Learning curves for high tibial osteotomy using patient-specific instrumentation: a case control study-Reference-Cited by-同舟云学术

Learning curves for high tibial osteotomy using patient-specific instrumentation: a case control study

Published:2024-07-03 Issue: Volume: Page:
ISSN:2364-7485
Container-title:Innovative Surgical Sciences
language:en
Short-container-title:

Author:

Stimolo Davide¹²^ORCID,Leggieri Filippo¹,Matassi Fabrizio¹,Barra Angelo³,Civinini Roberto¹,Innocenti Matteo¹²

Affiliation:

1. Department of Orthopaedics, AOU Careggi Florence , 60222 University of Florence , Florence , Italy

2. University of Florence, School of Human Health Sciences , Largo Brambilla 3, 50134 Florence , Italy

3. Department of Technical Professions and Rehabilitation , AOU Careggi Florence , Florence , Italy

Abstract

Abstract Objectives Three-dimensional (3D) planning and Patient Specific Instrumentation (PSI) can help the surgeon to obtain more predictable results in Medial Opening Wedge High Tibial Osteotomy (mOW-HTO) than the conventional techniques. We compared the accuracy of the PSI and standard techniques and measured the learning curve for surgery time and number of fluoroscopic shots. Methods We included the first 12 consecutive cases of mOW-HTO performed with 3D planning and PSI cutting guides and the first 12 non-supervised mOW-HTO performed with the standard technique. We recorded surgery time and fluoroscopic time. We calculated the variation (Δ delta) between the planned target and the postoperative result for Hip Knee Ankle Angle (HKA), mechanical medial Proximal Tibia Angle (MPTA), Joint Line Convergence Angle (JLCA) and tibial slope (TS) and compared it both groups. We also recorded the complication rate. We then calculated the learning curves for surgery time, number of fluoroscopic shots, Δ from target in both groups. CUSUM analysis charts for learning curves were applied between the two groups. Results Mean surgical time and mean number of fluoroscopic shots were lower in PSI group (48.58±7.87 vs. 58.75±6.86 min; p=0.034 and 10.75±3.93 vs. 18.16±4.93 shots; p<0.001). The postoperative ΔHKA was 0.42±0.51° in PSI vs. 1.25±0.87° in conventional, p=0.005. ΔMPTA was 0.50±0.67° in PSI vs. 3.75±1.48° in conventional, p<0.001; ΔTS was 1.00±0.82° in PSI vs. 3.50±1.57° in conventional, p<0.001. ΔJLCA was 1.83±1.11° in PSI vs. 4±1.41° in conventional, p<0.001. The CUSUM analysis favoured PSI group regarding surgery time (p=0.034) and number of shots (p<0.001) with no learning curve effect for ΔHKA, ΔMPTA, ΔJLCA and ΔTS. Conclusions PSI cutting guides and 3D planning for HTO are effective in reducing the learning curves for operation time and number of fluoroscopic shots. Accuracy of the procedure has been elevated since the first cases.

Publisher

Walter de Gruyter GmbH

Link

https://www.degruyter.com/document/doi/10.1515/iss-2024-0007/pdf

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