Mise en place des protheses totales du genou assistee par ordinateur: comparaison avec la technique conventionnelle

High tibial osteotomy (HTO) is commonly used for genu varum deformity in young and active patients. Corrective valgus osteotomy may however lead to an oblique joint line in cases of associated femur varum or absence of tibia vara. The over-correction, needed to obtain good long-term clinical results, may increase the obliquity even more. To avoid this drawback, the authors suggest use of an accurate and reproducible radiological protocol including at least a standing AP long-leg X-ray to measure not only the hip-knee-ankle (HKA) angle but also the medial distal femoral mechanical angle (MDFMA) and the medial proximal tibial mechanical angle (MPTMA). These measures will guide the surgeon to choose the best indication, including HTO, double level osteotomy (DLO) and distal femoral osteotomy (DFO). Computer-navigation of the osteotomies is the best choice to achieve the preoperative goal. This paper will present the pre-and perioperative protocols of HTO and DLO and the rationale behind this way of thinking.

Section: Opening Wedge Hto Computer-navigatedmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Computer-assisted osteotomies for genu varum deformity: which osteotomy for which varus?

Saragaglia¹,

Mercier²,

Colle³

2009

“…Drawing on our experience with TKR and HTO navigation [15,19,20], we used the principles of computer-assisted surgery for double level osteotomy (DLO) hoping to increase the accuracy of this difficult procedure. Our experience is based on 42 DLO performed between August 2001 and June 2010 from 370 personal computer-assisted knee osteotomies for genu varum deformities (11.3%).…”

Section: Introductionmentioning

confidence: 99%

Results of forty two computer-assisted double level osteotomies for severe genu varum deformity

Saragaglia¹,

Blaysat²,

Mercier³

et al. 2011

Purpose The goal of this article was to present the clinical and radiological results of 42 severe genu varum operated on between August 2001 and June 2010 using computer navigation. Methods All the osteotomies were navigated using the Orthopilot® device (B-Braun-Aesculap, Tuttlingen, Germany). The procedure was performed such that after inserting the rigid bodies and calibrating the lower leg, we first made the femoral closing wedge osteotomy (from four to seven mm) which was fixed by an AO T-Plate, and then, after checking the residual varus, the tibial opening wedge osteotomy was made using a Biosorb® wedge (Tricalcium phosphate, SBM, Lourdes, France) and a plate (AO T-plate or C-plate). Results All the patients were assessed at a mean followup of 46 ± 27 months (range, 12-108). The mean Lyshölm-Tegner score was 83.3± 7.5 points (62-91) and the mean KOOS score was 95.1±3.2 points (89-100). Forty patients were satisfied (22) or very satisfied (18) with the result. Regarding the radiological results, the goal was reached in 92.7% of cases and the mean HKA angle was 181.83°±1.80°(177-185°). At that mid-term follow-up no patient had revision to a total knee arthroplasty. Conclusion Computer-assisted double level osteotomy in severe genu varum is a reliable, reproducible, and accurate technique. This procedure, which is very delicate, especially in reaching pre-operative objectives, is simplified by computer-assistance.

“…Computer-assisted surgery for TKA began at the end of the 1990s [9,10] and it soon became apparent that it was a remarkable tool on the one hand in fulfilling preoperative planning of the FMTA, and on the other hand in measuring pre-and post-implant mediolateral laxity [11]. Computerassisted navigation systems have since been used in the positioning of UKA and the initial results were very encouraging [12][13][14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Navigation of the tibial plateau alone appears to be sufficient in computer-assisted unicompartmental knee arthroplasty

Saragaglia

Picard

Refaie

2012

Purpose The aim of this study was to present our technique to implant unicompartmental knee arthroplasty (UKA) using navigation and to give our first results regarding the accuracy of the device. Methods A total of 33 patients with medial femorotibial osteoarthritis (31) or avascular necrosis (2) were included in this study. The mean preoperative hip-knee-ankle (HKA) angle was 172.7±2.2°(range 167-177°) and the preoperative planning aimed to reach an HKA angle between 175 and 179°(177±2°), a tibial varus at 3±1°, which means a tibial mechanical angle (TMA) close to 87±1°, and posterior tibial slope at 3±2°. In all cases, we used the OrthoPilot® device with dedicated software allowing us to navigate only the tibial plateau. Results The preoperative plan was reached in 93.9 % of cases for HKA angle, 84.8 % for TMA and 100 % for the posterior slope. Conclusions Unicompartmental knee navigation is reliable. The navigation of only the tibial bone cut is a reasonable option as has been shown in this study. Its role is invaluable in the positioning of mobile-bearing UKA, where the risk of overcorrection should not be underestimated.