Hiranaka Takaaki, Grasso Samuel, Davey Christopher, Fabbro Giacomo Dal, Ahedi Harbeer, Fritsch Brett, Parker David
Sydney Orthopaedic Research Institute, Landmark Orthopaedics, St. Leonards, Sydney, Australia.
Sydney Orthopaedic Research Institute, Landmark Orthopaedics, St. Leonards, Sydney, Australia.
J ISAKOS. 2025 Jun;12:100859. doi: 10.1016/j.jisako.2025.100859. Epub 2025 Apr 5.
Patient-specific instruments (PSIs) have been introduced to enhance the accuracy of medial opening wedge high tibial osteotomy (MOWHTO). This study aimed to evaluate the accuracy of a newly developed PSI and its impact on postoperative clinical outcomes.
Forty patients with varus alignment who underwent MOWHTO using the newly developed PSI were retrospectively analyzed for accuracy of correction. Radiographic evaluations, including hip-knee-ankle angle (HKA) and medial proximal tibial angle (MPTA) were performed using long-leg standing radiographs preoperatively and at 6 months postoperatively. Overall error was defined as the difference between the planned and achieved HKA (ΔHKA), while surgical error was defined as the difference between the planned and achieved MPTA (ΔMPTA). Planning error was defined as the difference between overall error and surgical error. For each type of error, positive values indicated over-correction, while negative values indicated under-correction. Knee Injury and Osteoarthritis Outcome Score (KOOS) data were collected and compared between preoperative and 12-month postoperative assessments.
The mean planned HKA was 182.4° ± 0.3°, and the achieved HKA was 182.6° ± 1.5° (p = 0.382). The mean planned MPTA was 93.1° ± 1.9°, and the achieved MPTA was 92.8° ± 1.9° (p = 0.358). The overall error was 0.2° ± 1.5° (38% under-correction and 62% over-correction). Surgical error (ΔMPTA) averaged -0.3° ± 1.1° (55% under-correction and 45% over-correction), while planning error averaged 0.6° ± 1.1° (30% under-correction and 70% over-correction). All KOOS subscales showed a statistically significant improvement at 12 months postoperatively compared to preoperative scores (p < 0.001).
The newly developed PSI workflow proved to be an accurate method for planning and performing MOWHTO. While overall error was low, the observed tendencies for surgical under-correction and planning over-correction highlight the need for careful consideration of these factors to optimize outcomes in the future.
Level IV, Retrospective Case Series.
患者特异性器械（PSIs）已被引入以提高内侧开口楔形高位胫骨截骨术（MOWHTO）的准确性。本研究旨在评估一种新开发的PSIs的准确性及其对术后临床结果的影响。
对40例行MOWHTO并使用新开发的PSIs的内翻畸形患者进行回顾性分析，以评估矫正的准确性。使用长腿站立位X线片在术前和术后6个月进行影像学评估，包括髋-膝-踝角（HKA）和胫骨近端内侧角（MPTA）。总误差定义为计划的和实际达到的HKA之间的差值（ΔHKA），而手术误差定义为计划的和实际达到的MPTA之间的差值（ΔMPTA）。计划误差定义为总误差和手术误差之间的差值。对于每种类型的误差，正值表示过度矫正，负值表示矫正不足。收集膝关节损伤和骨关节炎结局评分（KOOS）数据，并在术前和术后12个月评估之间进行比较。
计划的平均HKA为182.4°±0.3°，实际达到的HKA为182.6°±1.5°（p = 0.382）。计划的平均MPTA为93.1°±1.9°，实际达到的MPTA为92.8°±1.9°（p = 0.358）。总误差为0.2°±1.5°（38%矫正不足和62%过度矫正）。手术误差（ΔMPTA）平均为-0.3°±1.1°（55%矫正不足和45%过度矫正），而计划误差平均为0.6°±1.1°（30%矫正不足和70%过度矫正）。与术前评分相比，所有KOOS子量表在术后12个月均显示出统计学上的显著改善（p < 0.001）。
新开发的PSIs工作流程被证明是一种用于计划和实施MOWHTO的准确方法。虽然总误差较低，但观察到的手术矫正不足和计划过度矫正的趋势突出了在未来优化结果时仔细考虑这些因素的必要性。
IV级，回顾性病例系列。
