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The influence of the weight-bearing state on three-dimensional (3D) planning in lower extremity realignment – analysis of novel vs. state-of-the-art planning approaches

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Názov: The influence of the weight-bearing state on three-dimensional (3D) planning in lower extremity realignment – analysis of novel vs. state-of-the-art planning approaches
Autori: Hodel, Sandro, Arn-Roth, Tabitha, Haug, Florian, Carillo, Fabio, Vlachopoulos, Lazaros, Fucentese, Sandro F, Fürnstahl, Philipp
Prispievatelia: University of Zurich, Hodel, Sandro
Zdroj: Arch Orthop Trauma Surg
Informácie o vydavateľovi: Springer Science and Business Media LLC, 2024.
Rok vydania: 2024
Predmety: Male, Adult, Smith & Nephew (United Kingdom) and Karl Storz SE & Co. KG (Germany). Sandro Fucentese is a board member of the EKA, Zimmer Biomet (USA), 610 Medicine & health, Weight-Bearing, 03 medical and health sciences, 2732 Orthopedics and Sports Medicine, Imaging, Three-Dimensional, 0302 clinical medicine, Ray Computed/methods Retrospective Studies Middle Aged Male *Osteotomy/methods Female Adult Tibia/surgery/diagnostic imaging Lower Extremity/surgery/diagnostic imaging Aged Automatization Knee Leg alignment Osteotomy Patient, Humans, Retrospective Studies, Aged, Tibia, 11476 Digital Society Initiative, specific instrumentation Tibia osteotomy Nr. 320030_182352/1). Sandro Fucentese is a consultant for Medacta SA (Switzerland), Bearing/physiology *Imaging, Three, Middle Aged, 2746 Surgery, ESSKA osteotomy expert group. The remaining offers have nothing to disclose, Orthopaedic Surgery, Osteotomy, Lower Extremity, 10046 Balgrist University Hospital, Swiss Spinal Cord Injury Center, Female, Humans *Weight, Dimensional/methods *Tomography, Tomography, X-Ray Computed
Popis: Background The use of 3D planning to guide corrective osteotomies of the lower extremity is increasing in clinical practice. The use of computer-tomography (CT) data acquired in supine position neglects the weight-bearing (WB) state and the gold standard in 3D planning involves the manual adaption of the surgical plan after considering the WB state in long-leg radiographs (LLR). However, this process is subjective and dependent on the surgeons experience. A more standardized and automated method could reduce variability and decrease costs. Purpose The aim of the study was (1) to compare three different three-dimensional (3D) planning modalities for medial open-wedge high tibial osteotomy (MOWHTO) and (2) to describe the current practice of adapting NWB CT data after considering the WB state in LLR. The purpose of this study is to validate a new, standardized approach to include the WB state into the 3D planning and to compare this method against the current gold standard of 3D planning. Our hypothesis is that the correction is comparable to the gold standard, but shows less variability due compared to the more subjective hybrid approach. Methods Three surgical planning modalities were retrospectively analyzed in 43 legs scheduled for MOWHTO between 2015 and 2019. The planning modalities included: (1) 3D hybrid (3D non-weight-bearing (NWB) CT models after manual adaption of the opening angle considering the WB state in LLR, (2) 3D NWB (3D NWB CT models) and (3) 3D WB (2D/3D registration of 3D NWB CT models onto LLR to simulate the WB state). The pre- and postoperative hip-knee-ankle angle (HKA) and the planned opening angle (°) were assessed and differences among modalities reported. The relationship between the reported differences and BMI, preoperative HKA (LLR), medial meniscus extrusion, Outerbridge osteoarthritis grade and joint line convergence angle (JLCA) was analyzed. Results The mean (std) planned opening angle of 3D hybrid did not differ between 3D hybrid and 3D WB (0.4 ± 2.1°) (n.s.) but was higher in 3D hybrid compared to 3D NWB (1.1° ± 1.1°) (p = 0.039). 3D WB demonstrated increased preoperative varus deformity compared to 3D NWB: 6.7 ± 3.8° vs. 5.6 ± 2.7° (p = 0.029). Patients with an increased varus deformity in 3D WB compared to 3D NWB (> 2 °) demonstrated more extensive varus alignment in LLR (p = 0.009) and a higher JLCA (p = 0.013). Conclusion Small intermodal differences between the current practice of the reported 3D hybrid planning modality and a 3D WB approach using a 2D/3D registration algorithm were reported. In contrast, neglecting the WB state underestimates preoperative varus deformity and results in a smaller planned opening angle. This leads to potential under correction in MOWHTO, especially in patients with extensive varus deformities or JLCA. Clinical Relevance Incorporating the WB state in 3D planning modalities has the potential to increase accuracy and lead to a more consistent and reliable planning in MOWHTO. The inclusion of the WB state in automatized surgical planning algorithms has the potential to reduce costs and time in the future.
