EFFECTIVENESS OF HIGH TIBIAL OSTEOTOMY ASSISTED BY THREE-DIMENSIONAL PRINTING TECHNOLOGY FOR CORRECTION OF VARUS KNEE WITH OSTEOARTHRITIS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 CHENGuoxian ¹ , LIGuoshan ¹ , LINZongjin ¹ , CHENXuanhuang ² , WENGZhen ¹ , XUGuosong ¹ , ZENGQingdong ¹ , ZHENGZugao ² , ZHANGGuodong ² , YUZhengxi ²

1. Department of Joint Surgery, the First Hospital of Putian City, Putian Fujian, 351100, P. R. China;
2. Department of Orthopedics, Affiliated Hospital of Putian University;

Corresponding author：

CHENGuoxian, Email: cosain2000@163.com

Keywords：

Three-dimensional printing technology; Cutting block; High tibial osteotomy; Varus knee; Osteoarthritis

DOI：

10.7507/1002-1892.20160082

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Objective To evaluate the effectiveness of high tibial osteotomy (HTO) assisted by three-dimensional (3-D) printing technology for correction of varus knee with osteoarthritis. Method Between January 2014 and June 2015, 16 patients (20 knees) with varus knee and osteoarthritis underwent HTO assisted by 3-D printing technology; a locking compression plate was used for internal fixation after HTO. There were 6 males and 10 females, aged 30-60 years (mean, 45.5 years). The disease duration was 1-10 years (mean, 6.2 years). The unilateral knee was involved in 12 cases and bilateral knees in 4 cases. According to Koshino's staging system, 3 knees were classified as stage I, 7 knees as stage Ⅱ, 8 knees as stage Ⅲ, and 2 knees as stage IV. Preoperative Hospital for Special Surgery (HSS) knee score was 63.8±2.2; the femorotibial angle was (184.8±2.9) °; and Insall-Salvati index was 1.03±0.13. Results All the wounds healed primarily, and no complication of infection, osteofacial compartment syndrom, or deep vein thrombosis was observed. All patients were followed up 6-18 months (mean, 12.6 months). Personal paralysis was observed in 1 case (1 knee), and was cured after expectant treatment. Bone union time was 2.7-3.4 months (mean, 2.9 months). At 6 months after operation, the femorotibial angle was (173.8±2.0) °, showing significant difference when compared with preoperative one (t=11.70, P=0.00) ; Insall-Salvati index was 1.04±0.12, showing no significant difference when compared with preoperative one (t=-0.20, P=0.85) ; and HSS knee score was significantly increased to 88.9±3.1 (t=-25.44, P=0.00) . At last follow-up, the results were excellent in 13 knees, good in 6 knees, fair in 1 knee, and the excellent and good rate was 95%. Conclusions 3-D printing cutting block can greatly improve the accuracy of HTO, avoid repeated X-ray and multiple osteotomy, shorten the operation time, and ensure better effectiveness for correction of varus knee with osteoarthritis.

Citation： CHENGuoxian, LIGuoshan, LINZongjin, CHENXuanhuang, WENGZhen, XUGuosong, ZENGQingdong, ZHENGZugao, ZHANGGuodong, YUZhengxi. EFFECTIVENESS OF HIGH TIBIAL OSTEOTOMY ASSISTED BY THREE-DIMENSIONAL PRINTING TECHNOLOGY FOR CORRECTION OF VARUS KNEE WITH OSTEOARTHRITIS. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(4): 407-411. doi: 10.7507/1002-1892.20160082 Copy

