Planungsgenauigkeit bei Open Wedge HTO

Schröter, Steffen; Günzel, J.; Freude, Thomas; Ateschrang, Atesch; Stöckle, Ulrich; Albrecht, Dirk

doi:10.1055/s-0032-1314957

Cited by 15 publications

(23 citation statements)

References 31 publications

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“…Alignment was determined with the long-leg fully weight-bearing AP radiograph. The deformity analysis was performed according to Paley et al 29 and planning of the osteotomy was performed according to Miniaci et al 30 Because of well-known inaccuracy using the drawing method, 31 we used the digital technique which was described by Elson et al 32 If the correct angle was more than 15 degrees, according to the preoperative plan, the patient was excluded from this study. Before surgery, we used CT images to design and fabricate threedimensional (3D)-printed patient-specific instrument (PSI) guides for clinical use.…”

Section: Radiographic Assessmentmentioning

confidence: 99%

Patellar Height Is Not Altered When the Knee Axis Correction Is Less than 15 Degrees and Has Good Short-Term Clinical Outcome

et al. 2019

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The objectives of our study were to evaluate (1) patellar height changes when the knee axis correction was < 15 degrees and (2) the clinical effect after open wedge high tibial osteotomy (OWHTO). Sixty-nine patients (69 knees) undergoing OWHTO between January 2016 and June 2017 were enrolled in this prospective study. All patients underwent OWHTO using a three-dimensional (3D)-printed patient-specific instrument. We used X-ray and lower-limb computed tomography scan to measure the osteotomy angle, patellar height, and other patellofemoral joint indices. We used the hospital for special surgery knee (HSS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Kujala's scores to evaluate the clinical outcome. All knee axis corrections were less than 15 degrees. The change in posterior tibial slope (PTS) did not show a statistically significant difference. We observed that the patellar height was not altered when we used femur referenced measurement method. The change in modified Miura–Kawamura index (MKI) and Femoral patellar height index (FPHI) did not show a statistically significant difference. The differences in Blackburne–Peel index (BPI) and Caton–Deschamps index (CDI) were statistically significant, decreasing from 0.91 ± 0.12 and 1.06 ± 0.11 preoperatively to 0.79 ± 0.13 and 0.95 ± 0.11 postoperatively, respectively. In the axial plane, we did not observe a change in lateral patellar shift (LPS), but we found that lateral patellar tilt (LPT) showed a significant decrease from 8.67 ± 2.60 degrees preoperatively to 6.13 ± 2.30 postoperatively, respectively. The tuberositas tibae–trochlear groove (TT–TG) distance showed a significant decrease after OWHTO from 14.30 ± 4.10 mm preoperatively to 11.52 ± 3.63 mm postoperatively. The clinical score showed a significant increase after OWHTO, and all patients were satisfied with the outcome. After OWHTO, the patellar height was not altered when the knee axis correction was < 15 degrees. It was also found that there was still lateral displacement of the patella. Internal rotation of the distal tibia is an important cause of LPT reduction. After OWHTO, all patients achieved satisfactory clinical outcomes. At 1-year short-term follow-up, patients did not report discomfort in the patellofemoral joint. The Level of Evidence for this study was IV.

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Section: Radiographic Assessmentmentioning

confidence: 99%

Patellar Height Is Not Altered When the Knee Axis Correction Is Less than 15 Degrees and Has Good Short-Term Clinical Outcome

et al. 2019

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“…Limited accuracy in osteotomy correction of varus malalignment in the knee is an unsolved issue of tremendous importance since bony corrections are applied with increasing frequency for many indications, such as unicompartmental osteoarthritis (OA), instabilities, and corrections for aesthetical reasons [ 8 , 23 , 37 ].…”

Section: Introductionmentioning

confidence: 99%

Preoperative joint line convergence angle correction is a key factor in optimising accuracy in varus knee correction osteotomy