Druh dokumentu: Article
Other literature type
Popis súboru: 2024_Hodel_The_influence_of_the_weight_bearing.pdf - application/pdf
Jazyk: English
ISSN: 1434-3916
DOI: 10.1007/s00402-024-05289-3
DOI: 10.5167/uzh-269241
Prístupová URL adresa: https://pubmed.ncbi.nlm.nih.gov/38554205
https://www.zora.uzh.ch/id/eprint/269241/
https://doi.org/10.5167/uzh-269241
Rights: CC BY
Prístupové číslo: edsair.doi.dedup.....6a4dd6244736432c539e735ecc4ed840
Databáza: OpenAIRE
Popis
Abstrakt:Background The use of 3D planning to guide corrective osteotomies of the lower extremity is increasing in clinical practice. The use of computer-tomography (CT) data acquired in supine position neglects the weight-bearing (WB) state and the gold standard in 3D planning involves the manual adaption of the surgical plan after considering the WB state in long-leg radiographs (LLR). However, this process is subjective and dependent on the surgeons experience. A more standardized and automated method could reduce variability and decrease costs. Purpose The aim of the study was (1) to compare three different three-dimensional (3D) planning modalities for medial open-wedge high tibial osteotomy (MOWHTO) and (2) to describe the current practice of adapting NWB CT data after considering the WB state in LLR. The purpose of this study is to validate a new, standardized approach to include the WB state into the 3D planning and to compare this method against the current gold standard of 3D planning. Our hypothesis is that the correction is comparable to the gold standard, but shows less variability due compared to the more subjective hybrid approach. Methods Three surgical planning modalities were retrospectively analyzed in 43 legs scheduled for MOWHTO between 2015 and 2019. The planning modalities included: (1) 3D hybrid (3D non-weight-bearing (NWB) CT models after manual adaption of the opening angle considering the WB state in LLR, (2) 3D NWB (3D NWB CT models) and (3) 3D WB (2D/3D registration of 3D NWB CT models onto LLR to simulate the WB state). The pre- and postoperative hip-knee-ankle angle (HKA) and the planned opening angle (°) were assessed and differences among modalities reported. The relationship between the reported differences and BMI, preoperative HKA (LLR), medial meniscus extrusion, Outerbridge osteoarthritis grade and joint line convergence angle (JLCA) was analyzed. Results The mean (std) planned opening angle of 3D hybrid did not differ between 3D hybrid and 3D WB (0.4 ± 2.1°) (n.s.) but was higher in 3D hybrid compared to 3D NWB (1.1° ± 1.1°) (p = 0.039). 3D WB demonstrated increased preoperative varus deformity compared to 3D NWB: 6.7 ± 3.8° vs. 5.6 ± 2.7° (p = 0.029). Patients with an increased varus deformity in 3D WB compared to 3D NWB (> 2 °) demonstrated more extensive varus alignment in LLR (p = 0.009) and a higher JLCA (p = 0.013). Conclusion Small intermodal differences between the current practice of the reported 3D hybrid planning modality and a 3D WB approach using a 2D/3D registration algorithm were reported. In contrast, neglecting the WB state underestimates preoperative varus deformity and results in a smaller planned opening angle. This leads to potential under correction in MOWHTO, especially in patients with extensive varus deformities or JLCA. Clinical Relevance Incorporating the WB state in 3D planning modalities has the potential to increase accuracy and lead to a more consistent and reliable planning in MOWHTO. The inclusion of the WB state in automatized surgical planning algorithms has the potential to reduce costs and time in the future.
ISSN:14343916
DOI:10.1007/s00402-024-05289-3