Skip to main content
SpringerLink
Log in

Navigated opening wedge high tibial osteotomy improves intraoperative correction angle compared with conventional method

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The correction angle after high tibial osteotomy (HTO) depends on an accurate preoperative planning and an accurate intraoperative technique. We hypothesized that the use of a navigation system in opening wedge HTO would improve the intraoperative target angles in the coronal and sagittal planes.

Methods

Postoperative femoro-tibial angle (FTA) and tibial posterior slope (TPS) in 28 knees with navigated opening wedge HTO were compared to those in 31 knees with the conventional method. Intraoperative correction angle was determined by the predicted medial opening width in the conventional group, and by the change of hip-knee-ankle angle in the navigated group. We defined lateral unstable knee as the knees with lateral cortex breakage or lateral tibial plateau fracture.

Results

Mean postoperative FTA was higher in the conventional group than in the navigated group (P < 0.037). In the conventional group, 4 lateral unstable knees were corrected to 174.6°. In the navigated group, 5 lateral unstable knees were corrected to 170.3° and no knees showed FTA > 173°. Mean change in TPS was greater in the conventional group than in the navigated group (P = 0.001).

Conclusion

The navigation system in opening wedge HTO might reduce undercorrection in the knees with lateral cortex breakage or lateral tibial plateau fracture, and provide the better intraoperative FTA and TPS.

Level of evidence

III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Ahlbäck S (1968) Osteoarthrosis of the knee. A radiographic investigation. Acta Radiol Diagn (Stockh): Suppl 277:7–72

    Google Scholar 

  2. Akamatsu Y, Koshino T, Saito T, Wada J (1997) Changes in osteosclerosis of the osteoarthritic knee after high tibial osteotomy. Clin Orthop Relat Res 334:207–214

    Article  PubMed  Google Scholar 

  3. Bäthis H, Perlick L, Tingart M, Lüring C, Zurakowski D, Grifka J (2004) Alignment in total knee arthroplasty: a comparison of computer-assisted surgery with the conventional technique. J Bone Joint Surg Br 86:682–687

    Article  PubMed  Google Scholar 

  4. Debeyre J, Artigou JM (1972) Long term results of 260 tibial osteotomies for frontal deviations of the knee. Rev Chir Orthop Reparatrice Appar Mot 58:335–339

    PubMed  CAS  Google Scholar 

  5. Dowd GS, Somayaji HS, Uthukuri M (2006) High tibial osteotomy for medial compartment osteoarthritis. Knee 13:87–92

    Article  PubMed  CAS  Google Scholar 

  6. Dugdale TW, Noyes FR, Styer D (1992) Preoperative planning for high tibial osteotomy: the effect of lateral tibiofemoral separation and tibiofemoral length. Clin Orthop Relat Res 274:248–264

    PubMed  Google Scholar 

  7. El-Azab H, Halawa A, Anetzberger H, Imhoff AB, Hinterwimmer S (2008) The effect of closed- and open-wedge high tibial osteotomy on tibial slope: a retrospective radiological review of 120 cases. J Bone Joint Surg Br 90:1193–1197

    Article  PubMed  CAS  Google Scholar 

  8. Giffin JR, Vogrin TM, Zantop T, Woo SL, Harner CD (2004) Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med 32:376–382

    Article  PubMed  Google Scholar 

  9. Goleski P, Warkentine B, Lo D, Gyuricza C, Kendoff D, Pearle AD (2008) Reliability of navigated lower limb alignment in high tibial osteotomies. Am J Sports Med 36:2179–2186

    Article  PubMed  Google Scholar 

  10. Hankemeier S, Hufner T, Wang G, Kendoff D, Zheng G, Richter M, Gosling T, Nolte L, Krettek C (2005) Navigated intraoperative analysis of lower limb alignment. Arch Orthop Trauma Surg 125:531–535

    Article  PubMed  Google Scholar 

  11. Hankemeier S, Hufner T, Wang G, Kendoff D, Zeichen J, Zheng G, Krettek C (2006) Navigated open-wedge high tibial osteotomy: advantages and disadvantages compared to the conventional technique in a cadaver study. Knee Surg Sports Traumatol Arthrosc 14:917–921

    Article  PubMed  CAS  Google Scholar 

  12. Heijens E, Kornherr P, Meister C (2009) The role of navigation in high tibial osteotomy: a study of 50 patients. Orthopedics 32:S40–43

    Article  Google Scholar 

  13. Hernigou P, Medevielle D, Debeyre J, Goutallier D (1987) Proximal tibial osteotomy for osteoarthritis with varus deformity: a ten to thirteen-year follow-up study. J Bone Joint Surg Am 69:332–354

    PubMed  CAS  Google Scholar 

  14. Hooper G, Leslie H, Burn J, Schouten R, Beci I (2005) Oblique upper tibial opening wedge osteotomy for genu varum. Oper Orthop Traumatol 17:662–673

    Article  PubMed  Google Scholar 

  15. Insall JN, Dorr LD, Scott RD, Scott WN (1989) (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14

    PubMed  Google Scholar 

  16. Keppler P, Gebhard F, Grützner PA, Wang G, Zheng G, Hüfner T, Hankemeier S, Nolte LP (2004) Computer aided high tibial open wedge osteotomy. Injury 35:S- A68–78

