title: Computer aided high tibial open wedge osteotomy.
abstract: High tibial osteotomy is a widely accepted treatment of medial compartment osteoarthritis as well as other lower extremity deformities. However, it is a technically demanding procedure. The lack of exact intraoperative real time control of the mechanical axis often results in postoperative malalignments, which is one reason for poor long term results. These problems can be addressed with the use of a surgical navigation system. Following exposure, dynamic reference bases (DRBs) are attached to the femur, and the proximal and the distal part of the tibia. After intraoperative measurement of the deformities and correction planning, the osteotomy is performed under navigational guidance. The wedge size, joint line orientation, and tibial plateau slope are monitored during correction. The in vitro evaluation with a plastic bone model suggests that the error of deformity correction is less than 1.7 degrees (95% confidence limits) in the frontal, and less than 2.3 degrees (95% confidence limits) in the sagittal plane, respectively. On a cadaver study of 13 legs, the mechanical axis intersected the Fujisawa line in 80.7% (range 77.5-85.8%). The preliminary clinical experience confirms these results. A novel computer tomography free navigation system for high tibial osteotomy has been developed that holds the promise of improving the accuracy, reliability, and safety of this kind of approach.
authors.affiliation: Abteilung für Unfallchirurgie, Chirurgische Universitätsklinik Ulm, 89075 Ulm, Germany. peter.keppler@medizin.uni-ulm.de
authors.forename: Peter
authors.initials: P
authors.lastname: Keppler
authors.forename: Florian
authors.initials: F
authors.lastname: Gebhard
authors.forename: Paul A
authors.initials: PA
authors.lastname: Grützner
authors.forename: Gongli
authors.initials: G
authors.lastname: Wang
authors.forename: Guoyan
authors.initials: G
authors.lastname: Zheng
authors.forename: Tobias
authors.initials: T
authors.lastname: Hüfner
authors.forename: Stefan
authors.initials: S
authors.lastname: Hankemeier
authors.forename: Lutz-Peter
authors.initials: LP
authors.lastname: Nolte
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D015588:Observer Variation; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D011859:Radiography; D015203:Reproducibility of Results; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D013977:Tibia / Q000601:surgery*