If I told you each patients bunion is different form other patients bunions, that would sound like an obvious assessment we can all agree on. If I told you that each patient requires different considerations during a surgical repair, again, I think that is an obvious statement as well.

So if all bunions are different, wouldn’t it be better to have a solution tailored specifically to repair your unique bunion deformity?

Thankfully, there is a solution to get you the most precise correction of your bunion at the source of your bunion using Patient Specific Instrumentation(PSI).

What is PSI?

Patient specific instrumentation is a process by which specialized instruments and often implants are created for the individual patient. Prior to surgery, engineers are able to create specialized equipment for your unique anatomy, using CT scan images. This technology is been used for years in orthopedic surgery for things like knee and ankle replacements with excellent customized results.

Custom 3d printed model of the patients foot will be made as well as 3D printed cutting guide for use in procedure.

CT images used to plan before you cut. Precision reduction in all dimensions are created and put into cutting guide.

Precision cutting guide made for patient.

Using the CT scan images, A 3-D reconstruction of your foot can be created utilizing CT scans prior to surgery. This allows engineers and 3-D printers to create specialized cutting guides just for your foot. This has several advantages for the patient which we will list here. We should do better than a one size fits all approach.

1) Reduced Operating Time

By creating specialized cutting guides for your individual foot the surgeon is able to cut down an OR time by making the procedure more efficient.

Previous Lapiplasty® system very precise, but positioner(orange) and one size fits all cutting guide.

Typically, during a bunion procedure, bone cuts are made to realign the bone. In the case of Lapiplasty® a small joint that is the origin of the deformity, is reduced and fixated to realign the bone in its appropriate anatomic position. In order to obtain correction, several instruments are needed including a special reduction clamp and additional incisions are needed to accomplish this task. While this procedure has been established as one of the best procedures available obtaining precise results, success is still dependent on the surgeon technique and appropriate placement of cutting guides.

Lapiplasty IntelliGuide® system snaps directly to your bone, and eliminates positioner use, black 3D printed foot.

The PSI system with Treace Medical is called IntelliGuide PSI®, and uses a custom made 3-D cutting guide created especially for you. The surgeon does not have to do any special reductions, because all corrections are made right in the cutting guide. The CT scan images are used to dial in precise correction of your bunion. All three issues with your foot are addressed with this special cutting guide; this includes the width of your foot, the abnormal rotation of the metatarsal and abnormal elevation of the metatarsal bone that creates your bunion. This eliminates numerous steps in the operating room. The result in a more anatomic reduction and a quicker procedure. Less time in the operating room means less handling of your tissues, fewer and potentially shorter incisions, and less time under anesthesia for you.

2). Increase Precision and Accuracy.

By making cutting guides specifically made for you, the cuts are much more precise and more appropriately placed. The IntelliGuide® snaps onto your own anatomy and can be fixated in place while the surgeon does the work. This means that instead of depending on the finesse and carpentry skills of the surgeon only, you get the advantage of a 3-D guide just for your anatomy, with precise reduction cutting angles built right into guide. This makes the precision much more reproducible for multiple patients and can enhance alignment. Accuracy and precision of the guide dials in the appropriate correction, making alignment better. Better alignment makes the foot look as normal as possible and makes recovery easier; a precisely aligned joint moves better than one that is “almost” aligned.

Precises cuts are pre-planned and then 3D printed right into cutting guide.

3) Improved Appearance of the Foot

By getting the precise reduction of the bunion dialed in prior to your surgery, results are more reproducible, resulting in better appearing outcomes and better alignment of your joint, allowing for more normal function at the great toe joint long term/

4). Minimization of Complication Rates

Surgery is hard. By identifying potential issues before we get into the operating room, the surgeon is less likely to run into complications during surgery, that would delay the procedure or recovery.

Using the IntelliGuide® reduces the need for additional incisions for reduction clamps and can help shorten the length of the primary incision.

Smaller incisions result in less swelling and pain as well as more cosmetically appearing scars. It has been shown that increased time in the operating room also increases complication rates like swelling, pain, and bleeding.

Summation

The implementation of PSI in bunion surgery is in my opinion the future of all bunion surgeries. Patients want a personalized approach to their surgery because they know that they have individualized needs in their procedure; why not have an individualized approach just for them. The PSI use in orthopedic joint replacement has resulted in excellent results, to the point where the majority of deice companies in this area all have a option for PSI implantation or are in the process of creating one.

The more anatomic and precise results can be, only benefits you the patient and the surgeon to provide the best possible care.

If you are interested in moving forward or learning more, please make an appointment with 3-D Doc, Dr. Paul Steinke, and ask for the precision of PSI.

Bunion Surgery: reduced surgery time, more precise results and the best possible appearance of your foot with Patient Specific Bunion Instrumentation (PSI)

Traveling for bunion surgery to North Texas; follow this guide to make it an easy, less stressful experience