Computer-assisted navigation for the intraoperative assessment of lower limb alignment in high tibial osteotomy can avoid outliers compared with the conventional technique

Abstract

Purpose Longterm outcomes after valgization high tibial osteotomy (HTO) to treat varus osteoarthritis seem to depend mainly on correction precision. Intraoperative assessment of leg alignment based on radiological visualization of the mechanical axis is difficult and its precision is limited. A promising approach to improving precision is to make use of navigation systems. The case-control study reported here involved the evaluation of patients whose varus osteoarthritis had been treated by open-wedge high tibial ostoetomy, and an analysis of the effect of computerguided navigation on postoperative leg alignment. Methods Forty patients with medial varus osteoarthritis managed by open-wedge high tibial osteotomy using a surgical navigation system were included in the present study (Group 1). They were compared with a retrospective control group (Group 2) of 40 patients with respect to postoperative leg alignment, correlation of planned and definitive correction, and postoperative deviation from the Fujisawa point. ResultsThe mean values for planned and definitive correction showed no significant differences for identical demographic data. As a percentage of the width of the tibial plateau the postoperative weight-bearing radiographs showed a mechanical line that intersected with the knee base line at the desired value of 62 % (Fujisawa point) in 58.8 % (SD ± 6.1) in Group 1 and in 58.6 % (SD ± 8.1) in Group 2. Despite similar mean values a significantly higher number of corrections were outside the reference area (n = 7) in the non-navigated group, whereby all corrections were within the desired range in the navigated group. There were no significant differences in operation time.Conclusions This study showed that the use of a navigation system can not increase the precision of the openwedge HTO procedure in patients with varus osteoarthritis but it can eliminate the outliers of a well defined range. Level of evidence Case-control study, Retrospective comparative study, Level III.

The use of navigation in medial opening wedge high tibial osteotomy can improve tibial slope maintenance and reduce radiation exposure

“…Our findings agreed with previous studies that reported comparable operation time in both groups [13,15], although they conflicted with some other articles that reported longer operative times in the navigation group [10,12,14]. Furthermore, the additional operation time in navigation group was only about two minutes in our series, which was definitely shorter than previous studies reporting longer operation times ranging from ten to 23 minutes [10,12,14].…”

“…However, both surgeons were highly experienced in high tibial osteotomy before the start of this series, as confirmed by the results of the operative time and the target coronal alignment achievement. The operative time in the each group was far shorter than those of other reports, although we did not include about 15-20 minutes of wound closure time in the operation time [10,13,15]. The proportion of the coronal alignment outliers was less than those mean values of the previous studies in the literature [10,12,[14][15][16].…”

“…Most of the previous studies that compared the results of navigated HTO with those after the conventional method reported that the navigated group achieved more accurate coronal alignment with less frequent outliers than the conventional group [10][11][12][13][14][15][16]. However, a concerning incidence of outliers is still reported even in navigated HTO, with a wide range, from 0 to 35 % [7,10,12,[14][15][16][17]. Whether the use of navigation improves sagittal alignment is still controversial [11][12][13]18].…”

Modular device used in the surgery of the human tibia

“…This is a surgical technique involving the creation of a bone wedge in the proximal tibia in order to eliminate the axial deviations suffered in the lower limb. The main purpose of the intervention is to realign the mechanical axis of the lower limb and, consequently, to redistribute the forces in the joint by unloading the affected section [5,6,10,11,16]. The main limitation of the correction is an angular one, not being allowed to exceed 18-20°, for larger values it is necessary to perform total prosthesis.…”

Comparative Study of Opening-Wedge High Tibial Osteotomy With and Without a Combined Computed Tomography–Based and Image-Free Navigation System

“…17 Previous researchers reported that use of image-free navigation systems improved the intraoperative technique. [17][18][19][20][21][22] These systems can be monitored 2-or 3-dimensionally in real time. Meanwhile, a computed tomography (CT)ebased navigation system, which is related to both accurate preoperative planning and accurate intraoperative technique, has already been used to plan the osteotomy plane preoperatively and to insert guide wires on the virtual osteotomy plane on-screen intraoperatively in closedwedge high tibial osteotomy.…”