Purpose
To evaluate the accuracy and precision of postoperative coronal plane alignment using
3D-printed patient-specific instrumentation (PSI) in the setting of proximal tibial
or distal femoral osteotomies.
Methods
A systematic review evaluating the accuracy of 3D-printed PSI for coronal plane alignment
correcting knee osteotomies was performed. The primary outcomes were accuracy of coronal
plane limb alignment correction and number of correction outliers. Secondary variables
were duration of surgery, number of intraoperative fluoroscopic images, complications,
cost, and clinical outcomes (as applicable).
Results
Ninety-three studies were identified, and 14 were included in the final analysis.
Overall, mean postoperative deviation from target correction ranged from 0.3° to 1°
for all studies using hip-knee angle measurements and 2.3% to 4.9% for all studies
using weight-bearing line measurements. The incidence of correction outliers was assessed
in 8 total studies and ranged from 0 to 25% (total n = 10 knees) of patients corrected with 3D-printed PSI. Osteotomies performed with
3D-printed cutting guides or wedges demonstrated significantly shorter operative times
(P < .05) and fewer intraoperative fluoroscopic images (P < .05) than control groups in four case control studies.
Conclusion
Patients undergoing distal femoral osteotomy or proximal tibial osteotomy procedures
with 3D-printed patient-specific cutting guides and wedges had highly accurate coronal
plane alignment with a low rate of outliers. Patients treated with 3D printed PSI
also demonstrated significantly shorter operative times and decreased intraoperative
fluoroscopy when compared to conventional techniques.
Level of Evidence
Level IV, systematic review of Level III-IV studies
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Article info
Publication history
Published online: March 01, 2022
Accepted:
February 20,
2022
Received:
August 2,
2021
Footnotes
See commentary on page 2759
The authors report the following potential conflicts of interest or sources of funding:
R.F.L. receives royalties from Arthrex and Smith & Nephew, is a paid consultant for Arthrex, Ossur, and Smith & Nephew; receives research support from Arthrex, Linvatec, Ossur, and Smith & Nephew; is on the editorial governing board of AJSM and KSSTA; and has member committee appointment for AOSSM, ISAKOS, AANA, and ESKA. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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