    Article  Google Scholar 

  17. Kendoff D, Citak M, Pearle A, Gardner MJ, Hankemeier S, Krettek C, Hüfner T (2007) Influence of lower limb rotation in navigated alignment analysis: implications for high tibial osteotomies. Knee Surg Sports Traumatol Arthrosc 15:1003–1008

    Article  PubMed  CAS  Google Scholar 

  18. Kendoff D, Board TN, Citak M, Gardner MJ, Hankemeier S, Ostermeier S, Krettek C, Hüfner T (2008) Navigated lower limb axis measurements: influence of mechanical weight-bearing simulation. J Orthop Res 26:553–561

    Article  PubMed  Google Scholar 

  19. Kim SJ, Koh YG, Chun YM, Kim YC, Park YS, Sung CH (2009) 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 17:128–134

    Article  PubMed  CAS  Google Scholar 

  20. Koshino T, Murase T, Saito T (2003) Medial open-wedge high tibial osteotomy with use of porus hydroxyapatite to treat medial compartment osteoarthritis of the knee. J Bone Joint Surg Am 85:78–85

    Article  PubMed  Google Scholar 

  21. Lobenhoffer P, Agneskirchner JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11:132–138

    PubMed  Google Scholar 

  22. Lützner J, Gross AF, Günther KP, Kirschner S (2009) Reliability of limb alignment measurement for high tibial osteotomy with a navigation system. Eur J Med Res 14:447–450

    PubMed  Google Scholar 

  23. Marti CB, Gautier E, Wachtl SW, Jakob RP (2004) Accuracy of frontal and sagittal plane correction in open-wedge high tibial osteotomy. Arthroscopy 20:366–372

    Article  PubMed  Google Scholar 

  24. Miniaci A, Ballmer FT, Ballmer PM, Jakob RP (1989) Proximal tibial osteotomy: a new fixation device. Clin Orthop Relat Res 246:250–259

    PubMed  Google Scholar 

  25. Noyes FR, Goebel SX, West J (2005) Opening wedge tibial osteotomy: the 3-triangle method to correct axial alignment and tibial slope. Am J Sports Med 33:378–387

    Article  PubMed  Google Scholar 

  26. Odenbring S, Berggren AM, Peil L (1993) Roentgenographic assessment of the hip-knee-ankle axis in medial gonarthrosis: a study of reproducibility. Clin Orthop Relat Res 289:195–196

    PubMed  Google Scholar 

  27. Saleh M, Harriman P, Edwards DJ (1991) A radiological method for producing precise limb alignment. J Bone Joint Surg Br 73:515–516

    PubMed  CAS  Google Scholar 

  28. Saragaglia D, Roberts J (2005) Navigated osteotomies around the knee in 170 patients with osteoarthritis secondary to genu varum. Orthopedics 28:1269–1274

    Google Scholar 

  29. Sim JA, Kwak JH, Yang SH, Choi ES, Lee BK (2010) Effect of weight-bearing on the alignment after open wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 18:874–878

    Article  PubMed  Google Scholar 

  30. Song EK, Seon JK, Park SJ, Seo HY (2008) Navigated open wedge high tibial osteotomy. Sports Med Arthrosc 16:84–90

    Article  PubMed  Google Scholar 

  31. Takahashi T, Yamanaka N, Komatsu M, Ogawa Y, Yoshida S, Yamamoto H (2004) A new computer-assisted method for measuring the tibio-femoral angle in patients with osteoarthritis of the knee. Osteoarthr Cartil 12:256–259

    Article  PubMed  CAS  Google Scholar 

  32. Takeuchi R, Ishikawa H, Aratake M, Bito H, Saito I, Kumagai K, Akamatsu Y, Saito T (2009) Medial opening wedge high tibial osteotomy with early full weight bearing. Arthroscopy 25:46–53

    Article  PubMed  Google Scholar 

  33. Takeuchi R, Bito H, Akamatsu Y, Shiraishi T, Morishita S, Koshino T, Saito T (2010) In vitro stability of open wedge high tibial osteotomy with synthetic bone graft. Knee 17:217–220

    Article  PubMed  Google Scholar 

  34. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49

    PubMed  Google Scholar 

  35. van Raaij TM, Brouwer RW, de Vlieger R, Reijman M, Verhaar JA (2008) Opposite cortical fracture in high tibial osteotomy: lateral closing compared to the medial opening-wedge technique. Acta Orthop 79:508–514

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan

    Y. Akamatsu, N. Mitsugi, Y. Mochida, N. Taki & H. Kobayashi

  2. Department of Orthopedic Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan

    R. Takeuchi & T. Saito

Authors
  1. Y. Akamatsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N. Mitsugi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Y. Mochida
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. N. Taki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H. Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R. Takeuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. T. Saito
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Y. Akamatsu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

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 20, 586–593 (2012). https://doi.org/10.1007/s00167-011-1616-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-011-1616-8

Keywords

Search

Navigation