Accuracy, patient-reported and surgical-related outcomes in patient-specific 3D-printed versus standard high tibial osteotomy: A systematic review with meta-analysis.

Abstract

Patient-specific instrumentation (PSI) aims to maximise the correction accuracy during high tibial osteotomy (HTO). The aim was to evaluate the correction accuracy of knee alignment and the surgical-related outcomes of PSI HTO in knees with osteoarthritis and compare the results against standard HTO. Databases were searched for studies using PSI HTO for the treatment of knee osteoarthritis. Meta-analyses were reported as mean differences (MDs) for continuous outcomes or proportions and risk ratio (RR) for dichotomous outcomes, with 95% confidence intervals (CIs). Twenty-one trials (16 studies) comprising 825 patients (52.1 ± 6.0 years, 57.6% men) were included (n = 530 PSI, n = 231 standard HTO, n = 64 navigated HTO). Meta-analyses of PSI showed that postoperative medial proximal tibial angle, mechanical femorotibial angle and posterior tibial slope were not significantly different from the planned. Hip-knee-ankle angle was significantly lower than planned (MD = -0.79, 95% CI -1.17 to -0.41). Visual analogue scale decreased significantly (MD = -3.94, 95% CI -5.39 to -2.5) and Functional Knee Society Score improved significantly (MD = 23.99, 95% CI 15.11 to 32.87). Comparing PSI and standard HTO, PSI was significantly shorter (MD = -19.52, 95% CI -28.92 to -10.11) and required significantly fewer fluoroscopies (MD = -16.65, 95% CI -32.34 to -0.96). Proportion of complications in PSI was 17.8% and led to 1.2% for reinterventions. No significant difference between PSI and standard HTO for risk of complications was observed (RR = 0.90, 95% CI 0.47 to 1.73). Patient-specific HTO leads to high accuracy in correction, improvement in clinical outcomes, and reduced surgery time and number of fluoroscopies.