1.	高石军, 邵德成, 陆搏, 等. 关节镜下清理胫骨高位截骨骑缝钉固定术治疗膝骨关节炎. 中国矫形外科杂志, 2006, 14(3) :192-195.
2.	Jackson JP, Waugh W. Tibial osteotomy for osteoarthritis of the knee. J Bone Joint Surg (Br), 1961, 43-B:746-751.
3.	Amedola A, Bonasia DE. Results of high tibial osteotomy:review of the literature. Int Orthop, 2010, 34(2) :155-160.
4.	Sherman C, Cabanela ME. Closing wedge osteotomy of the tibia and the femur in the treatment of gonarthrosis. Int Orthop, 2010, 34(2) :173-184.
5.	Owen BD, Christensen GE, Reinhardt JM, et al. Rapid prototype patient-specific drill template for cervical pedicle screw placement. Comput Aided Surg, 2007, 12(5) :303-308.
6.	Lu S, Xu YQ, Lu WW, et al. A novel patient-specific navigational template for cervical pedicle screw placement. Spine (Phila Pa 1976) , 2009, 34(26) :E959-966.
7.	Schweizer A, Fürnstahl P, Nagy L. Three-dimensional correction of distal radius intra-articular malunions using patient-specific drill guides. J Hand Surg (Am), 2013, 38(12) :2339-2347.
8.	Inzana JA, Olvera D, Fuller SM, et al. 3D printing of composite calcium phosphate and collagen scaffolds for bone regeneration. Biomaterials, 2014, 35(13) :4026-4034.
9.	Insall J, Salvati E. Patella position in the normal knee joint. Radiology, 1971, 101(1) :101-104.
10.	Miniaci A, Ballmer FT, Ballmer PM, et al. Proximal tibial osteotomy. A new fixiation device. Clin Orthop Related Res, 1989, (246) :250-259.
11.	Kirgis A, Albrecht S. Palsy of the deep personal nerve after proximal tibial osteotomy. An anatomical study. J Bone Joint Surg (Am), 1992, 74(8) :1180-1185.
12.	Hankemeier S, Paley D, Pape HC, et al. Knee para-articular focal dome osteotomy. Orthopade, 2004, 33(2) :170-177.
13.	Börjesson M, Weidenhielm L, Mattsson E, et al. Gait and clinical measurements in patients with knee osteoarthritis after surgery:a prospective 5-year follow-up study. Knee, 2005, 12(2) :121-127.
14.	Chae DJ, Shetty GM, Wang KH, et al. Early complications of medial opening wedge high tibial osteotomy using autologous trieortieal iliae bone gran and T-plate fixation. Knee, 2011, 18(4) :278-284.
15.	Lu S, Xu YQ, Chen GP, et al. Efficacy and accuracy of a novel rapid prototyping drill template for cervical pedicle screw placement. Comput Aided Surg, 2011, 16(5) :240-248.
16.	Sun W, Li J, Li Q, et al. Clinical effectiveness of hemipelvic reconstruction using computer-aided custom-made prostheses after resection of mal ignant pelvic tumors. J Arthroplasty, 2011, 26(8) :1508-1513.
17.	Lee M, Wu BM. Recent advances in 3D printing of tissue engineering scaffolds. Methods Mol Biol, 2012, 868:257-267.
18.	Won SH, Lee YK, Ha YC, et al. Improving pre-operative planning for complex total hip replacement with a rapid prototype model enabling surgical simulation. Bone Joint J, 2013, 95-B(11) :1458-1463.
19.	王均, 陆声, 周游, 等. 3D打印技术辅助创伤性膝内翻畸形矫正的初步临床应用. 中华创伤骨科杂, 2015, 17(1) :40-44.
20.	Brouwer RW, Bierma-Zeinstra SM, van Koeveringe AJ, et al. Patellar height and the inclination of the tibial plateau after high tibial osteotomy. The open versus the closed-wedge technique. J Bone Joint Surg (Br), 2005, 87(9) :1227-1232.

