Clin Orthop Surg.  2016 Dec;8(4):349-357. 10.4055/cios.2016.8.4.349.

Computer-Assisted Navigation in High Tibial Osteotomy

Affiliations
  • 1Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea. tesstore@empas.com

Abstract

Computer-assisted navigation is used to improve the accuracy and precision of correction angles during high tibial osteotomy. Most studies have reported that this technique reduces the outliers of coronal alignment and unintended changes in the tibial posterior slope angle. However, more sophisticated studies are necessary to determine whether the technique will improve the clinical results and long-term survival rates. Knowledge of the navigation technology, surgical techniques and potential pitfalls, the clinical results of previous studies, and understanding of the advantages and limitations of the computer-assisted navigation are crucial to successful application of this new technique in high tibial osteotomy. Herein, we review the evidence concerning this technique from previous studies.

Keyword

Knee; Tibia; Osteotomy; Computer-assisted surgery

MeSH Terms

Humans
Osteotomy/*methods
Surgery, Computer-Assisted/*methods
Tibia/*diagnostic imaging/*surgery

Figure

  • Fig. 1 Computer-assisted closed-wedge high tibial osteotomy. The navigation provides information on the deformity (A), medial proximal tibial angle (B), level of osteotomy (C), correction angle (D), and wedge size (arrows).

  • Fig. 2 Four-pin guide technique for wedge resection. Two proximal and two distal K-wires are inserted using a precalibrated navigated drill guide. The anteroposterior image shows the accurate placement of the K-wires, and the two pairs of K-wires are completely parallel.

  • Fig. 3 Wedge resection and stabilization. (A) The wedge is removed, and the medial far cortex is then carefully decorticated using a sharp electric saw or an osteotome. A valgus force is applied slowly to the extremity until the proximal and distal osteotomy surfaces are firmly attached. (B) Next, the osteotomy site is rigidly fixed using a Miniplate staple (U&I Co.) of an appropriate size.

  • Fig. 4 Confirmation of the correction angle assessed under navigation guidance and in postoperative weight-bearing radiography. The postoperative alignment assessed under navigation (A) is well correlated with the radiographic measurement obtained in the standing position (B).

  • Fig. 5 Computer-assisted open-wedge high tibial osteotomy. (A) The navigation system provides information concerning the deformity, medial proximal tibial angle, level of osteotomy, and correction angle (arrows). (B) The medial wedge is carefully opened, hinging on the posterolateral cortex of the tibia until the expected alignment is achieved.


