Early experience using patient-specific instrumentation in opening wedge high tibial osteotomy



Patient-specific instruments (PSI) have been designed to improve the accuracy of performing opening-wedge high-tibial osteotomies (OW-HTO). This study aims to evaluate the lower limb alignment, by comparing pre-operative desired correction to post-operative achieved correction, the difference in surgical time and number of radiological exposures in OW-HTO using patient-specific instruments (PSI) versus conventional osteotomies and the specific and non-specific complications that occurred.


We performed a single-centre, retrospective, observational study, including 25 consecutive patients undergoing OW-HTO using PSI, from January 2019 to October 2020.


Pre-operatively, the mean hip-knee angle (HKA) was 167°, the mean tibial slope was 7.9° and the mean medial proximal tibial angle (MPTA) was 82.5°. Post-operatively, the mean HKA was 182.2° (180.1–184.7°), the tibial slope was 6.5° (4.2–12.9°) and the MPTA was 92.8° (90.6–93°). In both coronal and sagittal plane, all knees were within 2° from the planned value. The mean tourniquet time, by which the surgical time was measured, was 40 minutes and the average number of intra-operative fluoroscopic images was 10 (range: 7–14), significantly less than when using conventional techniques.


The use of PSI in OW-HTO allows accurate achievement of the desired correction, while shortening the OR time. The number of radiological exposures is also decreased, in comparison with the conventional osteotomies.

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Availability of data and materials

The data sets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.


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Author information




Vlad Predescu is the main surgeon, having operated all of the cases included in this study. He is also responsible for the conception and design of the study.

Alina-Maria Grosu is secondary surgeon in some of the cases, also being responsible for the design of study, data analysis and article drafting.

Iulian Gherman is secondary surgeon in some of the cases and responsible for the interpretation of data.

Catalin Prescura and Valentin Hiohi provided critical review of the article.

Bogdan Deleanu provided interpretation of data and is a critical reviewer.

All authors read and approved the final manuscript.

Corresponding author

Correspondence to Alina-Maria Grosu.

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This retrospective study was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Consent to publish individual data was obtained from all patients.

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The authors declare that they have no conflict of interest.

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Predescu, V., Grosu, AM., Gherman, I. et al. Early experience using patient-specific instrumentation in opening wedge high tibial osteotomy. International Orthopaedics (SICOT) (2021). https://doi.org/10.1007/s00264-021-04964-z

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  • Open-wedge tibial osteotomy
  • Patient-specific instruments
  • Osteotomy
  • Accuracy