Computer-Assisted High Tibial Osteotomy: Preliminary Results

Abstract

Open-wedge high tibial osteotomy (HTO) is an established technique for the treatment of symptomatic varus malaligned knees. In this study, we prospectively followed up 13 patients (14 knees) who underwent navigation system-supported HTO for varus knee deformity. Preoperatively all patients underwent a physical examination, and anteroposterior and laterolateral lower limb weight-bearing digital radiographs were obtained. The following parameters were examined: (1) Insall-Salvati index; (2) posterior tibial slope angle; (3) mechanical femorotibial angle; (4) inferior limb length. At a mean follow-up of 12.6 months, clinical examination showed satisfactory results in all patients. The mean Modified Cincinnati Rating System Questionnaire rating increased significantly from 46.5 ± 7.2 to 84.6 ± 8, while the mean Knee Society Score increased significantly from 51.4 ± 9.9 to 85.1 ± 7.3. The mean Insall-Salvati index changed from 1.11 preoperatively to 1.10 postoperatively (P=.742). According to the navigation system data, the femorotibial mechanical axis was corrected from a varus of 6.3° ± 1.9° to a valgus of 2.1° ± 1.6°. These data matched postoperative radiographic lower limb weight-bearing data. In the group of patients in whom we evaluated the posterior tibial slope with the navigation system, we detected an increase of 0.3° ± 0.4° compared with the preoperative radiographic examination evaluations; the comparison between the postoperative and the preoperative radiograhic examination results showed an increase of 0.5° ± 0.7° (P=.87). The results of our study seem to show greater accuracy of mechanical axis correction and smaller increase in tibial slope when a navigation system is used in open-wedge HTO.

Computer-Assisted Navigation in High Tibial Osteotomy: A Systematic Review of the Literature

“…Iorio et al [49] prospectively followed-up 13 patients who underwent 14 navigated open wedge HTO after a mean of 12.6 months. Like the cadaveric study performed by Yamamoto et al [45], the authors used Orthopilot™ 3D open wedge HTO software, although only 6 patients had the additional transmitter fixed to monitor the tibial slope.…”

3D Surgical Printing Cutting Guides for Open-Wedge High Tibial Osteotomy: Do It Yourself

“…21 In the last decade, several techniques based on intraoperative navigation have shown an increased surgical accuracy in HTO for modifying axial alignment and for controlling tibial slope on the sagittal plane, with respect to classic techniques based on anatomic landmarks and introperative fluoroscopy. 22,23 The main disadvantage of navigation techniques is the long learning curve, coupled with increased surgical time. 15 Navigation is based on real-time intraoperative positioning, whereas positioning guide systems, such as the method that we propose, are not initially depending on intraoperative positioning, which reduces surgical time.…”

Preoperative surgical planning versus navigation system in valgus tibial osteotomy: a cross-sectional study

“…The navigation system has been used in tibial osteotomies for almost a decade and provides information about the alignment, the load axis, varus and valgus stress, speed, range of motion, limb length and slope. Despite the increased surgical time and the fact that it has a longer learning curve, navigation is considered a promising adjunct for intraoperative use to avoid under-and overcorrections [7,[11][12][13][17][18][19].…”

“…In this decade, a new tool has been developed to control intra-operative alignment of the leg. This is a navigation system that is positioned at strategic points on the femur and the tibia and, according to the measurements made by the software, to demonstrate, on the computer screen, the alignment of the limb in real time [11][12][13]. It is expected that the navigation system will provide a more accurate alignment correction of the limb and possibly improve the long-term results.…”