A novel device for greater precision and safety in open-wedge high tibial osteotomy: cadaveric study

  • Cristiano Hossri RibeiroEmail author
  • Mauricio Sante Bettio Mod
  • Daniel Isch
  • Clemens Baier
  • Guenther Maderbacher
  • Nilson Roberto Severino
  • Daniele Cristina Cataneo
Arthroscopy and Sports Medicine



The complications of the open-wedge osteotomy technique (slope, hypo- and hypercorrection and fractures) are related to difficulties in the control of the open-wedge angle during surgery.

Materials and methods

In this cadaveric study, we evaluated the safety and precision of a novel system, the Realignment High Control System (RHC), in the correction of knee mechanical axis and slope. The RHC has a fixation plate coupled to a dynamic device that opens the osteotomy continuously, allowing plate fixation before osteotomy wedge opening.


All procedures were easily performed, with no fractures. The openings equaled the indicated by the navigation system for 7.5° and 10°, and for 5°, there was a statistically, although not clinically significant, difference of 0.6°. The slope shown by the RHC setting and in the navigation system was significantly different for the 10° setting only, with a mean difference of 0.563°.


RHC facilitates the surgical technique of high tibial osteotomy, with gradual wedge opening, precise correction of the mechanical axis, and appropriate control of the tibial slope, even with larger openings.


High-tibial-osteotomy Knee osteoarthritis Genu varum Computer-assisted surgery Surgical technique 


Compliance with ethical standards

Conflicts of interest

Cristiano Hossri Ribeiro and Daniel Isch created the new system and receive royalties for the product from Astrolab (the manufacturer). The other authors have no conflicts of interest to disclose.

Supplementary material

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Supplementary material 3 (DOCX 12 kb)
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Supplementary material 4 (PDF 387 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Cristiano Hossri Ribeiro
    • 1
    Email author
  • Mauricio Sante Bettio Mod
    • 2
  • Daniel Isch
    • 3
  • Clemens Baier
    • 4
  • Guenther Maderbacher
    • 4
  • Nilson Roberto Severino
    • 5
  • Daniele Cristina Cataneo
    • 6
  1. 1.Knee Surgery DivisionHospital OrtoSão José dos CamposBrazil
  2. 2.Ápice ClinicSorocabaBrazil
  3. 3.SafrimaBernSwitzerland
  4. 4.Asklepios KlinikBad AbbachGermany
  5. 5.Department of Orthopedics and TraumatologySanta Casa de Misericórdia de São Paulo (SCSP)São PauloBrazil
  6. 6.Surgery and Orthopaedics DepartmentUniversidade Estadual de São Paulo (Unesp)BotucatuBrazil

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