Development of an Image-Free Navigation Tool for High Tibial Osteotomy

High tibial osteotomy (HTO) is a common therapy for medial gonarthrosis. Intraoperative planning and control of the correction is difficult. Therefore a workflow for a navigation with an image-free navigation system was developed for direct control of the correction of varus/valgus, internal/external rotation, and increase/decrease of the tibial slope. After registration of the lower limb, two k-wires define the osteotomy plane or planes for open- or closed-wedge osteotomy, respectively. The correction is accomplished under navigation system control in real-time. A rigid plate fixation is used for the fixation of the HTO. The reliability and accuracy of the system was approved with an aluminium phantom model.

[1]  D. Paley,et al.  Mechanical axis deviation of the lower limbs. Preoperative planning of uniapical angular deformities of the tibia or femur. , 1992, Clinical orthopaedics and related research.

[2]  K. Masuhara,et al.  The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. , 1979, The Orthopedic clinics of North America.

[3]  A. Imhoff,et al.  Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics: a biomechanical study in human cadaveric knees , 2004, Archives of Orthopaedic and Trauma Surgery.

[4]  L. Nolte,et al.  A fluoroscopy-based surgical navigation system for high tibial osteotomy. , 2005, Technology and health care : official journal of the European Society for Engineering and Medicine.

[5]  J. Rudan,et al.  High tibial osteotomy. A prospective clinical and roentgenographic review. , 1990, Clinical orthopaedics and related research.

[6]  Dominique Saragaglia,et al.  Navigated osteotomies around the knee in 170 patients with osteoarthritis secondary to genu varum. , 2005, Orthopedics.

[7]  C. Wirth,et al.  High tibial osteotomy versus unicompartmental joint replacement in unicompartmental knee joint osteoarthritis: 7-10-year follow-up prospective randomised study. , 2001, The Knee.

[8]  Randy E. Ellis,et al.  A Surgical Planning and Guidance System for High Tibial Osteotomy , 1999 .

[9]  A. Avolio,et al.  Factors influencing long-term results in high tibial osteotomy. , 1991, Clinical orthopaedics and related research.

[10]  Daniel Kendoff,et al.  Navigated intraoperative analysis of lower limb alignment , 2005, Archives of Orthopaedic and Trauma Surgery.

[11]  H. Cameron,et al.  Prognostic factors in the outcome of supracondylar femoral osteotomy for lateral compartment osteoarthritis of the knee. , 1997, Canadian journal of surgery. Journal canadien de chirurgie.

[12]  S. Odenbring,et al.  Roentgenographic assessment of the hip-knee-ankle axis in medial gonarthrosis. A study of reproducibility. , 1993, Clinical orthopaedics and related research.

[13]  D. Paley,et al.  Mechanical axis deviation of the lower limbs. Preoperative planning of multiapical frontal plane angular and bowing deformities of the femur and tibia. , 1992, Clinical orthopaedics and related research.

[14]  D. Paley,et al.  [Principles of deformity correction around the knee]. , 2000, Der Orthopade.

[15]  J. Finkelstein,et al.  Varus Osteotomy of the Distal Part of the Femur. A Survivorship Analysis* , 1996, The Journal of bone and joint surgery. American volume.

[16]  R. Bourne,et al.  The Install Award. Survivorship of the high tibial valgus osteotomy. A 10- to -22-year followup study. , 1999, Clinical orthopaedics and related research.

[17]  P. Lobenhoffer,et al.  TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia--early results in 92 cases. , 2003, Injury.

[18]  C Krettek,et al.  Intraoperative control of axes, rotation and length in femoral and tibial fractures. Technical note. , 1998, Injury.

[19]  M. B. Coventry.  OSTEOTOMY OF THE UPPER PORTION OF THE TIBIA FOR DEGENERATIVE ARTHRITIS OF THE KNEE. A PRELIMINARY REPORT. , 1965, The Journal of bone and joint surgery. American volume.

[20]  Guoyan Zheng,et al.  Computer aided high tibial open wedge osteotomy. , 2004, Injury.

[21]  G. Bentley,et al.  Distal femoral osteotomy for lateral compartment osteoarthritis of the knee. , 1998, Orthopedics.

[22]  P. Hernigou.  Open wedge tibial osteotomy: combined coronal and sagittal correction. , 2002, The Knee.

[23]  A. Imhoff,et al.  Korrekturosteotomie bei Primary-Varus-, Double-Varus- und Triple-Varus-Knieinstabilität mit Kreuzbandersatz , 2004, Der Orthopäde.

[24]  P Harriman,et al.  A radiological method for producing precise limb alignment. , 1991, The Journal of bone and joint surgery. British volume.