Precision of Pacient-specific Instrumented Open Wedge High Tibial Osteotomy vs Conventional Technicque

NCT ID: NCT07212777

Last Updated: 2025-11-17

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

50 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-11-15

Study Completion Date

2028-10-31

Brief Summary

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This study is a randomized clinical trial that will compare two surgical techniques for patients with knee osteoarthritis and varus deformity who are candidates for medial opening wedge high tibial osteotomy. The goal is to evaluate whether using patient-specific 3D-printed surgical guides improves the accuracy of the bone cut compared with the conventional technique performed with anatomical landmarks and fluoroscopy.

A total of 50 adult patients will be randomly assigned to one of two groups: conventional osteotomy or osteotomy assisted by patient-specific instrumentation (PSI). The main outcome is the accuracy of the osteotomy cut, measured by comparing preoperative planning with the postoperative CT scan. Secondary outcomes include leg alignment, surgical time, radiation exposure, complications, and functional recovery assessed with validated questionnaires (KOOS, WOMAC, IKDC, EQ-5D) and gait analysis using depth cameras.

Patients will be followed for up to 12 months after surgery to evaluate clinical and radiological outcomes.

Detailed Description

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Medial opening wedge high tibial osteotomy is a well-established surgical procedure to correct knee alignment in patients with medial knee osteoarthritis and varus deformity. The accuracy of the bone cut is critical for surgical success. However, conventional techniques performed with anatomical landmarks and fluoroscopy may result in variability and suboptimal correction.

Recent advances in 3D imaging and printing allow the creation of patient-specific surgical guides designed from preoperative CT scans. These guides may improve the accuracy and reproducibility of the osteotomy.

This single-center randomized clinical trial will include 50 adult patients, randomly assigned to undergo conventional osteotomy or osteotomy assisted by patient-specific instrumentation. The main outcome is the accuracy of the osteotomy cut compared with preoperative planning. Secondary outcomes include leg alignment, surgical efficiency, radiation exposure, complications, and functional recovery. Patients will be followed for 12 months.

Conditions

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Arthritis (Knee) Varus Knee

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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Conventional surgery

Osteotomy using conventional technique

Group Type ACTIVE_COMPARATOR

Medial Open Wedge Hight Tibial Osteotomy using conventional surgery techniques

Intervention Type PROCEDURE

Conventional Medial Open Wedge Hight Tibial Osteotomy

Patient-specific instrumentation

Osteotomy using 3D-printed patient-specific instrumentation

Group Type EXPERIMENTAL

Medial Open Wedge Hight Tibial Osteotomy using patient-specific instrumentation

Intervention Type PROCEDURE

Medial Open Wedge Hight Tibial Osteotomy using 3D printed patient-specific instrumentation as a guide for the osteotomy

Interventions

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Medial Open Wedge Hight Tibial Osteotomy using patient-specific instrumentation

Medial Open Wedge Hight Tibial Osteotomy using 3D printed patient-specific instrumentation as a guide for the osteotomy

Intervention Type PROCEDURE

Medial Open Wedge Hight Tibial Osteotomy using conventional surgery techniques

Conventional Medial Open Wedge Hight Tibial Osteotomy

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Informed consent: able to sign informed consent
* Clinical: predominantly medial pain/limitation refractory ≥3-6 months
* Mobility: flexion ≥90º and flexion contracture ≤10º Stability: varus/valgus and pivot-shift ≤ grade 1.
* Radiology:

* Medial gonarthrosis Ahlbäck I-III with preserved lateral compartment.
* Patellofemoral Iwano 0-2 without disabling patellofemoral pain.
* Varus alignment: HKA 4-10°.
* Predominantly tibial deformity (decreased MPTA; LDFA close to normal) according to planning.
* Anatomy/technical feasibility: proximal tibial morphology suitable for medial opening osteotomy and PSI guide placement.

Exclusion Criteria

* Comorbidity/clinical situations:

* Inflammatory arthritis (e.g., RA, spondyloarthropathies), unresolved previous joint infection or osteomyelitis.
* Severe peripheral vasculopathy (ABI \<0.7), advanced peripheral neuropathy or Charcot foot.
* Poorly controlled diabetes (HbA1c \>8.5%), advanced renal/hepatic failure (eGFR \<30 ml/min/1.73 m²; Child-Pugh B/C).
* Smoking \>20 cigarettes/day without commitment to cessation; active IV drug use or uncontrolled alcoholism.
* BMI \>35 kg/m².
* Disorder affecting gait (e.g., neurological disease).
* Inability to walk at a speed of at least 0.8m/s
* Anatomy/radiology

* Multiplanar deformities not correctable with isolated medial opening tibial valgus osteotomy (e.g., dominant femoral deformity).
* Severe medial subchondral bone defect or extensive necrosis.
* Sequelae of proximal tibia fracture or previous ipsilateral HTO that prevent correction or guide use.
* Treatments/medication and logistics

* Anticoagulation/antiplatelet therapy that cannot be suspended or bridged.
* Systemic corticosteroids \>10 mg/day or high-risk immunosuppressants without possibility of adjustment.
* Intra-articular infiltration (HA/CS/PRP) within the previous 60 days (respect defined wash-out).
* Pregnancy.
* Participation in another interfering trial.
* Inability to undergo CT (e.g., uncontrollable claustrophobia).
* Inability to complete ≥12 months of follow-up.
Minimum Eligible Age

18 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Hospital Universitario Virgen de la Victoria

OTHER

Sponsor Role collaborator

University of Malaga

OTHER

Sponsor Role lead

Responsible Party

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Dr. Antonio I Cuesta-Vargas

Full Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Antonio I Cuesta-Vargas, Prof., PhD

