Custom-Made Devices Represent a Promising Tool to Increase Correction Accuracy of High Tibial Osteotomy: A Systematic Review of the Literature and Presentation of Pilot Cases with a New 3D-Printed System

Background: The accuracy of the coronal alignment corrections using conventional high tibial osteotomy (HTO) falls short, and multiplanar deformities of the tibia require consideration of both the coronal and sagittal planes. Patient-specific instrumentations have been introduced to improve the control of the correction. Clear evidence about customized devices for HTO and their correction accuracy lacks. Methods: The databases PUBMED and EMBASE were systematically screened for human and cadaveric studies about the use of customized devices for high tibial osteotomy and their outcomes concerning correction accuracy. Furthermore, a 3D-printed customized system for valgus HTO with three pilot cases at one-year follow-up was presented. Results: 28 studies were included. The most commonly used custom-made devices for HTO were found to be cutting guides. Reported differences between the achieved and targeted correction of hip-knee-ankle angle and the posterior tibial slope were 3° or under. The three pilot cases that underwent personalized HTO with a new 3D-printed device presented satisfactory alignment and clinical outcomes at one-year follow-up. Conclusion: The available patient-specific devices described in the literature, including the one used in the preliminary cases of the current study, showed promising results in increasing the accuracy of correction in HTO procedure.