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

Computer-Assisted Navigation in High Tibial Osteotomy

• Song SJ
• Bae DK

• KMID: 2412315
• DOI: http://doi.org/10.4055/cios.2016.8.4.349

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

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  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).

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  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.

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  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.

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  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).

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  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.

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