Three dimensional-printed patient-specific cutting guides for femoral varization osteotomy: Do it yourself

Introduction: In valgus knees of young patients, opening-wedge distal femoral osteotomy is a valid treatment option for axial corrections. It allows the surgeon to achieve accurate correction, which is directly related to the functional outcome and survivorship of the osteotomy. This study presents a new technique based on three-dimensional (3D)-printed cutting guides for opening-wedge distal femoral osteotomies, in which pre-operative planning and intraoperative executional accuracy play a major role. Material and methods: Pursuing axial correction accuracy, 3D-printed patient-specific positioning guides and wedge spacers were both created and used by the surgeon to implement the femoral osteotomy. The proposed technique was performed in 12 consecutive patients (cases). The results were compared with 20 patients (controls) in which opening-wedge distal femoral osteotomies were performed following the traditional technique. Accuracy of the axial correction, surgical time, fluoroscopic time and costs were measured. Results: More accurate axial correction with reduced surgical time (32 min less), intraoperative fluoroscopic images (59 images less) and costs (estimated (sic)412 less) were achieved with the use of the customized guides when compared with the traditional technique. Discussion: Accurate correction of the axial alignment of the limb is a critical step in survivorship of the osteotomy. Improving the technique to enhance accuracy focused on this issue. Conclusions: The use of patient-customized cutting guides minimised human error; therefore, surgical time was reduced and accurate axial correction was achieved. The surgeon mastered all steps in a do-it-yourself philosophy style. (C) 2017 Elsevier B.V. All rights reserved.