Accuracy of patient-specific three-dimensional-printed osteotomy and reduction guides for distal femoral osteotomy in dogs with medial patella luxation.

Authors: 
Hall EL, Baines S, Bilmont A, Oxley B.
Vet Surg. 2018 Nov 17. doi: 10.1111/vsu.13126. [Epub ahead of print]

OBJECTIVE: To compare precorrectional and postcorrectional femoral alignment following distal femoral osteotomy using patient-specific 3-dimensional (3D)-printed osteotomy and reduction guides in vivo and ex vivo.

STUDY DESIGN: Prospective study.

SAMPLE POPULATION: Ten client-owned dogs and matching 3D-printed plastic bone models.

METHODS: Distal femoral osteotomy was performed via a standard approach using osteotomy and reduction guides developed with computer-aided design software prior to 3D-printing. Femoral osteotomy and reduction was also performed on 3D-printed models of each femur with identical reprinted guides. Femoral varus angle (FVA) and femoral torsion angle (FTA) were measured on postoperative computed tomographic images by 3 observers.

RESULTS: In vivo, the mean difference between target and achieved postoperative was 2.29° (±2.29°, P = .0076) for the FVA, and 1.67° (±2.08°, P = .300) for the FTA. Ex vivo, the mean difference between target and achieved postoperative was 0.29° (±1.50°, P = .813) for the FVA, and -2.33° (±3.21°, P = .336) for the FTA. Intraobserver intraclass correlation coefficients (ICC; 0.736-0.998) and interobserver ICC (0.829 to 0.996) were consistent with an excellent agreement.

CONCLUSION: Use of 3D-printed osteotomy and reduction guides allowed accurate correction of FTA in vivo and both FVA and FTA ex vivo.

CLINICAL SIGNIFICANCE: Use of 3D-printed osteotomy and reduction guides may improve the accuracy of correction of femoral alignment but warrant further evaluation of surgical time, perioperative complications, and patient outcomes compared with conventional techniques.