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Opening Wedge High Tibial Osteotomy Using Combined Computed Tomography-Based and Image-Free Navigation System.

ABSTRACT: For opening wedge high tibial osteotomy (OWHTO), it is recommended that the osteotomy line is parallel to the medial tibial posterior slope (TPS) in the sagittal view and that the alignments are simultaneously controlled in the coronal and sagittal views. Here combined computed tomography (CT)-based and image-free navigation systems were used for intraoperative reference during OWHTO. Using the CT-based navigation, 2 entry points for insertion of Kirschner wires were preoperatively set up and an accurate osteotomy plane was intraoperatively duplicated. Preoperative planning anticipated a femorotibial angle of 170°, representing a weight-bearing ratio of 62.5%, on the whole-leg radiograph. The original TPS in the sagittal view was aimed to be preserved postoperatively. The hip-knee-ankle (HKA) correction angle was preoperatively measured on the whole-leg radiograph, and the HKA angle and flexion angle were intraoperatively monitored in real time using the image-free navigation. We have introduced an operative technique for OWHTO using CT-based and image-free navigation systems. We expect that this method, with the osteotomy plane parallel to the tibial plateau plane in the sagittal view and simultaneous control of coronal and sagittal alignments, will enable actuation of accurate alignment in the 2 planes and lead to improvements in patient activity in future.

SUBMITTER: Akamatsu Y

PROVIDER: S-EPMC5621968 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Purpose:To evaluate the short-term clinical outcomes, complications, hospitalization time, and readmission rate related to day-case opening wedge high tibial osteotomy (OWHTO) with intraosseous PEEK (polyether ether ketone) implant, in the treatment of knee osteoarthritis. Methods:An observational study on patients treated with OWHTO using intraosseous PEEK implant was performed with a period of 12 months follow-up. Grade of Knee Injury and Osteoarthritis Outcome Score (KOOS) was assessed preoperatively, at 6 months, and at 12 months postoperatively. A simple t test was used to analyze the outcomes. P values <.05 were considered significant. Complications and revision surgeries were registered. Results:In the period from 2016 to 2017, a consecutive group of 40 patients (13 female, 27 male) with symptomatic medial knee osteoarthritis and varus malalignment were included in the study. The average age of the patients was 54.9 (± 7.6) years. In total, 30 (77%) patients met the criterion for minimal clinically important difference in KOOS scores. The KOOS symptoms improved from 58.1 ± 20 to 78.5 ± 16.5 (P < .0001), pain from 48.1 ± 18.2 to 78.6 ± 18.5 (P < .0001), activities of daily living from 59.0 ± 19.5 to 84.1 ± 15.2 (P < .0001), sport from 23.2 ± 17.6 to 55.6 ± 26.3 (P < .0001), and quality of life from 28.4 ± 12.8 to 61.5 ± 22.5 (P < .0001) at 1-year follow-up. The average hospitalization time at the Day Surgery Unit was 5.6 ± 0.7 hours, and 4 (10%) patients had to be readmitted to the hospital within 2 weeks postoperatively. The overall complication rate was 18%. Complications that required revision surgery were registered in 4 patients (10%), including 2 non-unions and 2 progressions of osteoarthritis. Conclusions:The day-case OWHTO with intraosseous PEEK implant was a success in 77% of the cases. The results and complications were comparable with other published studies. Despite a short hospitalization time, the readmission rate was low. Level of Evidence:IV, therapeutic case series.

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Opening Wedge High Tibial Osteotomy Using Combined Computed Tomography-Based and Image-Free Navigation System.

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