Surgical accuracy in high tibial osteotomy: coronal equivalence of computer navigation and gap measurement

Schröter, Steffen; Ihle, Christoph; Elson, David W.; Döbele, Stefan; Stöckle, Ulrich; Ateschrang, Atesch

doi:10.1007/s00167-016-3983-7

Cited by 76 publications

(82 citation statements)

References 40 publications

(96 reference statements)

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“…Several studies have shown a discrepancy between plans based on AP full‐leg‐length radiographs in the standing and supine positions . In contrast, another study showed no difference between plans . In this study, there were no significant differences between correction angles determined using 3D planning versus radiographs in the standing and supine positions.…”

Section: Discussioncontrasting

confidence: 69%

“…contrast, another study showed no difference between plans. 27 In this study, there were no significant differences between correction angles determined using 3D planning versus radiographs in the standing and supine positions. In our opinion, the main reason why postoperative WBL% was variable is that it is difficult to predict the laxity of soft tissue, especially the medial stabilizer, surrounding the knee after OWHTO.…”

Section: Discussionmentioning

confidence: 50%

“…Afterwards, the osteotomy plane was opened in accordance with the previously measured correction angle. The correction angle was based on the predicted medial opening width . Therefore, the anterior width ( y ) and posterior width ( x ) of the opening gap (mm) needed to maintain preoperative PTS after correction were measured (Fig.…”

Section: Methodsmentioning

confidence: 99%

“…In addition, it is unclear whether preoperative 3D planning contributes to more precise postoperative realignment in the clinical setting. We hypothesize that clarifying both issues in OWHTO will provide clinically relevant information for intraoperative decision‐making in the absence of a computer‐assisted navigation system that surgeons have used to control PTS …”

mentioning

confidence: 99%

“…We hypothesize that clarifying both issues in OWHTO will provide clinically relevant information for intraoperative decision-making in the absence of a computer-assisted navigation system that surgeons have used to control PTS. [23][24][25][26][27] The objective of this study was to define the correlation between the anterior and posterior widths of the medial opening gap for maintaining preoperative PTS and to assess the degree of coronal and sagittal correction error when the osteotomy surface is opened from the anteromedial direction using a preoperative planning software program. In addition, we evaluated differences in preoperative 2D and 3D plans and postoperative correction accuracy using 3D planning in the clinical setting.…”

mentioning

confidence: 99%

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Clinical efficacy of preoperative 3D planning for reducing surgical errors during open‐wedge high tibial osteotomy

Kuriyama

Morimoto²,

Shimoto

et al. 2019

Journal Orthopaedic Research

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Increases in posterior tibial slope (PTS) with open‐wedge high tibial osteotomy (OWHTO) are often related to two surgical errors: Symmetric opening of the osteotomy gap and a tendency to open the gap from the anteromedial direction. The study objective was to define trends in these two errors using computer simulation and clinical effects of their countermeasures. First, 60 knees with varus deformity were assessed with three‐dimensional (3D) planning using computed tomography to allow for the mechanical axis to pass through a point at 62.5% of the width of the tibial plateau, defined as the weight‐bearing line percentage (WBL%). Anterior and posterior widths of the opening gap to maintain PTS were measured. The effect on PTS when osteotomy gaps were opened from the anteromedial direction up to 30° was evaluated. Mean anterior width (y) was 6.6 mm (range, 2.2–10.9) and mean posterior width (x) was 9.1 mm (range, 3.9–15.7), which can be expressed as y = 0.75x − 0.24. Opening gaps from the anteromedial direction at 10°, 20°, and 30° led to a mean PTS increase of 1.9°, 3.9°, and 5.6°, respectively. In most cases, WBL% with anteromedial opening at 30° passed through a point at less than 60%. In 47 knees that underwent OWHTO using 3D planning, postoperative coronal and sagittal bone corrections were mostly accurate. However, postoperative WBL% was negatively correlated with correction angle because of difficulties in predicting medial joint tightness. Preoperative 3D planning for OWHTO can reduce surgical errors, but postoperative WBL% remains variable. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res

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Section: Discussioncontrasting

confidence: 69%

Section: Discussionmentioning

confidence: 50%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Clinical efficacy of preoperative 3D planning for reducing surgical errors during open‐wedge high tibial osteotomy

Kuriyama

Morimoto²,

Shimoto

et al. 2019

Journal Orthopaedic Research

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Superior accuracy in knee double level osteotomy using a novel hybrid fixation technique compared to conventional double plating