Behrendt

Akoto

Bartels

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose This study aimed to identify and prevent preoperative factors that can be influenced in preoperative planning to reduce postoperative malcorrections. Methods The method used in this study was a retrospective two-centre analysis of 78 pre and postoperative fully weight-bearing radiographs of patients who underwent valgus osteotomy correction due to symptomatic medial compartment osteoarthritis. A computer software (TraumaCad®) was used to aim for an intersection point of the mechanical tibiofemoral axis (mTFA) with the tibia plateau at 55–60% (medial = 0%, lateral = 100%). Postoperative divergence ± 5% of this point was defined as over- and undercorrection. Preoperative joint geometry factors were correlated with postoperative malcorrection. Planning was conducted using the established method described by Miniaci (Group A) and with additional correction of the joint line convergence angle (JLCA) using the formula JLCA-2/2 (Group B). Additionally, in a small clinical case series, planning was conducted with JLCA correction. Statistical analysis was performed using (multiple) linear regression analysis and analysis of variance (ANOVA) with p < 0.05 considered significant. Results In 78 analysed cases, postoperative malcorrection was detected in 37.2% (5.1% undercorrection, 32.1% overcorrection). Linear regression analysis revealed preoperative body mass index (BMI, p = 0.04), JLCA (p = 0.0001), and osteotomy level divergence (p = 0.0005) as factors correlated with overcorrection. In a multiple regression analysis, JLCA and osteotomy level divergence remained significant factors. Preoperative JLCA correction reduced the planned osteotomy gap (A 9.7 ± 2.8 mm vs B 8.3 ± 2.4 mm; p > 0.05) and postoperative medial proximal tibial angle (MPTA: A 94.3 ± 2.1° vs B 92.3 ± 1.5°; p < .05) in patients with preoperative JLCA ≥ 4°. The results were validated using a virtual postoperative correction of cases with overcorrection. A case series (n = 8) with a preoperative JLCA > 4 revealed a postoperative accuracy using the JLCA correction of 3.4 ± 1.9%. Conclusion Preoperative JLCA ≥ 4° and tibial osteotomy level divergence were identified as risk factors for postoperative overcorrection. Preoperative JLCA correction using the formula JLCA-2/2 is proposed to better control ideal postoperative correction and reduce MPTA. The intraoperatively realised osteotomy level should be precisely in accordance with preoperative planning. Level of evidence III, cross-sectional study.

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“…Despite the improvement in surgical accuracy in OWHTO, there are considerable reports of a tendency toward undercorrection, and there are ongoing efforts to improve the surgical accuracy in modern OWHTO [37][38][39][40][41]. Alemayehu et al reported that the amount of compression required to fix the plate at the osteotomy site depends on the severity of the proximal tibial varus deformity.…”

Section: Preoperative Planning Using 3dmentioning

confidence: 99%

Preoperative Planning Using 3D Printing Technology in Orthopedic Surgery

Alemayehu

Zhang

Tahir

et al. 2021

BioMed Research International

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The applications of 3D printing technology in health care, particularly orthopedics, continue to broaden as the technology becomes more advanced, accessible, and affordable worldwide. 3D printed models of computed tomography (CT) and magnetic resonance image (MRI) scans can reproduce a replica of anatomical parts that enable surgeons to get a detailed understanding of the underlying anatomy that he/she experiences intraoperatively. The 3D printed anatomic models are particularly useful for preoperative planning, simulation of complex orthopedic procedures, development of patient-specific instruments, and implants that can be used intraoperatively. This paper reviews the role of 3D printing technology in orthopedic surgery, specifically focusing on the role it plays in assisting surgeons to have a better preoperative evaluation and surgical planning.

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Planungsgenauigkeit bei Open Wedge HTO

Abstract: The results are comparable to those of other publications. However, taking into account the required accuracy of the drawn plan combined with the surgical precedure, it is not possible to achieve results within the desired tolerance.

Cited by 15 publications

References 31 publications

Patellar Height Is Not Altered When the Knee Axis Correction Is Less than 15 Degrees and Has Good Short-Term Clinical Outcome

Patellar Height Is Not Altered When the Knee Axis Correction Is Less than 15 Degrees and Has Good Short-Term Clinical Outcome

Preoperative joint line convergence angle correction is a key factor in optimising accuracy in varus knee correction osteotomy

Preoperative Planning Using 3D Printing Technology in Orthopedic Surgery

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