The effect of valgus and varus femoral osteotomies on measures of anteversion in the dog

Three-dimensionally printed osteotomy and reaming guides for correction of a multiplanar femoral deformity stabilized with an interlocking nail in a dog

OBJECTIVE

To describe the use of virtual surgical planning (VSP) and three-dimensionally (3D) printed surgical guides for corrective osteotomies stabilized with an interlocking nail in a dog with a multiplanar femoral deformity.

STUDY DESIGN

Case report.

ANIMALS

An 8-year-old male neutered mixed breed dog weighing 44 kg.

METHODS

A dog was presented for a right grade 3 lateral patellar luxation secondary to a multiplanar femoral deformity due to a suspected femoral malunion. A computed tomography (CT) scan was obtained to create virtual femoral models. Corrective osteotomies were simulated with VSP. Custom osteotomy guides and reaming guides were designed to facilitate the correction and the placement of an interlocking nail. The preoperative femoral model, virtually aligned femoral model, custom osteotomy guides, and reaming guides were 3D printed, sterilized, and utilized intraoperatively. A CT scan was performed postoperatively to assess femoral length and alignment.

RESULTS

Custom osteotomy and reaming guides were used as intended by the VSP. Postoperative femoral length as well as frontal, sagittal, and axial plane alignment were within 0.7 mm, 2.2°, 0.5°, and 1.6°, respectively, of the virtually planned femoral model. Two months postoperatively, the dog was sound on visual gait examination, and the patella tracked in the trochlear groove throughout stifle range of motion and was unable to be manually luxated. Radiographs obtained 2 months postoperatively revealed static femoral alignment and implants. Both osteotomies were discernable with callus bridging.

CONCLUSION

Virtual surgical planning and custom osteotomy and reaming guides facilitated complex femoral corrective osteotomies and interlocking nail placement.

Surgical correction of pes varus deformity in dachshunds using three-dimensional-printed patient-specific guide system: nine tibiae in seven cases (2018-2022)

OBJECTIVES

To describe the use of a three-dimensional-printed patient-specific guide system for the treatment of distal tibial varus deformity in Dachshunds and retrospectively report the clinical and radiographic outcome.

MATERIALS AND METHODS

Pes varus deformity in nine limbs of seven dachshunds was treated with corrective osteotomy using a three-dimensional-printed patient-specific guide system. Data from computed tomography were processed to obtain virtual 3D-models of the tibias, which were used for computer-aided design-based surgical planning, three-dimensional-printed patient-specific guide system design and evaluation of planned versus achieved tibial correction. Clinical outcomes were evaluated by lameness score and post-operative owner-reported questionnaire at a minimum of 15 months.

RESULTS

The gait abnormality resolved in all limbs. The osteotomy healed uneventfully in eight tibiae. Implant failure occurred in one tibia but was successfully revised. There was good correlation between planned and achieved deformity correction, with mean translational error <1 mm in all planes, and mean angulation correction error <2° in all planes.

CLINICAL SIGNIFICANCE

A 3D-printed patient-specific osteotomy and reduction guide system facilitates the accurate correction of tibial pes varus deformity with very good clinical outcomes. Opening osteotomy, stabilised with orthogonal locking plates and without the application of bone graft led to satisfactory bone healing in all cases.

Comparing the Accuracy of Patient-Specific Guide and Universal Guide for Distal Femoral Osteotomy in Dogs

OBJECTIVE

 To introduce a novel universal guide design for distal femoral osteotomy (DFO) to treat femoral deformities and other hindlimb orthopaedic diseases, and to compare its accuracy to the patient-specific guide in vitro and ex vivo on X-ray and computed tomography (CT).

METHODS

 Thirteen anatomic specimens of canine femurs and 13 3D-printed femoral bone models were subjected to DFO using a patient-specific and a universal guide. The anatomical lateral distal femoral angle and anteversion angle were measured on radiographic and CT images before and after surgical procedure and used to compare the accuracy of the surgical guides in treating uniplanar or biplanar deformities. Bone models were used to compare the accuracy with ex vivo models.

RESULTS

 The mean correction errors were -1.18° to 0.72° on X-ray and -1.91° to 0.53° on CT scan. The analysis showed no statistically significant difference in the mean error between the groups based on type of guide used, nor in the mean error between groups based on whether anteversion correction was performed based on both the CT and X-ray imaging data.

CONCLUSION

 Both the patient-specific and universal guides can produce accurate results in DFO surgery, and the universal guide shows potential as a useful surgical tool.

