2023 ISAKOS Biennial Congress ePoster
Impacted Bone Allograft Personalised by a Novel 3D Printed Customization Kit Produces High Surgical Accuracy In Opening Wedge High Tibial Osteotomy: A Pilot Study
Wouter Van Genechten, MD, Antwerp BELGIUM
Annemieke Van Haver, PhD, MSc, Antwerp BELGIUM
Stijn Bartholomeeusen, MD, Malle, Antwerp BELGIUM
Jozef Michielsen, MD, PhD, Antwerp, Antwerp BELGIUM
Steven Claes, MD, PhD, Herentals BELGIUM
Peter Verdonk, MD, PhD, Zwijnaarde BELGIUM
AZ Herentals, Herentals, Antwerp, BELGIUM
FDA Status Not Applicable
Summary
IMPACTED BONE ALLOGRAFT PERSONALISED BY A NOVEL 3D PRINTED CUSTOMIZATION KIT PRODUCES HIGH SURGICAL ACCURACY IN OPENING WEDGE HIGH TIBIAL OSTEOTOMY
ePosters will be available shortly before Congress
Abstract
Purpose
Medial opening wedge high tibial osteotomy (MOWHTO) has been associated with inconsistent surgical accuracy and slow recovery. The objective was to assess surgical accuracy, short-term clinical outcome and pain levels when using 3D planning and patient-specific instrumentation (PSI) to prepare customized impacted bone allografts.
Methods
Thirty subjects (age 48y±13) were included in a double-center prospective case series. A low-dose CT-scan (hip-knee-ankle joint) was performed to generate 3D bone models, a MOWHTO was simulated, and PSI was designed and 3D printed based on the complementary negative of the planned osteotomy gap. Clinical outcome was assessed at 2, 4, 12 weeks and 1 year using NRS, KOOS, UCLA activity score and anchor questions. A linear-mixed model approach was implemented for data analysis.
Results
Mean preoperative 3D values were 175.0°±2.2 mechanical femorotibial angle (mFTA), 85.0°±3.0 medial proximal tibial angle (MPTA), 87.6°±1.4 lateral distal femoral angle (LDFA) and 94.1°±3.4 medial posterior tibial slope (MPTS). Target planning ranged from slight varus to the lateral eminence. Postoperative 3D analysis showed an accuracy of 1.1°±0.7 ?MPTA (p=0.04) and 1.2°±1.2 ?MPTS (p=0.11). Pain levels decreased from 5.9±0.4 at baseline to 4.3±0.4 at 2 weeks (p=0.01) and 2.7±0.4 at 4 weeks (p<0.001). KOOS increased from 34.1±5.2 to 53.8±5.2 at 12 weeks (p<0.001). At 4 weeks, 60% was able to drive a car and 80% was able to walk with 1 crunch or without.
Conclusion
The study suggests that advanced 3D printed instrumentation to personalize structural bone allograft in MOWHTO combines the benefits of (1) PSI techniques by optimizing surgical accuracy (1.1°±0.7 absolute MPTA difference) and (2) impacting a structural allograft by improving early pain levels while allowing safe weight-bearing and early resumption of daily-life activities.