Mabrouk,

Monda,

Bell

et al. 2024

J. exp. orthop.

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PurposeThis study aimed to compare two different double‐level knee osteotomy (DLO) fixation techniques. The primary outcome reported the radiological coronal plane correction and its accuracy. The secondary outcomes reported the correction outliers, the clinical outcomes, the 5‐year postoperative satisfaction and the complications.MethodsA retrospective review of a single surgeon osteotomy database identified 52 cases of DLO between 2011 and 2019, of which 24 cases met the inclusion criteria. Patients were categorised into two groups: the nail‐plate (NP) group fixed with a magnetic extendable intramedullary tibial nail and femoral conventional plate, and the double‐plate (DP) group fixed with conventional plates (tibia and femur). Radiographic parameters were recorded, including the mechanical femorotibial angle (mFTA), medial proximal tibial angle (MPTA), mechanical lateral distal femoral angle (mLDFA), joint line convergence angle (JLCA) and weight‐bearing line ratio (Mikulicz %). Surgical accuracy was calculated as the difference between the achieved and the planned correction. Outliers were defined as those with a greater than 10% difference from the planned correction. Simple knee value scores and visual analogue scale for pain were recorded preoperatively and postoperatively at 2 and 5 years. Five‐year patient satisfaction was recorded.ResultsA total of 24 patients were included: the NP group (n = 12) and the DP group (n = 12). Significant coronal plane corrections were achieved in the NP group for the mean mFTA (preoperative 167.9° ± 3.4° to postoperative 182.1° ± 1.4°), the mean MPTA (preoperative 83.5° ± 2.9° to postoperative 91.3° ± 2.8°) and the mean mLDFA (preoperative 89.8° ± 3.4° to postoperative 85.9° ± 4.4°). Similarly, significant coronal plane corrections were achieved in the DP group for the mean mFTA (preoperative 168.6° ± 4.4° to postoperative 182.2° ± 2°), the mean MPTA (preoperative 84.2° ± 2° to postoperative 88.3° ± 4.1°) and the mean mLDFA (preoperative 90.7° ± 2.9° to postoperative 83.9° ± 1.7°) (all p < 0.05). The mean correction accuracy was higher for the NP versus DP group at 3.4 ± 3.4% versus 7.1 ± 3.9% (intergroup p < 0.05). There were no outliers in the NP group versus two outliers (overcorrected) (16.7%) in the DP group. Significant clinical improvement was reported in both groups at 2 and 5 years postoperatively (all p < 0.05).ConclusionSuperior correction accuracy and no outliers were achieved in hybrid fixation double‐level knee osteotomy compared to the conventional double‐plating technique. The magnetic extendable nail offers the advantage of fine‐tuning the correction postoperatively and could be a potential research template for future designs of postoperative correction implants.Level of EvidenceLevel III, retrospective cohort study.

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Alignment rod and gap measurement methods achieve comparable alignment correction in opening wedge high tibial osteotomy for varus osteoarthritic knees

Onishi,

Kim,

Nakayama

et al. 2024

J. exp. orthop.

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PurposeTo compare clinical and radiological outcomes of medial opening wedge high tibial osteotomy (MOWHTO) using two different alignment methods: the alignment rod (AR) versus the gap measurement (GM) method. The primary outcome was to report the surgical accuracy of coronal plane corrections in each method.MethodsPatients who underwent MOWHTO with either AR or GM method between 2014 and 2022 at a single institution, with a minimum of 2 years of follow‐up, were included. The opening gap was gradually spread with an AR under fluoroscopic control in the AR group, whereas the osteotomy site was opened to the value of the measured gap distance in addition to the thickness of the bone saw in the GM group. Radiological assessment of geometric characteristics included hip–knee–ankle angle (HKA), medial proximal tibial angle (MPTA), mechanical lateral distal femoral angle and joint line convergence angle. Surgical accuracy, which is the deviation (Δ) between the intended and achieved correction, was compared between both methods. Clinical outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Scores.ResultsA total of 110 patients (n = 110 knees) with a mean age of 54.1 ± 8.4 years were included in the study. Radiological parameters were significantly improved as reflected by HKA correction from 171.6° ± 2.0° to 181.1° ± 2.6° in the AR group and from 171.0° ± 2.3° to 181.1° ± 2.8° in the GM group at 2 years (Intergroup n.s). There was no significant intergroup difference for all radiological parameters and clinical outcomes. There was no intergroup difference in the surgical accuracy as evaluated by Δvalues and absolute Δvalues of both HKA and MPTA (n.s).ConclusionsComparable correction accuracy was achieved in MOWHTO using either the AR or GM method. The GM method is simple and reliable in achieving the intended correction in MOWHTO.Level of EvidenceⅢ retrospective comparative study.

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Surgical accuracy in high tibial osteotomy: coronal equivalence of computer navigation and gap measurement

Abstract: I.

Cited by 76 publications

References 40 publications

Clinical efficacy of preoperative 3D planning for reducing surgical errors during open‐wedge high tibial osteotomy

Clinical efficacy of preoperative 3D planning for reducing surgical errors during open‐wedge high tibial osteotomy

Superior accuracy in knee double level osteotomy using a novel hybrid fixation technique compared to conventional double plating

Alignment rod and gap measurement methods achieve comparable alignment correction in opening wedge high tibial osteotomy for varus osteoarthritic knees

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