Role: PRINCIPAL_INVESTIGATOR

Universidad de Málaga

Juan Miguel Gómez-Palomo, PhD

Role: PRINCIPAL_INVESTIGATOR

Hospital Universitario Virgen de la Victoria

Locations

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Hospital Universitario Virgen de la Victoria de Málaga

Málaga, Málaga, Spain

Site Status RECRUITING

Countries

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Spain

Central Contacts

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Amparo Zamora-Mogollo

Role: CONTACT

+34673662020

Juan Miguel Gómez Palomo, PhD

Role: CONTACT

Facility Contacts

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Juan Miguel Gómez-Palomo, Dr, PhD

Role: primary

+34647000340

Amparo Zamora-Mogollo, MSc

Role: backup

+34673662020

References

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Studenski S, Perera S, Patel K, Rosano C, Faulkner K, Inzitari M, Brach J, Chandler J, Cawthon P, Connor EB, Nevitt M, Visser M, Kritchevsky S, Badinelli S, Harris T, Newman AB, Cauley J, Ferrucci L, Guralnik J. Gait speed and survival in older adults. JAMA. 2011 Jan 5;305(1):50-8. doi: 10.1001/jama.2010.1923.

Reference Type RESULT
PMID: 21205966 (View on PubMed)

Jacquet C, Sharma A, Fabre M, Ehlinger M, Argenson JN, Parratte S, Ollivier M. Patient-specific high-tibial osteotomy's 'cutting-guides' decrease operating time and the number of fluoroscopic images taken after a Brief Learning Curve. Knee Surg Sports Traumatol Arthrosc. 2020 Sep;28(9):2854-2862. doi: 10.1007/s00167-019-05637-6. Epub 2019 Jul 27.

Reference Type RESULT
PMID: 31352498 (View on PubMed)

Pang R, Jiang Z, Xu C, Shi W, Zhang X, Wan X, Bahat D, Li H, Senatov F, Bulygina I, Wang H, Zhang H, Li Z. Is Patient-Specific Instrumentation Accurate and Necessary for Open-Wedge High Tibial Osteotomy? A Meta-Analysis. Orthop Surg. 2023 Feb;15(2):413-422. doi: 10.1111/os.13483. Epub 2022 Dec 30.

Reference Type RESULT
PMID: 36585795 (View on PubMed)

Zhu X, Qian Y, Liu A, Xu P, Guo JJ. Comparative outcomes of patient-specific instrumentation, the conventional method and navigation assistance in open-wedge high tibial osteotomy: A prospective comparative study with a two-year follow up. Knee. 2022 Dec;39:18-28. doi: 10.1016/j.knee.2022.08.013. Epub 2022 Sep 14.

Reference Type RESULT
PMID: 36115179 (View on PubMed)

Cerciello S, Ollivier M, Corona K, Kaocoglu B, Seil R. CAS and PSI increase coronal alignment accuracy and reduce outliers when compared to traditional technique of medial open wedge high tibial osteotomy: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2022 Feb;30(2):555-566. doi: 10.1007/s00167-020-06253-5. Epub 2020 Sep 10.

Reference Type RESULT
PMID: 32910222 (View on PubMed)

Carey EG, Kamath AF, Vidal AF, Frush T, Alaia M, Baldwin RB, Ranawat A. Assessing the Impact of Patient-Specific Instrumentation and Fixation on Accuracy and Radiation Exposure in a Cadaveric Model of Medial Opening-Wedge High Tibial Osteotomy. Orthop J Sports Med. 2025 Jan 28;13(1):23259671241285430. doi: 10.1177/23259671241285430. eCollection 2025 Jan.

Reference Type RESULT
PMID: 39881858 (View on PubMed)

Miao Z, Li S, Luo D, Lu Q, Liu P. The validity and accuracy of 3D-printed patient-specific instruments for high tibial osteotomy: a cadaveric study. J Orthop Surg Res. 2022 Jan 29;17(1):62. doi: 10.1186/s13018-022-02956-2.

Reference Type RESULT
PMID: 35093132 (View on PubMed)

Chaouche S, Jacquet C, Fabre-Aubrespy M, Sharma A, Argenson JN, Parratte S, Ollivier M. Patient-specific cutting guides for open-wedge high tibial osteotomy: safety and accuracy analysis of a hundred patients continuous cohort. Int Orthop. 2019 Dec;43(12):2757-2765. doi: 10.1007/s00264-019-04372-4. Epub 2019 Jul 5.

Reference Type RESULT
PMID: 31273430 (View on PubMed)

Donnez M, Ollivier M, Munier M, Berton P, Podgorski JP, Chabrand P, Parratte S. Are three-dimensional patient-specific cutting guides for open wedge high tibial osteotomy accurate? An in vitro study. J Orthop Surg Res. 2018 Jul 9;13(1):171. doi: 10.1186/s13018-018-0872-4.

Reference Type RESULT
PMID: 29986731 (View on PubMed)

Jones GG, Jaere M, Clarke S, Cobb J. 3D printing and high tibial osteotomy. EFORT Open Rev. 2018 May 21;3(5):254-259. doi: 10.1302/2058-5241.3.170075. eCollection 2018 May.

Reference Type RESULT
PMID: 29951264 (View on PubMed)

Stimolo D, Leggieri F, Matassi F, Barra A, Civinini R, Innocenti M. Learning curves for high tibial osteotomy using patient-specific instrumentation: a case control study. Innov Surg Sci. 2024 Jul 3;9(3):123-131. doi: 10.1515/iss-2024-0007. eCollection 2024 Sep.

Reference Type RESULT
PMID: 39309194 (View on PubMed)

Other Identifiers

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2025999010604889

Identifier Type: -

Identifier Source: org_study_id

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