3D medical imaging analysis, patient-specific instrumentation and individualized implant design, with additive manufacturing creates a new personalized high tibial osteotomy treatment option

Claudio Belvedere, Alisdair MacLeod, Alberto Leardini, Alberto Grassi, Giacomo Dal Fabbro, Stefano Zaffagnini, H S Gill

Research output: Contribution to journalArticlepeer-review

Abstract

High Tibial Osteotomy is frequently performed to correct varus knees misalignment and thus to prevent end-stage osteoarthritis. Traditional systems lack pre-surgical planning and custom-fit fixation plates. A new 3D printed system has been developed for a personalized surgical procedure. This starts with careful correction planning based on a standard preoperative long leg radiograph and a 3D scan of the knee by Cone-Beam CT, both in weight-bearing. From the latter, a 3D model of the proximal tibia is reconstructed, on which the surgery is planned. This allows the design of the surgical guide and fixation plate to match the tibial surface topology and 3D printed in medical grade titanium alloy using selective-laser-sintering. During surgery, the guided osteotomy and controlled opening mechanism ensure an accurate correction; this is stabilized with the custom-fit plate secured to the proximal tibia using locking screws of appropriate length. After a brief learning curve, the mean discrepancy between the plan and the achieved alignment was 1.2 ±1.4. The surgical time was reduced by an average of approximately 30%. From medical imaging of the patient to product delivery to the hospital, the overall timeframe was about 15 days.

Original languageEnglish
Article number2340041
Number of pages15
JournalJournal of Mechanics in Medicine and Biology
Volume23
Issue number6
DOIs
Publication statusPublished - 1 Aug 2023

Bibliographical note

Data access:
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Funding acknowledgment:
This study was partially funded by the Italian Ministry of Health under the “5 per mille” program.

Keywords

  • Custom-made
  • High Tibial Osteotomy
  • Joint modeling
  • Medical imaging
  • Personalized devices
  • Surgical procedure
  • Weight-Bearing CT

ASJC Scopus subject areas

  • Biomedical Engineering

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