J Korean Orthop Assoc.  2009 Oct;44(5):499-506. 10.4055/jkoa.2009.44.5.499.

A Comparative Study of the Navigated and Radiographic Measurements in Open and Closed Wedge High Tibial Osteotomy with Computer Assisted Surgery

• Bae DK
• Song SJ
• Yoon KH
• Kwak SJ

• KMID: 2186308
• DOI: http://doi.org/10.4055/jkoa.2009.44.5.499

Abstract

PURPOSE
We wanted to identify the difference of the measured values between a navigation system and radiographs when performing open and closed wedge high tibial osteotomy (HTO) under the control of a navigation system. MATERIALS AND METHODS: Thirty-two open wedge HTOs and 51 closed wedge HTOs were performed using a navigation system. The postoperative mechanical axis percent, which was planned on the navigation system, was 62%. The mechanical axis (MA) was measured before osteotomy and after fixation on the navigation system, and these were compared with the measured values from the radiographs. The difference of the postoperative MA between the navigation system and the radiographs was compared according to the type of HTO. The alteration of the tibial posterior slope angle was also compared. RESULTS: For the open wedge HTO, the mean MA after fixation was valgus 2.7degrees on the navigation system and the postoperative MA was valgus 4.0degrees on the radiograph. For the closed wedge HTO, the mean MA after fixation was valgus 3.5degrees on the navigation system and the postoperative MA was valgus 1.6degrees on the radiograph (p=0.000). The mean tibial posterior slope angle was increased by 5.3degrees after the open wedge HTO and it was decreased by 1.8degrees after closed wedge HTO (p=0.000). CONCLUSION: Performing HTO with a navigation system could increase the surgical accuracy because the navigation system checked the intraoperative correction angle in real time. Weight bearing makes a difference for the postoperative MA between the navigation system and radiographs. This should be taken into account, according to the type of HTO.

Keyword

Knee; Osteoarthritis; Open wedge and closed wedge high tibial osteotomy; Navigation system

MeSH Terms

Axis, Cervical Vertebra
Knee
Osteoarthritis
Osteotomy
Surgery, Computer-Assisted
Weight-Bearing

Figure

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  Fig. 1 (A) The mechanical axis % (MA%) shown on the preoperative ortho-roentgenogram is evaluated by percentile denotation [(b/a)×100]. "a" is the width of tibia plateau and "b" is the distance from the medial border of the medial tibial condyle to the point at which the mechanical axis intersects the knee joint line. It shows medial deviation of the mechanical axis. (B) The mechanical axis % (MA%) shown on the postoperative ortho-roentgenogram is evaluated by percentile denotation [(b'/a')×100]. "a'" is the width of tibia plateau and "b'" is the distance from the medial border of the medial tibial condyle to the point at which the mechanical axis intersects the knee joint line. It shows lateral deviation of the mechanical axis.

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  Fig. 2 Change of mechanical axis after the open wedge high tibial osteotomy using navigation system. (A) A 64-year-old woman have the open wedge high tibial osteotomy under navigation control. In the preoperative roentgenogram, the mechanical axis (MA) is varus 9.4° and the mechanical axis % (MA%) is 9.2%. The posterior slope angle of tibia is 8.0°. In the navigation system, the MA is varus 7.4° and the MA% is 22%. (B) In the navigation system, the post-osteotomy MA is valgus 3.5° and the MA% is 57.7%. In the postoperative 2 week roentgenogram, the MA is valgus 5.2° and the MA% is 72.9%. The posterior slope angle of tibia is 12.1°. The postoperative MA and MA% in roentgenogram is larger than the postosteotomy MA and MA% in navigation system. (C) In the postoperative 4 month roentgenogram, the MA is varus 1.2° and the MA% is 37.4%. There are two proximal screws breakage of Puddu plate and loss of correction angle.

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