INTRODUCTION Several recent studies have reported accurate and reliable use of patient-specific cutting guides (PSCG) for medial opening-wedge high tibial osteotomy (OW-HTO); however, a majority of these are small cases series or ex-vivo reports. The hypothesis of this study was that performing an OW-HTO with PSCG results in a reliable and accurate correction with good or satisfactory patient-reported functional outcomes at a mean of two years. We also hypothesized that the use of PSCG would not increase the rate of specific or non-specific complications. METHODS In this single-centre, observational study, a prospective cohort of a hundred patients (age < 60 years with isolated medial knee osteoarthritis and significant metaphyseal tibial vara) were included between February 2014 and November 2017 to investigate the safety and accuracy of OW-HTO using PSCG. The accuracy of post-operative alignment was defined by the difference between the desired correction defined pre-operatively and the correction obtained post-operatively measured on CT scan (ΔHKA, ΔMPTA, ΔPPTA). Functional outcomes were evaluated by the difference between the value obtained in the pre-operative questionnaire and that obtained at the last follow-up (mean 2 years) using the KOOS and UCLA activity scale. Intra-operative and post-operative complications were recorded. RESULTS The mean patient age was 44.17 ± 6.77 years; no patient was lost to follow-up at a mean of two years. The mean ΔHKA was 1 ± 0.95°, the mean ΔMPTA was 0.54 ± 0.63°, and the mean ΔPPTA was 0.43 ± 0.8°. No significant differences (all p values > 0.05) were observed between the desired correction defined pre-operatively and the correction obtained post-operatively (ΔHKA, ΔMPTA, ΔPPTA). An improvement of 27 ± 25 for the KOOS Pain, 28 ± 26 for the KOOS symptoms, 27 ± 28 for the KOOS ADL, 26 ± 33 for the KOOS sport/rec, 28 ± 38 for the KOOS QOL, and 2.6 ± 2.4 for the UCLA was obtained as compared with the pre-operative values (all p < 0.0001). No procedures observed were abandoned, and the PSCG was well positioned in all cases. The overall complication rate was 32% up to two years post-operatively, most of them being classed as minor events (28%). CONCLUSION Performing an OW-HTO with PSCG produces an accurate correction with good functional outcomes at a mean of two years. Furthermore, there is no increase in the rate of specific or non-specific complications. A study to assess the reproducibility of this technique, regardless of the surgical level, is needed.

中文翻译：

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针对特定患者的楔形高位胫骨截骨术切割指南：连续100位患者的安全性和准确性分析。

引言最近的几项研究报告了针对患者的切开导板（PSCG）准确可靠地用于内侧开口楔高位胫骨截骨术（OW-HTO）的研究；但是，其中大多数是小病例系列报告或离体报告。这项研究的假设是，用PSCG进行OW-HTO可以可靠，准确地校正患者，其平均报告的功能结局平均为两年。我们还假设PSCG的使用不会增加特异性或非特异性并发症的发生率。方法在这项单中心的观察性研究中，前瞻性队列研究了一百名患者（年龄< 在2014年2月至2017年11月之间纳入了60年的孤立性内侧膝关节骨关节炎和明显的干phy端胫腓骨变异性患者，以研究使用PSCG进行OW-HTO的安全性和准确性。术后对准的准确度由术前定义的所需校正与术后在CT扫描上测得的校正之间的差（ΔHKA，ΔMPTA，ΔPPTA）定义。使用KOOS和UCLA活动量表，通过术前问卷调查获得的值与上次随访（平均2年）获得的值之间的差异来评估功能结局。记录术中和术后并发症。结果患者平均年龄为44.17±6.77岁。平均两年没有患者失去随访。平均ΔHKA为1±0.95°，平均ΔMPTA为0。54±0.63°，且平均ΔPPTA为0.43±0.8°。术前定义的所需校正与术后获得的校正（ΔHKA，ΔMPTA，ΔPPTA）之间没有观察到显着差异（所有p值均> 0.05）。KOOS疼痛改善27±25，KOOS症状改善28±26，KOOS ADL改善27±28，KOOS sport / rec改善26±33，KOOS QOL改善28±38，KOOS QOL改善2.6±2.4与术前值相比，获得了UCLA（所有p <0.0001）。没有观察到的程序被遗弃，并且PSCG在所有情况下均处于良好位置。术后两年内总体并发症发生率为32％，其中大多数被归为轻微事件（28％）。结论用PSCG进行OW-HTO可以平均两年地进行准确的矫正，并具有良好的功能预后。此外，特异性或非特异性并发症的发生率没有增加。无论外科手术水平如何，都需要进行一项评估该技术可重复性的研究。