Evaluation of a customized 3D-printed saw guide for tibial plateau leveling osteotomy: An ex vivo study.

Abstract

To determine whether a tibial plateau leveling osteotomy (TPLO) performed with a customized 3D-printed guide and jig is more accurate than the traditional technique using a jig alone. In vitro study. Cadaveric canine pelvic limbs (n=10) and 20 synthetic bone models. Tibial plateau leveling osteotomy using a jig with (n=10) and without (n=10) a customized 3D-printed guide were performed in bone models, and TPLO using a jig with (n=5) and without (n=5) a customized 3D-printed guide were performed in cadaveric limbs. Angulation of the osteotomy, angulation of the proximal jig pin, angular/torsional deformity and medial cortex damage were measured from photographs of the specimens and compared. In the bone models, there were differences with and without the 3D guide for mean osteotomy inclination (-0.06° vs. -1.74°, P < .001), osteotomy torsion (5268 vs. 10 469 visible osteotomy pixels, P < .001), and medial cortical damage (2970 vs. 18 562 pixels, P < .001). In the cadaveric study, osteotomy inclination (-1.1° vs. 1.01°, P < .01), induced angular deformity (0.17° vs. -3.01°, P < .001) and angulation of the proximal jig pin (-0.27° vs. 0.80°, P < .001) differed between groups. The 3D-printed guide during TPLO resulted in slightly more accurate osteotomies and proximal jig pin placement, and reduced medial cortex damage. A customized 3D-printed guide may improve intraoperative accuracy for TPLO, although the clinical significance of the small benefits is unknown.