Effectiveness of distal femoral osteotomy assisted by three-dimensional printing technology for correction of valgus knee with osteoarthritis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 CHENGuoxian ¹ , LIGuoshan ¹ , LINZongjin ¹ , CHENXuanhuang ² , ZHANGGuodong ² , YOUFengyuan ¹ , CHENJinguo ¹ , ZENGQingdong ¹ , ZHENGFeng ² , YUZhengxi ²

1. Department of Orthopedics, the First Hospital of Putian City, Putian Fujian, 351100, P.R.China;
2. Department of Orthopedics, Affiliated Hospital of Putian University, Teaching Hospital of Fujian Medical University & Affiliated Putian Hospital of Southern Medical University & Affiliated Hospital of Putian University, Putian Fujian, 351100, P.R.China;

Corresponding author：

CHENGuoxian, Email: cosain2000@163.com

Keywords：

Three-dimensional printing technology; distal femoral osteotomy; cutting block; vaglus knee; osteoarthritis

DOI：

10.7507/1002-1892.201610062

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Objective To evaluate the effectiveness of distal femoral osteotomy aided by three-dimensional (3D) printing cutting block for correction of vaglus knee with osteoarthritis. Methods Between January 2014 and January 2016, 12 patients (15 knees) with vaglus deformity and lateral osteoarhritis underwent medial closing wedge distal femoral osteotomy. There were 5 males and 7 females, aged 30-60 years (mean, 43.8 years). The mean disease duration was 6.6 years (range, 1–12 years). The unilateral knee was involved in 9 cases and bilateral knees in 3 cases. According to Koshino’s staging system, 1 knee was classified as stage I, 9 knees as stage II, and 5 knees as stage III. The X-ray films of bilateral lower extremities showed that the femorotibial angle (FTA) and anatomical lateral distal femoral angle (aLDFA) were (160.40±2.69)° and (64.20±2.11)° respectively. Mimics software was used to design and print the cutting block by 3D printing technique. During operation, the best location of distal femoral osteotomy was determined according to the cutting block. After osteotomy, internal fixation was performed using a steel plate and screws. Results All incisions healed primarily; no complication of infection or deep vein thrombosis was observed. All patients were followed up 6-18 month (mean, 12.2 months). At 6 months after operation, the hospital for special surgery (HSS) score for knee was significantly improved to 89.07±2.49 when compared with preoperative score (65.27±1.49,t=–28.31,P=0.00); the results were excellent in 10 knees, good in 4 knees, and fair in 1 knee with an excellent and good rate of 93.3%. The bony union time was 2.9-4.8 months (mean, 3.3 months). Bone delayed union occurred in 1 case (1 knee). The postoperative FTA and aLDFA were (174.00±1.41)° and (81.87±1.06)° respectively, showing significant differences when compared with preoperative ones (t=–18.26，P=0.00;t=–25.19,P=0.00). The percentage of medial tibial plateau in whole tibial plateau was 49.78%±0.59%, showing no significant difference when compared with intraoperative measurement (49.82%±0.77%,t=0.14,P=0.89). Conclusion 3D printing cutting block can greatly improve the accuracy of distal femoral osteotomy, and ensure better effectiveness for correction of vaglus knee with osteoarthritis.

Citation： CHENGuoxian, LIGuoshan, LINZongjin, CHENXuanhuang, ZHANGGuodong, YOUFengyuan, CHENJinguo, ZENGQingdong, ZHENGFeng, YUZhengxi. Effectiveness of distal femoral osteotomy assisted by three-dimensional printing technology for correction of valgus knee with osteoarthritis. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(2): 134-138. doi: 10.7507/1002-1892.201610062 Copy

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11.	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.
12.	Lu S, XuYQ, Guo P,et al. Efficacy and accuracy of a novel rapid prototyping drill template for cervical pedicle screw placement. Computer Aided Surg, 2011, 16(5): 240-248.
13.	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.
14.	Lee M, Wu BM. Recent advances in 3D printing of tissue engineering scaffolds. Methods Mol Biol, 2012, 868(15): 257-267.
15.	张丰经, 刘晨宏, 孙华, 等. 股骨远端内侧闭合楔形截骨矫正中青年膝外翻. 中国矫形外科杂志, 2016, 24(1): 35-38.

1. 吉士俊, 潘少川, 王继孟. 小儿骨科学. 济南: 山东科学技术出版社, 1998: 420.
2. 吴阶平, 裘法祖. 黄家驷外科学. 5版. 北京: 人民卫生出版社, 1994: 2116.
3. 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.
4. Lu S, Xu YQ, Lu WW,et al. A novel patient-specific navigational template for cervical pedicle screw placement. Spine (Phila Pa1976), 2009, 34(26): E959-966.
5. 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.
6. 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.
7. Miniaci A, Ballmer FT, Ballmer PM,et al. Proximal tibial osteotomy: A new fixation device. Clin Orthop, 1989, (246): 250-259.
8. 黄野, 及松洁, 杜辉, 等. 锁定钢板固定的股骨髁上不全截骨技术治疗膝外翻. 中国骨与关节杂志, 2014, 3(7): 531-535.
9. Shoji H, Insall J. High tibial osteotomy for osteoarthritis of the knee with valgus deformity. J Bone Joint Surg (Am),1973, 55 (5): 963-973.
10. Sharma L, Sony J, Felson DT,et al. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA, 2001, 286 (2): 188-195.
11. 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.
12. Lu S, XuYQ, Guo P,et al. Efficacy and accuracy of a novel rapid prototyping drill template for cervical pedicle screw placement. Computer Aided Surg, 2011, 16(5): 240-248.
13. 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.
14. Lee M, Wu BM. Recent advances in 3D printing of tissue engineering scaffolds. Methods Mol Biol, 2012, 868(15): 257-267.
15. 张丰经, 刘晨宏, 孙华, 等. 股骨远端内侧闭合楔形截骨矫正中青年膝外翻. 中国矫形外科杂志, 2016, 24(1): 35-38.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of distal femoral osteotomy assisted by three-dimensional printing technology for correction of valgus knee with osteoarthritis

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