More accurate correction using "patient-specific" cutting guides in opening wedge distal femur varization osteotomies.

  • Jacquet Christophe
  • Chan-Yu-Kin Johanna
  • Sharma Akash
  • Argenson Jean-Noël
  • Parratte Sébastien
  • Ollivier Matthieu

  • Humans
  • Adult
  • Female
  • Male
  • Middle Aged
  • Osteotomy
  • Accuracy
  • Customized
  • Cutting-guide
  • External-opening
  • Femoral
  • Patient-Specific Modeling
  • Bone Malalignment/etiology/prevention & control/surgery
  • Femur/diagnostic imaging/surgery
  • Genu Valgum/diagnostic imaging/surgery
  • Osteoarthritis
  • Knee/diagnostic imaging/surgery
  • Osteotomy/instrumentation/methods
  • Perioperative Care
  • Tibia/surgery


PURPOSE: The distal femoral varization osteotomy (DFVO) by a lateral opening wedge osteotomy is an established intervention for patients suffering from lateral femoro-tibial osteoarthritis on a genu valgum deformity. In order to improve the accuracy of this correction, the use of a customized cutting guide (PSI) has been proposed as an alternative to conventional technique. The objective of our study was to compare the accuracy of post-operative alignment following DFVO in the coronal and sagittal plane using either a conventional abacus technique or PSI guide. METHOD: Twenty-one patients that underwent lateral opening wedge osteotomy from a technique using PSI based on 3D CT-scans were matched 1:1 to 21 patients operated on using a conventional technique (pre-operative planning performed on standard radiographs). The accuracy of the correction was analyzed, comparing coronal and sagittal mechanical post-operative angles with pre-operative planning. RESULTS: With regard to alignment in the coronal plane (HKA correction), our study demonstrated a significant improvement in the accuracy of the correction obtained in the PSI group compared to the conventional group (0.43 ± 0.50 vs 3.95 ± 1.64 p \textless 0.001). In the sagittal plane (PDFA correction), we also found a significant improvement in correction accuracy in the PSI group (0.52 ± 0.60 vs 3.10 ± 1.83 p \textless 0.001). There was a significant decrease in operating time (delta 7.7 ± 3.07 (1.5-13.9) (p = 0.0.161) and fluoroscopic images taken (6.9 ± 0.54 (5.8-8) p \textless 0.001). CONCLUSION: Our results suggest that the use of PSI in DFVO improves the accuracy of correction in both the coronal and sagittal planes compared to conventional techniques.