Three dimensional printing patient specific cutting guides for Pes cavus midfoot osteotomy—a retrospective cohort comparative study

This comparative cohort study evaluates the clinical efficacy of 3D-printed patient-specific cutting guides (PSCGs) versus conventional manual techniques in correcting rigid midfoot pes cavus deformities.

A retrospective analysis of 40 patients (80 feet) undergoing Cole osteotomy between 2021 and 2023 was conducted. Patients were stratified into two matched cohorts: Group A (manual osteotomy, n = 20) and Group B (PSCG-assisted, n = 20). Radiographic parameters (Meary’s angle, TMI, TCA, Djian-Annonier angle, Pitch angle) and functional outcomes (VAS, AOFAS, SF-36) were analyzed preoperatively and at mean 17-month follow-up. Surgical metrics including operative time, fluoroscopy frequency, and complication rates were systematically compared.

Radiographic analysis demonstrated superior angular correction in the PSCG-assisted cohort versus conventional osteotomy, with significantly improved bilateral Meary’s angle (Right: 1.94°±0.62 vs. 6.04°±2.20, P < 0.05; Left: 1.62°±0.54 vs. 6.39°±2.04, P < 0.05) and TMI angle (Right: 4.32°±3.14 vs. 8.51°±8.12, P < 0.05; Left: 4.74°±2.44 vs. 8.53°±5.93, P < 0.05). The PSCG technique achieved equivalent correction in TCA, Djian-Annonier, and Pitch angles while demonstrating enhanced consistency (38–66% reduction in standard deviations). Functionally, PSCG-assisted procedures yielded superior AOFAS scores (97.71 ± 0.77 vs. 92.07 ± 2.25, Δ = 5.64 [95%CI 4.54–6.74], P < 0.05) and SF-36 outcomes, particularly in general health (Δ = 16.96, P < 0.05) and mental well-being (Δ = 7.92, P = 0.001). Operative metrics favored PSCG with 36% shorter procedure time (82.9 ± 13.9 vs. 129.0 ± 39.6 min, P < 0.05) and 77% reduced intraoperative fluoroscopy (4.65 ± 1.06 vs. 20.07 ± 2.92 exposures, P < 0.05). No surgical site infections occurred in the PSCG group versus one superficial SSI in controls

3D-printed PSCGs provide anatomically precise, efficient correction of complex midfoot deformities while minimizing intraoperative radiation exposure, establishing this technology as a safe and reproducible alternative to conventional techniques.