Navigation Guided Open Wedge High Tibial Osteotomy

Jong-Keun Seon; Ha-Sung Kim; Do-Youn Kim; Eun-Kyoo Song

doi:10.4055/jkoa.2014.49.2.107

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Seon, Kim, Kim, and Song: Navigation Guided Open Wedge High Tibial Osteotomy

Symposium

Osteotomy for Osteoarthritis of the Knee

Journal of the Korean Orthopaedic Association 2014; 49(2): 107-117.

Published online: 29 April 2014

DOI: https://doi.org/10.4055/jkoa.2014.49.2.107

Navigation Guided Open Wedge High Tibial Osteotomy

Jong-Keun Seon, M.D., Ph.D., Ha-Sung Kim, M.D., Do-Youn Kim, M.D., Eun-Kyoo Song, M.D., Ph.D.

Department of Orthopaedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea.

Correspondence to: Eun-Kyoo Song, M.D., Ph.D. Department of Orthopaedic Surgery, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun 519-763, Korea. TEL: +82-61-379-7676, FAX: +82-61-379-7681, eksong@chonnam.ac.kr

Received 14 November 2013 Revised 22 January 2014 Accepted 21 March 2014

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Navigation systems are currently being widely used in orthopedic surgery. The mechanical axis alignment can be judged accurately via a navigation system. High tibial osteotomy (HTO) is a procedure that aims to change the mechanical axis of the lower limb, transferring the body weight across healthy articular cartilage. Several studies have shown that accurate correction is the leading predictor for success. And, by using a navigation system, accurate multiplane measurements of the lower limb alignment can be performed intraoperatively in real time, and alignment adjustments can be made as the surgeon desires. Compared with the conventional cable-method, computer navigation significantly improves the accuracy of postoperative leg axis, reduces correction variability with fewer outliers, and reduces radiation time. This paper reviews the advantages, clinical results, complications, pitfalls, and posterior tibial slope control in navigation guided open wedge HTO.

Keywords: navigation, computer-assisted surgery, knee, osteotomy

Figures and Tables

Figure 1

Optical navigation system. Appearance (A), monitor (B, C).

Figure 2

Electromagnetic navigation system. (A) A structure: monitor, detector. (B) Intraoperative instrument.

Figure 3

The cable method for assessment of intraoperative leg alignment is not accurate because it depends on limb rotation and alignment guide position.

Figure 4

Intraoperative leg alignment measured using a navigation system before (A) and after valgus opening (B). The mechanical axis was adequately corrected without increasing posterior slope.

Figure 5

Aescular open wedge plate system.

Figure 6

The surgical procedures. (A) The Pes anserius was retracted and the superficial medial collateral ligament was clearly visualized. (B) Oblique tibial tuberosity osteotomy. (C) Valgization by the stepwise insertion of three coupled chisels, and measurement of the opening gap. (D) Wedge shaped opening and open wedge plates.

Figure 7

Preoperative (A) and postoperative (B) radiographs showing satisfactory alignment without change in posterior slope; 6 mm anterior and 9 mm posterior plates were used.

Table 1

Current Outcome Studies of Comparison between Navigational High Tibial Osteotomy and Conventional High Tibial Osteotomy

Values are presented as number or mean±standard deviation.

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