Are three-dimensional patient-specific cutting guides for open wedge high tibial osteotomy accurate? An in vitro study

Mathias Donnez (1) , Matthieu Ollivier (1) , Maxime Munier (2) , Philippe Berton , Jean-Pierre Podgorski , Patrick Chabrand (1) , Sebastien Parratte (1)

1 ISM - Institut des Sciences du Mouvement Etienne Jules Marey
2 IML - Institut du Mouvement et de l’appareil Locomoteur [Hôpital Sainte-Marguerite - APHM]

Background: The aim of this in vitro study was to assess the accuracy of three-dimensional patient-specific cutting guides for open wedge high tibial osteotomy (OWHTO) to provide the planned correction in both frontal and sagittal planes. Methods: Ten cadaveric tibias underwent OWHTO performed using a patient-specific cutting guide based on 3D preoperative planning. An initial CT scan of the tibias was performed, and after segmentation, 3D geometrical models of the pre-OWHTO tibias were obtained. Reference planes were defined, and OWHTO virtually planned to then design patient-specific cutting guides. OWHTO were performed using the patient-specific cutting guides. The patient-specific cutting guide controls the cut and the correction of the OWHTO in both planes. 3D models of post-OWHTO tibias were created after a postoperative CT scan. Geometrical post-OWHTO 3D models were superimposed on pre-OWHTO 3D models. Mechanical medial proximal tibial angle (mMPTA) in the frontal plane and posterior tibial slope (PTS) in the sagittal plane were compared between planned-OWHTO and post-OWHTO 3D reconstructions relative to the pre-OWHTO reference planes and axis. Pearson's and Lin's correlation tests were performed to assess precision and accuracy of patient-specific cutting guides. Results: The mean difference between post-OWHTO and planned-OWHTO was 0.2° (max 0.5°, SD 0.3°) in the frontal plane and − 0.1° (max 0.8°, SD 0.5°) in the sagittal plane. Statistically significant correlations were found between the planned-OWHTO and post-OWHTO configurations for the mMPTA (p < 0.0001) and PTS (p < 0.0001) measurements, and the bias correction factor was 0.99 in both planes. Conclusions: 3D patient-specific cutting guides for OWHTO-based 3D virtual planning is a reliable and accurate method of achieving multiplanar correction in both frontal and sagittal planes.

Mots clés: Knee surgery; Osteoarthrosis; Medial gonarthrosis; Osteotomy; Open wedge high tibial osteotomy; Patientspecific; Accuracy; Tibial slope correction

Domaines: Chirurgie; Rhumatologie et système ostéo-articulaire; Ingénierie biomédicale

Mathias Donnez, Matthieu Ollivier, Maxime Munier, Philippe Berton, Jean-Pierre Podgorski, et al.. Are three-dimensional patient-specific cutting guides for open wedge high tibial osteotomy accurate? An in vitro study. Journal of Orthopaedic Surgery and Research, 2018, 13, pp.171. ⟨10.1186/s13018-018-0872-4⟩. ⟨hal-01846729⟩