Evaluation of a customized 3D-printed saw guide for tibial plateau leveling osteotomy: An ex vivo study.

OBJECTIVE: To determine whether a tibial plateau leveling osteotomy (TPLO) performed with a customized 3D-printed guide and jig is more accurate than the traditional technique using a jig alone. STUDY DESIGN: In vitro study. SAMPLE POPULATION: Cadaveric canine pelvic limbs (n = 10) and 20 synthetic bone models. METHODS: Tibial plateau leveling osteotomy using a jig with (n = 10) and without (n = 10) a customized 3D-printed guide were performed in bone models, and TPLO using a jig with (n = 5) and without (n = 5) a customized 3D-printed guide were performed in cadaveric limbs. Angulation of the osteotomy, angulation of the proximal jig pin, angular/torsional deformity and medial cortex damage were measured from photographs of the specimens and compared. RESULTS: In the bone models, there were differences with and without the 3D guide for mean osteotomy inclination (-0.06° vs. -1.74°, P < .001), osteotomy torsion (5268 vs. 10 469 visible osteotomy pixels, P < .001), and medial cortical damage (2970 vs. 18 562 pixels, P < .001). In the cadaveric study, osteotomy inclination (-1.1° vs. 1.01°, P < .01), induced angular deformity (0.17° vs. -3.01°, P < .001) and angulation of the proximal jig pin (-0.27° vs. 0.80°, P < .001) differed between groups. CONCLUSION: The 3D-printed guide during TPLO resulted in slightly more accurate osteotomies and proximal jig pin placement, and reduced medial cortex damage. CLINICAL SIGNIFICANCE: A customized 3D-printed guide may improve intraoperative accuracy for TPLO, although the clinical significance of the small benefits is unknown.