1. 高石军, 邵德成, 陆搏, 等. 关节镜下清理胫骨高位截骨骑缝钉固定术治疗膝骨关节炎. 中国矫形外科杂志, 2006, 14(3) :192-195.
2. Jackson JP, Waugh W. Tibial osteotomy for osteoarthritis of the knee. J Bone Joint Surg (Br), 1961, 43-B:746-751.
3. Amedola A, Bonasia DE. Results of high tibial osteotomy:review of the literature. Int Orthop, 2010, 34(2) :155-160.
4. Sherman C, Cabanela ME. Closing wedge osteotomy of the tibia and the femur in the treatment of gonarthrosis. Int Orthop, 2010, 34(2) :173-184.
5. Owen BD, Christensen GE, Reinhardt JM, et al. Rapid prototype patient-specific drill template for cervical pedicle screw placement. Comput Aided Surg, 2007, 12(5) :303-308.
6. Lu S, Xu YQ, Lu WW, et al. A novel patient-specific navigational template for cervical pedicle screw placement. Spine (Phila Pa 1976) , 2009, 34(26) :E959-966.
7. Schweizer A, Fürnstahl P, Nagy L. Three-dimensional correction of distal radius intra-articular malunions using patient-specific drill guides. J Hand Surg (Am), 2013, 38(12) :2339-2347.
8. Inzana JA, Olvera D, Fuller SM, et al. 3D printing of composite calcium phosphate and collagen scaffolds for bone regeneration. Biomaterials, 2014, 35(13) :4026-4034.
9. Insall J, Salvati E. Patella position in the normal knee joint. Radiology, 1971, 101(1) :101-104.
10. Miniaci A, Ballmer FT, Ballmer PM, et al. Proximal tibial osteotomy. A new fixiation device. Clin Orthop Related Res, 1989, (246) :250-259.
11. Kirgis A, Albrecht S. Palsy of the deep personal nerve after proximal tibial osteotomy. An anatomical study. J Bone Joint Surg (Am), 1992, 74(8) :1180-1185.
12. Hankemeier S, Paley D, Pape HC, et al. Knee para-articular focal dome osteotomy. Orthopade, 2004, 33(2) :170-177.
13. Börjesson M, Weidenhielm L, Mattsson E, et al. Gait and clinical measurements in patients with knee osteoarthritis after surgery:a prospective 5-year follow-up study. Knee, 2005, 12(2) :121-127.
14. Chae DJ, Shetty GM, Wang KH, et al. Early complications of medial opening wedge high tibial osteotomy using autologous trieortieal iliae bone gran and T-plate fixation. Knee, 2011, 18(4) :278-284.
15. Lu S, Xu YQ, Chen GP, et al. Efficacy and accuracy of a novel rapid prototyping drill template for cervical pedicle screw placement. Comput Aided Surg, 2011, 16(5) :240-248.
16. Sun W, Li J, Li Q, et al. Clinical effectiveness of hemipelvic reconstruction using computer-aided custom-made prostheses after resection of mal ignant pelvic tumors. J Arthroplasty, 2011, 26(8) :1508-1513.
17. Lee M, Wu BM. Recent advances in 3D printing of tissue engineering scaffolds. Methods Mol Biol, 2012, 868:257-267.
18. Won SH, Lee YK, Ha YC, et al. Improving pre-operative planning for complex total hip replacement with a rapid prototype model enabling surgical simulation. Bone Joint J, 2013, 95-B(11) :1458-1463.
19. 王均, 陆声, 周游, 等. 3D打印技术辅助创伤性膝内翻畸形矫正的初步临床应用. 中华创伤骨科杂, 2015, 17(1) :40-44.
20. Brouwer RW, Bierma-Zeinstra SM, van Koeveringe AJ, et al. Patellar height and the inclination of the tibial plateau after high tibial osteotomy. The open versus the closed-wedge technique. J Bone Joint Surg (Br), 2005, 87(9) :1227-1232.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS OF HIGH TIBIAL OSTEOTOMY ASSISTED BY THREE-DIMENSIONAL PRINTING TECHNOLOGY FOR CORRECTION OF VARUS KNEE WITH OSTEOARTHRITIS

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