Is patient-specific instrumentation more precise than conventional techniques and navigation in achieving planned correction in high tibial osteotomy? - 19/11/20
, Camille Steltzlen b, Nicolas Bouguennec c, Jean-Loup Cartier d, Patrice Mertl e, Cécile Batailler f, Jean-Luc Hanouz g, Goulven Rochcongar h, Jean-Marie Fayard iThe
Francophone Arthroscopy Societyj
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Abstract |
Introduction |
Preoperative planning in high tibial osteotomy (HTO) is a critical step for achieving the desired correction and a clinically satisfactory outcome. Conventional radiography, navigation assistance and patient-specific instrumentation (PSI) are the 3 means of planning, but no prospective studies have compared precision between the 3. The aims of the present study were: (1) to analyze and compare correction precision between the 3 planning approaches at 1 year's follow-up; (2) to compare results to those reported in the literature; and (3) to analyze factors influencing the achievement of planned correction.
Hypothesis |
The study hypothesis was that PSI provides more precise and reproducible planned correction than conventional methods or navigation.
Material and method |
Between June 2017 and June 2018, a multicenter non-randomized prospective observational study was conducted in 11 centers. One hundred and twenty-six patients with Ahlbäck grade I, II or III idiopathic medial tibiofemoral osteoarthritis with stable knee were included and allocated to 3 preoperative planning groups: conventional (group 1), navigation (group 2) and PSI (group 3). Mean age at surgery was 51.2 years (range, 19-69 years; median, 53.2 years); 100 male, 26 female. Complete weight-bearing radiographic work-up was performed preoperatively and at 1 year's follow-up. The PSI group also underwent CT as part of guide production. Target angular correction and mechanical Hip-Knee-Ankle (HKA) axis were set preoperatively. The main endpoint was the difference between planned HKA and HKA at a minimum 12 months.
Results |
Mean HKA difference was 1.1±3 in group 1, 2.1±2.6 in group 2 and 0.3±3.1 in group 3. Precision was better with PSI, but not significantly when comparing all 3 groups together. On pairwise intergroup comparison, there was a significant difference only between groups 2 and 3, in favor of PSI (P=0.011).
Discussion |
None of the 3 techniques demonstrated superiority in achieving target correction at 1 year. The study hypothesis was thus not confirmed. All 3 techniques proved reliable and precise in HTO planning.
Level of evidence |
III, prospective non-randomized comparative study.
El texto completo de este artículo está disponible en PDF.Keywords : High tibial osteotomy, Navigation, PSI
Esquema
Vol 106 - N° 8S
P. S231-S236 - décembre 2020 Regresar al número
Artículo precedente
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- Nicolas Bouguennec, Guillaume Mergenthaler, Thomas Gicquel, Cyril Bryand, Elodie Nadau, Régis Pailhé, Jean Luc Hanouz, Jean Marie Fayard, Goulven Rochcongar, Francophone Arthroscopy Society
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Bienvenido a EM-consulte, la referencia de los profesionales de la salud.