Clinical study of three-dimensional printed navigation template assisted Ludloff osteotomy in treatment of moderate and severe hallux valgus_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 XU Yan ¹ , LIU Shuai ^1,2 , HU Jun ¹ , ZHANG Huikang ¹ , YAO Qingqiang ¹ , WANG Liming ¹

1. Department of Orthopaedics, Nanjing Hospital Affiliated to Nanjing Medical University (Nanjing First Hospital), Nanjing Jiangsu, 210006, P.R.China;
2. Department of Orthopaedics, Xuzhou Central Hospital, Xuzhou Jiangsu, 221009, P.R.China;

Corresponding?author：

XU Yan, Email: yanxu5427@aliyun.com

Keywords：

Hallux valgus; three-dimensional printing; Ludloff osteotomy; navigation template

DOI：

10.7507/1002-1892.201801163

Video：

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ObjectiveTo explore the effectiveness and advantage of three-dimensional (3D) printed navigation templates assisted Ludloff osteotomy in treatment of moderate and severe hallux valgus.MethodsBetween April 2013 and February 2015, 28 patients (28 feet) with moderate and severe hallux valgus who underwent Ludloff osteotomy were randomly divided into 2 groups (n=14). In group A, the patients were treated with Ludloff osteotomy assissted with a 3D printed navigation template. In group B, the patients were treated with traditional Ludloff osteotomy. There was no significant difference in gender, age, affected side, and clinical classification between 2 groups (P>0.05). The operation time and intraoperative blood loss were recorded. The ankle function of the foot at preoperation, immediate after operation, and last follow-up were assessed by the American Orthopedic Foot and Ankle Society (AOFAS) score. Besides, the X-ray film were taken to assess the hallux valgus angle (HVA), intermetatarsal angle (IMA), and the first metatarsal length shortening.ResultsAll patients were followed up 18-40 months (mean, 26.4 months). The operation time and intraoperative blood loss in group A were significantly less than those in group B (P<0.05). The HVA, IMA, and AOFAS scores in groups A and B at immediate after operaton and last follow-up were sinificantly improved when compared with preoperative values (P<0.05); but no significant difference was found between at immediate after operation and at last follow-up (P>0.05). No significant difference was found in HVA and IMA between group A and group B at difference time points (P>0.05). There were significant differences in AOFAS score and the first metatarsal length shortening at immediate after operation and at last follow-up between 2 groups (P<0.05). Except 1 case of metastatic metatarsalgia in group B, there was no other operative complications in both groups.Conclusion3D printed navigation template assisted Ludloff osteotomy can provide accurate preoperative planning and intraoperative osteotomy. It is an ideal method for moderate and severe hallux valgus.

Citation： XU Yan, LIU Shuai, HU Jun, ZHANG Huikang, YAO Qingqiang, WANG Liming. Clinical study of three-dimensional printed navigation template assisted Ludloff osteotomy in treatment of moderate and severe hallux valgus. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(7): 906-911. doi: 10.7507/1002-1892.201801163 Copy

1.	Trnka HJ. Osteotomies for hallux valgus correction. Foot Ankle Clin, 2005, 10(1): 15-33.
2.	Robinson AH, Limbers JP. Modern concepts in the treatment of hallux valgus. J Bone Joint Surg (Br), 2005, 87(8): 1038-1045.
3.	Easley ME, Trnka HJ. Current concepts review: hallux valgus part 1: pathomechanics, clinical assessment, and nonoperative management. Foot Ankle Int, 2007, 28(5): 654-659.
4.	Eltorai AE, Nguyen E, Daniels AH. Three-dimensional printing in orthopedic surgery. Orthopedics, 2015, 38(11): 684-687.
5.	Chen XJ, Xu L, Yang Y, et al. A semi-automatic computer-aided method for surgical template design. Sci Rep, 2016, 6: 20280.
6.	魏代清, 李翠, 徐楊博, 等. 3D 打印技術在足踝外科的應用進展. 中國修復重建外科雜志, 2017, 31(7): 880-884.
7.	王正義, 姜保國, 唐康來, 等. ?外翻外科治療專家共識. 中華骨與關節外科雜志, 2018, 11(2): 87-95.
8.	Wagner E, Ortiz C, Torres K, et al. Cost effectiveness of different techniques in hallux valgus surgery. Foot Ankle Surg, 2016, 22(4): 259-264.
9.	Castaneda DA, Myerson MS, Neufeld SK. The Ludloff osteotomy: a review of current concepts. Int Orthop, 2013, 37(9): 1661-1668.
10.	田書暢, 姚慶強, 殷信道, 等. iASSIST 智能導航系統與三維打印個性化膝關節截骨導板技術在人工全膝關節置換術中的應用效果比較. 中華外科雜志, 2017, 55(6): 423-429.
11.	周進, 姚慶強, 胡軍, 等. 3D 打印快速原型輔助全髖關節置換術在治療成人發育性髖關節發育不良中的應用. 中國數字醫學, 2017,12(2): 36-38.
12.	Zheng P, Xu P, Yao Q, et al. 3D-printed navigation template in proximal femoral osteotomy for older children with developmental dysplasia of the hip. Sci Rep, 2017, 7: 44993.
13.	Chiodo CP, Schon LC, Myerson MS. Clinical results with the Ludloff osteotomy for correction of adult hallux valgus. Foot Ankle Int, 2004, 25(8): 532-536.
14.	Chatzistergos PE, Karaoglanis GC, Kourkoulis SK, et al. Supplementary medial locking plate fixation of Ludloff osteotomy versus sole lag screw fixation: A biomechanical evaluation. Clin Biomech (Birstol, Avon), 2017, 47: 66-72.
15.	Schuh R, Willegger M, Holinka J, et al. Angular correction and complications of proximal first metatarsal osteotomies for hallux valgus deformity. Int Orthop, 2013, 37(9): 1771-1780.
16.	Jo YH, Park KC, Song YS, et al. Comparison of outcomes according to fixation technique following the modified Ludloff osteotomy for hallux valgus in patients with rheumatoid arthritis. BMC Musculoskelet Disord, 2017, 18(1): 371.
17.	Trnka HJ, Hofstaetter SG, Hofstaetter JG, et al. Intermediate-term results of the Ludloff osteotomy in one hundred and eleven feet. J Bone Joint Surg (Am), 2008, 90(3): 531-539.

