Malpositioning of patient-specific instruments within the possible degrees of freedom in high-tibial osteotomy has no considerable influence on mechanical leg axis correction

Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA
Lukas JudSandro F Fucentese

Abstract

Patient-specific instruments (PSIs) are helpful tools in high tibial osteotomy (HTO) in patients with symptomatic varus malalignment of the mechanical leg axis. However, the precision of HTO can decrease with malpositioned PSI. This study investigates the influence of malpositioned PSI on axis correction, osteotomy, and implant placement. With a mean three-dimensional (3D) model (0.8° varus), PSI-navigated HTOs were computer simulated. Two different guide designs, one with stabilising hooks and one without, were used. By adding rotational and translational offsets of different degrees, wrong placements of PSI were simulated. After 5° valgisation of the postoperative mechanical axis, the distance between joint-plane and osteotomy screws, respectively, were measured. The same simulations were performed in a patient with varus deformity (7.4° varus). In the mean 3D model, the postoperative mechanical axis was within 3.9°-4.5° valgus with mean value of 4.1° ± 0.1° (correct axis 4.2° valgus). Surgical failure concerning osteotomy occurred in 17 of 76 HTOs. Significantly safer screw placement was observed using PSI with stabilising hooks (p = 0.012). In the case of the 3D model with 7.4° varus deformity, the postoperative mechanical ...Continue Reading

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Citations

Jul 29, 2019·Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA·Christophe JacquetMatthieu Ollivier
Feb 29, 2020·Journal of Experimental Orthopaedics·Sandro F FucentesePhilipp Fürnstahl
Feb 14, 2021·International Orthopaedics·Vlad PredescuBogdan Deleanu
Apr 24, 2021·Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA·Sandro HodelSandro F Fucentese

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