30-year-old Partiban from Malaysia was an avid futsal player until he started noticing pain in his left knee throughout one year. The pain worsened until he had difficulties squatting and running; it eventually caused him to stop playing futsal. The patient was referred to Prof. Dr. Azhar M. Merican, who deduced that the underlying cause for the pain was a deformity of the patient’s left upper tibia. The deformity was due to the malunion of a fracture sustained in a motor vehicle accident when the patient was 14 years old. At the time, the fracture had been treated with a plaster cast.
Prof. Azhar advised that surgery was necessary to correct the knee hyperextension and valgus deformity of Partiban’s tibia. Due to the malalignment of the healed fracture, his knee was bent outwards. This put strain on the patient’s lateral meniscus and increased the possibility of Partiban’s meniscus tearing. Another long-term danger involving premature cartilage wear is the development of osteoarthritis. Prof. Azhar and his team planned a biplanar correction. The abnormal anterior slope of the upper tibia would be corrected to a normal posterior slope (of 7° at least) and the valgus (bent outwards) deformity would also be addressed.
To achieve better accuracy and to virtually preplan the surgery in 3D to get the desired correction, Prof. Azhar asked Materialise to fabricate a patient-specific cutting guide to use during the operation. Based on CT scans of the patient’s anatomy, images were segmented in Materialise Mimics to create a virtual model of the patient’s bones. Then, in consultation with one of our clinical engineers, Prof. Azhar planned the surgery and approved the design of the 3D-printed drilling guide and 3D-printed cutting guide. The Materialise team also supplied a 3D-printed bone model so that the surgical team at the University of Malaya Specialist Center could visualize the patient’s bones before the operation.
Finally, the surgery was performed successfully, with the mechanical axis of the patient being fully restored to normal. The execution of the plan resulted in a very accurate correction. Partiban was able to return to work approximately two months after the surgery and is now back to playing sports.
Prof. Azhar comments: “Patient care is improved significantly with medical 3D printing and innovation solutions. The surgical planning tools provided by Materialise will help us (surgeons) treat cases with more precision.”
This is the first high tibia osteotomy case planned and performed with the assistance of 3D surgical tools by Materialise in Malaysia.
About Prof. Dr. Azhar Mahmood Merican
Professor Azhar M. Merican graduated in 1992 from the University of Southampton, and completed his orthopaedic training in 1999. He also completed a fellowship in arthroplasty in Sydney, and a doctorate at Imperial College London on the patellofemoral joint and the role of soft tissues in patellar tracking and stability. Merican is active in orthopaedic trauma surgery, elective orthopaedics, arthroscopic and knee ligament reconstruction as well as microsurgical free tissue transfer. He currently teaches at the Department of Orthopaedic Surgery at the University of Malaya in Kuala Lumpur, Malaysia.