Reference

1. Picardo NE, Khan W, Johnstone D. Computer-assisted navigation in high tibial osteotomy: a systematic review of the literature. Open Orthop J. 2012; 6:305–312.
Article
2. Thompson SR, Zabtia N, Weening B, Zalzal P. Arthroscopic and computer-assisted high tibial osteotomy using standard total knee arthroplasty navigation software. Arthrosc Tech. 2013; 2(2):e161–e166.
Article
3. Sharma L, Chmiel JS, Almagor O, et al. The role of varus and valgus alignment in the initial development of knee cartilage damage by MRI: the MOST study. Ann Rheum Dis. 2013; 72(2):235–240.
Article
4. Lutzner J, Gross AF, Gunther KP, Kirschner S. Precision of navigated and conventional open-wedge high tibial osteotomy in a cadaver study. Eur J Med Res. 2010; 15(3):117–120.
Article
5. Miniaci A, Ballmer FT, Ballmer PM, Jakob RP. Proximal tibial osteotomy: a new fixation device. Clin Orthop Relat Res. 1989; (246):250–259.
6. Noyes FR, Barber SD, Simon R. High tibial osteotomy and ligament reconstruction in varus angulated, anterior cruciate ligament-deficient knees: a two- to seven-year follow-up study. Am J Sports Med. 1993; 21(1):2–12.
Article
7. Hankemeier S, Hufner T, Wang G, et al. Navigated open-wedge high tibial osteotomy: advantages and disadvantages compared to the conventional technique in a cadaver study. Knee Surg Sports Traumatol Arthrosc. 2006; 14(10):917–921.
Article
8. Iorio R, Pagnottelli M, Vadala A, et al. Open-wedge high tibial osteotomy: comparison between manual and computer-assisted techniques. Knee Surg Sports Traumatol Arthrosc. 2013; 21(1):113–119.
Article
9. Noyes FR, Goebel SX, West J. Opening wedge tibial osteotomy: the 3-triangle method to correct axial alignment and tibial slope. Am J Sports Med. 2005; 33(3):378–387.
Article
10. Young SW, Safran MR, Clatworthy M. Applications of computer navigation in sports medicine knee surgery: an evidence-based review. Curr Rev Musculoskelet Med. 2013; 6(2):150–157.
Article
11. Bae DK, Song SJ. Computer assisted navigation in knee arthroplasty. Clin Orthop Surg. 2011; 3(4):259–267.
Article
12. Bae DK, Song SJ, Yoon KH. Closed-wedge high tibial osteotomy using computer-assisted surgery compared to the conventional technique. J Bone Joint Surg Br. 2009; 91(9):1164–1171.
Article
13. Song EK, Seon JK, Park SJ. How to avoid unintended increase of posterior slope in navigation-assisted open-wedge high tibial osteotomy. Orthopedics. 2007; 30:10 Suppl. S127–S131.
14. Yim JH, Seon JK, Song EK. Posterior tibial slope in medial opening-wedge high tibial osteotomy: 2-D versus 3-D navigation. Orthopedics. 2012; 35:10 Suppl. 60–63.
Article
15. Khadem R, Yeh CC, Sadeghi-Tehrani M, et al. Comparative tracking error analysis of five different optical tracking systems. Comput Aided Surg. 2000; 5(2):98–107.
Article
16. Gebhard F, Krettek C, Hufner T, et al. Reliability of computer-assisted surgery as an intraoperative ruler in navigated high tibial osteotomy. Arch Orthop Trauma Surg. 2011; 131(3):297–302.
Article
17. Keppler P, Gebhard F, Grutzner PA, et al. Computer aided high tibial open wedge osteotomy. Injury. 2004; 35:Suppl 1. S-A68–S-A78.
Article
18. Kendoff DO, Fragomen AT, Pearle AD, Citak M, Rozbruch SR. Computer navigation and fixator-assisted femoral osteotomy for correction of malunion after periprosthetic femur fracture. J Arthroplasty. 2010; 25(2):333.e13–333.e19.
Article
19. Yaffe MA, Koo SS, Stulberg SD. Radiographic and navigation measurements of TKA limb alignment do not correlate. Clin Orthop Relat Res. 2008; 466(11):2736–2744.
Article
20. Kyung BS, Kim JG, Jang KM, et al. Are navigation systems accurate enough to predict the correction angle during high tibial osteotomy? Comparison of navigation systems with 3-dimensional computed tomography and standing radiographs. Am J Sports Med. 2013; 41(10):2368–2374.
Article
21. Bae DK, Park CH, Kim EJ, Song SJ. Medial cortical fractures in computer-assisted closing-wedge high tibial osteotomy. Knee. 2016; 23(2):295–299.
Article
22. Goleski P, Warkentine B, Lo D, Gyuricza C, Kendoff D, Pearle AD. Reliability of navigated lower limb alignment in high tibial osteotomies. Am J Sports Med. 2008; 36(11):2179–2186.
Article
23. Yamamoto Y, Ishibashi Y, Tsuda E, Tsukada H, Kimura Y, Toh S. Validation of computer-assisted open-wedge high tibial osteotomy using three-dimensional navigation. Orthopedics. 2008; 31:10 Suppl 1. 68–71.
24. Saragaglia D, Chedal-Bornu B. Computer-assisted osteotomy for valgus knees: medium-term results of 29 cases. Orthop Traumatol Surg Res. 2014; 100(5):527–530.
Article
25. Ribeiro CH, Severino NR, Moraes de Barros Fucs PM. Opening wedge high tibial osteotomy: navigation system compared to the conventional technique in a controlled clinical study. Int Orthop. 2014; 38(8):1627–1631.
Article
26. Akamatsu Y, Mitsugi N, Mochida Y, et al. Navigated opening wedge high tibial osteotomy improves intraoperative correction angle compared with conventional method. Knee Surg Sports Traumatol Arthrosc. 2012; 20(3):586–593.
Article
27. Kim SJ, Koh YG, Chun YM, Kim YC, Park YS, Sung CH. Medial opening wedge high-tibial osteotomy using a kinematic navigation system versus a conventional method: a 1-year retrospective, comparative study. Knee Surg Sports Traumatol Arthrosc. 2009; 17(2):128–134.
Article
28. Maurer F, Wassmer G. High tibial osteotomy: does navigation improve results? Orthopedics. 2006; 29:10 Suppl. S130–S132.
29. Saragaglia D, Roberts J. Navigated osteotomies around the knee in 170 patients with osteoarthritis secondary to genu varum. Orthopedics. 2005; 28:10 Suppl. s1269–s1274.
Article
30. Iorio R, Vadala A, Giannetti S, et al. Computer-assisted high tibial osteotomy: preliminary results. Orthopedics. 2010; 33:10 Suppl. 82–86.
Article
31. Na YG, Eom SH, Kim SJ, Chang MJ, Kim TK. The use of navigation in medial opening wedge high tibial osteotomy can improve tibial slope maintenance and reduce radiation exposure. Int Orthop. 2016; 40(3):499–507.
Article
32. Miller BS, Downie B, McDonough EB, Wojtys EM. Complications after medial opening wedge high tibial osteotomy. Arthroscopy. 2009; 25(6):639–646.
Article
33. Nelissen EM, van Langelaan EJ, Nelissen RG. Stability of medial opening wedge high tibial osteotomy: a failure analysis. Int Orthop. 2010; 34(2):217–223.
Article
34. Takeuchi R, Umemoto Y, Aratake M, et al. A mid term comparison of open wedge high tibial osteotomy vs unicompartmental knee arthroplasty for medial compartment osteoarthritis of the knee. J Orthop Surg Res. 2010; 5(1):65.
Article
35. van Raaij TM, Brouwer RW, de Vlieger R, Reijman M, Verhaar JA. Opposite cortical fracture in high tibial osteotomy: lateral closing compared to the medial opening-wedge technique. Acta Orthop. 2008; 79(4):508–514.
Article
36. Kessler OC, Jacob HA, Romero J. Avoidance of medial cortical fracture in high tibial osteotomy: improved technique. Clin Orthop Relat Res. 2002; (395):180–185.
Article
37. Saragaglia D, Mercier N, Colle PE. Computer-assisted osteotomies for genu varum deformity: which osteotomy for which varus? Int Orthop. 2010; 34(2):185–190.
Article
38. Goradia VK. Computer-assisted and robotic surgery in orthopedics: where we are in 2014. Sports Med Arthrosc. 2014; 22(4):202–205.
39. Citak M, Kendoff D, O'Loughlin PF, Pearle AD. Heterotopic ossification post navigated high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2009; 17(4):352–355.
Article
Full Text Links
  • CIOS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr