Reliability of computer-assisted surgery as an intraoperative ruler in navigated high tibial osteotomy

Abstract

BackgroundComputer-assisted surgery (CAS) can act as an intraoperative ruler in high tibial osteotomy (HTO) to visualize continuously the leg during surgery.QuestionsThe aim of the study is to evaluate the accuracy of CAS with respect to preoperative planning and postoperative deviation from the planned leg axis in HTO. In addition, the influence of surgeon experience as well as operation time and perioperative complications are analyzed.MethodsA prospective multicenter study case series with follow-up at 6 weeks was performed in six centers. Medial open-wedge HTO with Tomofix® was done using computer assisted navigation technique with the Brainlab VV Osteotomy 1.0 module.ResultsFifty-one patients with medial gonarthritis were treated with navigated HTO. The follow-up rate was 98%. The majority of HTO–CAS patients fell within the tolerated limit of ±3° for leg axis deviation, however, seven patients were reported with deviations outside of this range: three patients had deviations of >3°–4.5° and four patients >4.5°, respectively. Eight intraoperative complications were documented, partially resulting from technical problems associated with the navigation system. During the 6-week follow-up period, three postoperative complications were experienced, all not associated with navigation technology.ConclusionsIn about 85% of cases, a perfect result in terms of deviation of the planned mechanical leg axis could be achieved. Computer assistance in HTO proved to be a helpful tool regarding intraoperative control of leg axis.Level of evidenceLevel I, High quality prospective study (all patients were enrolled at the same preoperative planning point with ≥80% follow-up of enrolled patients).

High Tibial Open-Wedge Osteotomy – New Techniques and Early Results

“…Ideal correction of the leg of the leg is difficult to achieve, and postoperative malalignment is often observed following high tibial osteotomy (Dahl, 2000;Noyes et al, 2000). The challenge for achieving a permanent surgical solution is to achieve the planned axis intraoperatively (Gebhard et al, 2011). Computer-assisted navigation systems may improve the precision and accuracy of the leg axis correction while offering simulation tools that can predict the postoperative alignment (Gebhard et al, 2011) (Fig.…”

Opening Wedge High Tibial Osteotomy

“…Recently, we used the navigation system as the main instrument for controlling the degree of correction of the osteotomy (Song et al, 2007). Navigation in the osteotomy adds greater accuracy and precision, despite the longer surgery time (Gebhard et al, 2011).…”

“…Few complications of HTO are described in the literature Waugh, 1974, Rinonapoli et al, 1998;Song et al, 2007;Gebhard et al, 2011, Hart et al, 2007, Ribeiro et al, 2009, Miller et al, 2009, Meidinger et al, 2011, Gaasbeek et al, 2010. However, due to the continuous development of the technique and of new synthesis materials, new studies should be undertaken in order to evaluate the complication rates according to each modality of HTO.…”

“…In recent years, we have seen an increase in the number of publications on the use of the computerized navigation system in osteotomy (Gebhard et al, 2011;Hart et al, 2007). Its purpose is to help obtain the ideal final mechanical axis.…”

“…Simple clinical observation and/or the use of the scalpel handle in the radioscopy do not show great precision (Noyes et al, 2000). But the navigation system gives accuracy and precision to the osteotomy, despite the increased surgery times and the risk of fracture of the femur and tibia (Song et al, 2007;Gebhard et al, 2011;Hart et al, 2007).…”