Assessing the Impact of Patient-Specific Instrumentation and Fixation on Accuracy and Radiation Exposure in a Cadaveric Model of Medial Opening-Wedge High Tibial Osteotomy.

BACKGROUND

Traditional freehand techniques in high tibial osteotomy (HTO) have been shown to lack precision and accuracy. Patient-specific instrumentation (PSI) and fixation created from cross-sectional imaging have recently been introduced to address this problem.

PURPOSE/HYPOTHESIS: The purpose of the study was to compare traditional freehand techniques versus PSI in a human cadaveric model of HTO. It was hypothesized that the osteotomies performed using PSI would require less radiation exposure for operating room staff and would reduce deviation from the planned correction in the coronal, sagittal, and axial planes.

STUDY DESIGN

Controlled laboratory study.

METHODS

Sixteen matched cadaveric knees underwent medial opening-wedge HTO via the freehand method (n = 8) or PSI technique (n = 8) with a predetermined planned opening-wedge size. Computed tomography was used to measure the achieved wedge size as well as alignment parameters in the coronal, sagittal, and axial planes. Radiation dose, number of fluoroscopic images taken, and total operative time were recorded.

RESULTS

The mean deviation from the planned wedge size was smaller in the PSI group compared with the freehand group (0.505 vs 3.016 mm, respectively; < .01). Total radiation dose to medical staff (0.85 vs 2.04 mGy; < .01) and number of fluoroscopic images (15.5 vs 41; < .01) were also smaller in the PSI versus the freehand group, respectively. No difference was seen in total operative time between the 2 groups ( = .62).

CONCLUSION

In cadaveric specimens, the PSI technique demonstrated superior accuracy and decreased radiation exposure for medical staff compared with the traditional freehand technique without compromising operative efficiency.

CLINICAL RELEVANCE

The use of PSI when HTO is performed can lead to more accurate operations and potentially improve outcomes.