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Meta-Analysis
. 2023 Feb;15(2):413-422.
doi: 10.1111/os.13483. Epub 2022 Dec 30.

Is Patient-Specific Instrumentation Accurate and Necessary for Open-Wedge High Tibial Osteotomy? A Meta-Analysis

Ran Pang #  1 , Zhaohui Jiang #  1 , Chunlei Xu  1 , Wei Shi  1 , Xinglong Zhang  1 , Xin Wan  1 , Daniel Bahat  2 , Hui Li  1   3 , Fedor Senatov  4 , Inna Bulygina  4 , Hu Wang  5 , Huafeng Zhang  1 , Zhijun Li  1
Affiliations
Meta-Analysis

Is Patient-Specific Instrumentation Accurate and Necessary for Open-Wedge High Tibial Osteotomy? A Meta-Analysis

Ran Pang et al. Orthop Surg. 2023 Feb.

Abstract

The purpose of this meta-analysis was to identify if patient-specific instrumentation (PSI) could increase the accuracy of the correction in high tibial osteotomy (HTO) and to explore the assessment indices and the necessity of using a PSI in HTO. A systematic search was carried out using online databases. A total of 466 patients were included in 11 papers that matched the inclusion criteria. To evaluate the accuracy of PSI-assisted HTO, the weight bearing line ratio (WBL%), hip-knee-ankle angle (HKA), mechanical medial proximal tibial angle (mMPTA), and posterior tibial slope angle (PTSA) were measured preoperatively and postoperatively and compared to the designed target values. Statistical analysis was performed after strict data extraction with Review Manager (version 5.4). Significant differences were detected in WBL% (MD = -36.41; 95% CI: -42.30 to -30.53; p < 0.00001), HKA (MD = -9.95; 95% CI: -11.65 to -8.25; p < 0.00001), and mMPTA (MD = -8.40; 95% CI:-10.27 to -6.53; p < 0.00001) but not in PTSA (MD = 0.34; 95% CI: -0.59 to 1.27; p = 0.47) between preoperative and postoperative measurements. There was no significant difference between the designed target values and the postoperative correction values of HKA (MD = 0.14; 95% CI: -0.19 to 0.47; p = 0.41) or mMPTA (MD = 0.11; 95% CI -0.34 to 0.55; p = 0.64). The data show that 3D-based planning of PSI for HTO is both accurate and safe. WBL%, HKA, and mMPTA were the optimal evaluation indicators of coronal plane correction. Sagittal correction is best evaluated by the PTSA. The present study reports that PSI is accurate but not necessary in typical HTO.

Keywords: High tibial osteotomy; Meta-analysis; Osteoarthritis; Patient-specific cutting guides; Patient-specific instrumentation; Three-dimensional.

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Conflict of interest statement

All authors certify that he or she has no funding or commercial associations that might pose a conflict of interest in connection with the submitted article.

Figures

Fig. 1
Fig. 1
Flow chart showing identification and selection of cases
Fig. 2
Fig. 2
Comparison of WBL% in the pre‐ and postoperative measurements
Fig. 3
Fig. 3
Comparison of HKA in the pre‐ and postoperative measurements
Fig. 4
Fig. 4
Comparison of HKA in the designed target values and postoperative measurements
Fig. 5
Fig. 5
Comparison of mMPTA in the pre‐ and postoperative measurements
Fig. 6
Fig. 6
Comparison of mMPTA in the designed target and postoperative measurements
Fig. 7
Fig. 7
Comparison of PTSA in the pre‐ and postoperative measurements
See this image and copyright information in PMC

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