Use of 3D-Printed Patient Specific Guides in Osteotomies around the Knee

Abstract

High tibial osteotomies are challenging procedures that have traditionally implemented two-dimensional planning (2D) for a complex three-dimensional surgery (3D). In an effort to improve the accuracy and precision of the technique, there has been a growing interest in the use of patient specific instrumentation (PSI). The implementation of PSI in osteotomies has demonstrated consistent and reliable results in the correction of the hip-knee-ankle angle, proximal tibial angle, and the posterior tibial slope. Initial clinical studies describing the implementation of this technology have reported superior accuracy in both the coronal and sagittal planes as compared to free-hand techniques. Additionally, these studies reported a fast surgeon learning curve, short operative times, and minimal fluoroscopy exposure. The senior author's preferred closing wedge HTO technique utilizes a patient specific cutting guide with osteotomy fixation provided by an extra-cortical titanium alloy locking plate. This technique is designed to provide reliable and accurate HTOs while minimizing the risk of major complications such as hinge fractures on the contralateral cortex.