fluoroscopic control (P < 0.001). All surgeries were performed without complications such as a hinge fracture.ConclusionThe clinical use of PSI guides for osteotomies around the knee in the hands of low volume surgeons is a safe procedure. The PSI guides deliver a reliable accuracy under fluoroscopic control whereas their non-use of intraoperative fluoroscopy leads to a lack of accuracy. The use of fluoroscopic control during PSI guided correction osteotomies is highly recommended.Level of evidenceIV – Retrospective and experimental Study
Highlights
Correction osteotomies around the knee are common methods for the treatment of varus or valgus malalignment of the lower extremity
This study aims to answer the following questions: 1. Part 1: Are computer tomography (CT) based patient specific instrumentation (PSI) guides for correction osteotomies around the knee in the hands of low volume osteotomy surgeons a safe procedure?
Part one Material Between January 2018 and August 2019 there were 30 osteotomies around the knee performed in 29 patients using PSI guides with the Activmotion plate (Newclip Technics, Haute-Goulaine, France) by one low volume osteotomy surgeon
Summary
Correction osteotomies around the knee are common methods for the treatment of varus or valgus malalignment of the lower extremity. The intention is to reduce the one sided overload of the femoral-tibial joint [8]. Over or under correction can lead to persistent pain and a paradoxical joint line as well as biomechanical issues [23]. Various techniques have been described in the literature to achieve the desired correction [12, 19, 28]. Classic manual techniques use a standardized methodology with conventional instruments in order to determine the extent of the axis change [19]. Those techniques reach their limit especially in beginners or low volume surgeons [18, 30, 32]
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