Computed tomographic angular measurements using a bone-centered three-dimensional coordinate system are accurate in a femoral torsional deformity model and precise in clinical canine patients

Introduction

In small animal orthopedics, angular measurements in the canine femur are often applied in clinical patients with bone deformities and especially in complex and severe cases. Computed tomography (CT) has been shown to be more precise and accurate than two-dimensional radiography, and several methods are described. Measurement techniques evaluated in normal bones must prove accuracy in deformed bones in clinical settings.

Objectives

The goals of our study were to evaluate the accuracy of canine femoral torsion angle measurements in a femoral torsional deformity model and to test repeatability and reproducibility of canine femoral neck inclination, torsion, and varus angle measurements in CT datasets of dogs applying a CT-based technique using a three-dimensional (3D) bone-centered coordinate system.

Materials and methods

For precision testing, femoral torsion, femoral neck inclination, and femoral varus angles were measured in CT data of 68 canine hind limbs by two operators, and their results were compared. For accuracy testing, a femoral torsional deformity model was preset from 0° to +/-90° with a goniometer and scanned. Torsion angles were measured in the CT data and compared to the preset value.

Results

In the femoral torsion model, the Bland-Altman plots demonstrated a mean difference of 2.11°, and the Passing-Bablok analysis demonstrated a correlation between goniometer and CT-based measurements. In the clinical CT scans, intra- and interobserver agreement resulted in coefficients of variation for repeated measurements (%) between 1.99 and 8.26 for the femoral torsion, between 0.59 and 4.47 for the femoral neck inclination, and between 1.06 and 5.15 for the femoral varus angles.

Discussion

Evaluation of femoral malformations with torsional deformities is the target area of this technique. Further studies are required to assess its value in different types, degrees, and combinations of osseous deformities and to establish normal reference values and guidelines for corrective osteotomies.

Conclusion

Based on the results of this study, the accuracy of the torsion angle measurements and the precision of inclination, torsion, and the varus angle measurements were considered acceptable for clinical application.

Introduction of a bone-centered three-dimensional coordinate system enables computed tomographic canine femoral angle measurements independent of positioning

Introduction

Measurement of torsional deformities and varus alignment in the canine femur is clinically and surgically important but difficult. Computed tomography (CT) generates true three-dimensional (3D) information and is used to overcome the limitations of radiography. The 3D CT images can be rotated freely, but the final view for angle measurements remains a subjective variable decision, especially in severe and complex angular and torsional deformities. The aim of this study was the development of a technique to measure femoral angles in a truly three-dimensional way, independent of femoral positioning.

Methods

To be able to set reference points in any image and at arbitrary positions of the CT series, the 3D coordinates of the reference points were used for mathematical calculation of the angle measurements using the 3D medical imaging Software VoXim^®. Anatomical reference points were described in multiplanar reconstructions and volume rendering CT. A 3D bone-centered coordinate system was introduced and aligned with the anatomical planes of the femur. For torsion angle measurements, the transverse projection plane was mathematically defined by orthogonality to the longitudinal diaphyseal axis. For varus angle measurements, the dorsal plane was defined by a femoral retrocondylar axis. Independence positioning was tested by comparison of angle measurement results in repeated scans of 13 femur bones in different parallel and two double oblique (15/45°) positions in the gantry. Femoralvarus (or valgus), neck version (torsion), and inclination angles were measured, each in two variations.

Results

Resulting mean differences ranged between -0.9° and 1.3° for all six determined types of angles and in a difference of <1° for 17 out of 18 comparisons by subtraction of the mean angles between different positions, with one outlier of 1.3°. Intra- and inter-observer agreements determined by repeated measurements resulted in coefficients of variation for repeated measurements between 0.2 and 13.5%.

Discussion

The introduction of a bone-centered 3D coordinate system and mathematical definition of projection planes enabled 3D CT measurements of canine femoral varus and neck version and inclination angles. Agreement between angular measurements results of bones scanned in different positions on the CT table demonstrated that the technique is independent of femoral positioning.

Comparison of canine femoral torsion measurements using the axial and biplanar methods on three-dimensional volumetric reconstructions of computed tomography images

OBJECTIVE

To compare the results of the measurement of femoral torsion using the axial measurement method on three-dimensional (3D) volumetric reconstructions of computed tomography images AMM(CT), the biplanar measurement method on 3D volumetric reconstructions of computed tomography images BMM(CT) and a reference standard using the axial measurement method on stereolithographic bone models AMM (SBM).

STUDY DESIGN

Ex vivo study.