1. Trnka HJ. Osteotomies for hallux valgus correction. Foot Ankle Clin, 2005, 10(1): 15-33.
2. Robinson AH, Limbers JP. Modern concepts in the treatment of hallux valgus. J Bone Joint Surg (Br), 2005, 87(8): 1038-1045.
3. Easley ME, Trnka HJ. Current concepts review: hallux valgus part 1: pathomechanics, clinical assessment, and nonoperative management. Foot Ankle Int, 2007, 28(5): 654-659.
4. Eltorai AE, Nguyen E, Daniels AH. Three-dimensional printing in orthopedic surgery. Orthopedics, 2015, 38(11): 684-687.
5. Chen XJ, Xu L, Yang Y, et al. A semi-automatic computer-aided method for surgical template design. Sci Rep, 2016, 6: 20280.
6. 魏代清, 李翠, 徐楊博, 等. 3D 打印技術在足踝外科的應用進展. 中國修復重建外科雜志, 2017, 31(7): 880-884.
7. 王正義, 姜保國, 唐康來, 等. ?外翻外科治療專家共識. 中華骨與關節外科雜志, 2018, 11(2): 87-95.
8. Wagner E, Ortiz C, Torres K, et al. Cost effectiveness of different techniques in hallux valgus surgery. Foot Ankle Surg, 2016, 22(4): 259-264.
9. Castaneda DA, Myerson MS, Neufeld SK. The Ludloff osteotomy: a review of current concepts. Int Orthop, 2013, 37(9): 1661-1668.
10. 田書暢, 姚慶強, 殷信道, 等. iASSIST 智能導航系統與三維打印個性化膝關節截骨導板技術在人工全膝關節置換術中的應用效果比較. 中華外科雜志, 2017, 55(6): 423-429.
11. 周進, 姚慶強, 胡軍, 等. 3D 打印快速原型輔助全髖關節置換術在治療成人發育性髖關節發育不良中的應用. 中國數字醫學, 2017,12(2): 36-38.
12. Zheng P, Xu P, Yao Q, et al. 3D-printed navigation template in proximal femoral osteotomy for older children with developmental dysplasia of the hip. Sci Rep, 2017, 7: 44993.
13. Chiodo CP, Schon LC, Myerson MS. Clinical results with the Ludloff osteotomy for correction of adult hallux valgus. Foot Ankle Int, 2004, 25(8): 532-536.
14. Chatzistergos PE, Karaoglanis GC, Kourkoulis SK, et al. Supplementary medial locking plate fixation of Ludloff osteotomy versus sole lag screw fixation: A biomechanical evaluation. Clin Biomech (Birstol, Avon), 2017, 47: 66-72.
15. Schuh R, Willegger M, Holinka J, et al. Angular correction and complications of proximal first metatarsal osteotomies for hallux valgus deformity. Int Orthop, 2013, 37(9): 1771-1780.
16. Jo YH, Park KC, Song YS, et al. Comparison of outcomes according to fixation technique following the modified Ludloff osteotomy for hallux valgus in patients with rheumatoid arthritis. BMC Musculoskelet Disord, 2017, 18(1): 371.
17. Trnka HJ, Hofstaetter SG, Hofstaetter JG, et al. Intermediate-term results of the Ludloff osteotomy in one hundred and eleven feet. J Bone Joint Surg (Am), 2008, 90(3): 531-539.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical study of three-dimensional printed navigation template assisted Ludloff osteotomy in treatment of moderate and severe hallux valgus

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