SAMPLE POPULATIONS

Three-dimensional volumetric reconstructions of computed tomography images and stereolithographic bone models from 23 femurs of 14 dogs with hind limb lameness presented for orthopedic evaluation.

METHODS

Three-dimensional volumetric reconstructions of computed tomography images and stereolithographic bone models of each femur were created from computed tomography data. Femoral torsion was measured using the AMM (CT) and the BMM (CT) and compared with a reference standard, the AMM (SBM).

RESULTS

No differences were noted among the measurement methods (P = .0863). Median measurement of femoral torsion using the AMM (CT) was 34.2°, the BMM (CT) was 36.7°, and the AMM (SBM) was 32.3°.

CONCLUSION

No differences existed among the AMM (CT), the BMM (CT), and the AMM (SBM).

CLINICAL SIGNIFICANCE

Both AMM (CT) and BMM (CT) can be used to measure femoral torsion in dogs with orthopedic disease.

Measurement of the Femoral Anteversion Angle in Medium and Large Dog Breeds Using Computed Tomography

To promote the development of an optimally functional total hip prosthesis for medium and large dog breeds, accurate measurements of the normal anatomy of the proximal femur and acetabular retroversion are essential. The aim of the current study was to obtain precise normal values of the femoral anteversion angle using computed tomography on cadavers of mature dogs with normal hip joints of both medium and large breeds. Based on the length of their femora 58 dogs were allocated either to group I: ≤195 mm or group II: >195 mm. In the study the femoral anteversion angle (FAA) was measured on each femur using multi-slice spiral computed tomography (CT). The data were processed as multi-planar and three-dimensional reconstructions using Advantage Workstation software. The CT measurements showed that the mean ± standard deviation (SD) FAA of group I was 31.34 ± 5.47° and in group II it was 31.02 ± 4.95°. There were no significant mean difference associations between the length of the femur and the femoral neck angle in either group (P > 0.05). The data suggest that a prosthesis FAA of 31 degrees would be suitable for a wide range of dog sizes.

A computed tomographic graphical approach to guide correction of femoral torsion

OBJECTIVE

To report geometric methods to assess femoral transverse bone morphology and develop a virtual method to guide the surgical correction of femoral torsional deformities.

STUDY DESIGN

Observational study.

SAMPLE POPULATION

Sixteen client-owned dogs comprising 14 normal femurs and 14 femurs with angulation-rotation bone deformities.

METHODS

Femoral torsion angle was measured with computed tomographic (CT) three-dimensional (3D) multiplanar reconstruction. Distal femoral transverse morphology was estimated with geometric methods and compared to direct measurements to span a target 20° angle on 3D reconstructions. A virtual correction of 20° was performed, and 3D-printed bone models were created. Femoral torsion of corrected bone models was compared to precorrection.

RESULTS

Geometric estimates with an arc and chord of the metaphyseal area and chord of a best fit circle did not differ from direct measurement of femoral cortical length along the cranial cortex. Femoral torsion differed between normal femurs (25.8° ± 6°) and those with deformity (36.9° ± 8.4°, P < .001). Torsion that was measured on corrected 3D bone models did not differ from the expected torsion (preoperative +20°).

CONCLUSION

Geometric methods provided an accurate estimate of distal femoral transverse bone morphology. Rotation of the distal femur based on geometric methods resulted in an accurate correction of torsion.

CLINICAL SIGNIFICANCE

Femoral bone diameter can be measured on a CT cross-section, and rotation distance can be calculated to achieve a desired correction of torsion. This approach provides a simple and accurate method to guide the correction of femoral torsion.

Measurement of the femoral neck angle in medium and large dog breeds using computed tomography

The aim of this study was to get precise normal values of the femoral neck angle (FNA) in support of developing an optimally functioning total hip prosthesis for medium and large dog breeds. Accordingly, two- and three-dimensional computed tomographic images of the anatomical structures of the proximal femora of 58, hip-dysplasia-free, mature dogs of medium and large breeds were studied. Based on the length of their femora the dogs were allocated to Group I (from 145 to 195 mm) and Group II (from 196 to 240 mm). The FNA was measured on each femur using multi-slice spiral computed tomography (CT). The two- and three-dimensional image data were processed as multi-planar and threedimensional reconstructions using Advantage Workstation software. The CT measurements revealed that Group I had an average femoral neck angle of 147.59° (min. 144.05°, max. 153.35°), while in Group II the average FNA was 147.46° (min. 141°, max. 154.35°). There was no significant correlation between the length of the femur and the FNA in either group. The optimal FNA for a total hip prosthesis is 147.5° for medium and large dog breeds.