THE PLANE RADIOGRAPH OF THE KNEE FOR HIGH TIBIAL OSTEOTOMY ASSESSMENT IS IN CONTRAST TO STANDING ALIGNMENT VIRTUALLY ELABORATED HANDLING BASED PRE-OPERATION PLANNING

2017 ◽  
Vol 29 (01) ◽  
pp. 1750001 ◽  
Author(s):  
Amir Hossein Saveh ◽  
Seyed Morteza Kazemi ◽  
Ali Reza Zali ◽  
Omid Dehpour ◽  
Minoo Tabandegan ◽  
...  
Keyword(s):  
Lower Extremity ◽  
High Tibial Osteotomy ◽  
Lower Limb ◽  
Gold Standard ◽  
Control Method ◽  
Weight Bearing ◽  
Fine Tuning ◽  
Patient Specific ◽  
Tibial Osteotomy ◽  
Leg Length

High Tibial Osteotomy (HTO) is a popular approach among contemporary corrective lower extremity procedures. As a surgical method in the HTO, the Open-Wedge High Tibial Osteotomy (OWHTO) preserves leg length, avoids dissection near the nerve and allows for fine-tuning of the angle by gradually inserting a wedge into a tibia. Nowadays, the gold standard approach to the OWHTO is based on the patient’s Long-Leg Radiograph (LLR) assessment. These standard weight bearing views of the lower extremity have their own practical advantages. This study aims to closely look at existing gold standard OWHTO planning method and assess its accuracy compared to a true patient’s weight bearing posture. The study attempts to introduce a method which can be used as a template for the HTO planning and has less weakness than the existing method. This method will assess the lower limb weight bearing three-dimensionally using a patient specific Computer Tomography (CT) data. The method has been validated using a Standing Alignment Virtually Elaborated Handling (SAVEH) of the lower limb using fluoroscopy giving an in vivo dynamic weight bearing analysis of the knee. The outcome of typical examples on assessment of the natural mechanical axis of the knee using proposed method has shown more accuracy than common two-dimensional LLR image control method. The study concluded that looking at the OWHTO without any address of the real three-dimensional orientation of the knee bones specially during standing phase of gait may be a missing point of view on OWHTO surgery.

scholarly journals Clinical Experience Using a 3D-Printed Patient-Specific Instrument for Medial Opening Wedge High Tibial Osteotomy

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Jesse Chieh-Szu Yang ◽  
Cheng-Fong Chen ◽  
Chu-An Luo ◽  
Ming-Chau Chang ◽  
Oscar K. Lee ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Weight Bearing ◽  
Ct Scanning ◽  
Tibial Slope ◽  
Patient Specific ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Time Saving ◽  
X Ray ◽  
Specific Instrument

Purpose. High tibial osteotomy (HTO) has been adopted as an effective surgery for medial degeneration of the osteoarthritis (OA) knee. However, satisfactory outcomes necessitate the precise creation and distraction of osteotomized wedges and the use of intraoperative X-ray images to continually monitor the wedge-related manipulation. Thus HTO is highly technique-demanding and has a high radiation exposure. We report a patient-specific instrument (PSI) guide for the precise creation and distraction of HTO wedge. Methods. This study first parameterized five HTO procedures to serve as a design rationale for an innovative PSI guide. Preoperative X-ray and computed tomography- (CT-) scanning images were used to design and fabricate PSI guides for clinical use. The weight-bearing line (WBL) of the ten patients was shifted to the Fujisawa’s point and instrumented using the TomoFix system. The radiological results of the PSI-guided HTO surgery were evaluated by the WBL percentage and tibial slope. Results. All patients consistently showed an increased range of motion and a decrease in pain and discomfort at about three-month follow-up. This study demonstrates the satisfactory accuracy of the WBL adjustment and tibial slope maintenance after HTO with PSI guide. For all patients, the average pre- and postoperative WBL are, respectively, 14.2% and 60.2%, while the tibial slopes are 9.9 and 10.1 degrees. The standard deviations are 2.78 and 0.36, respectively, in postoperative WBL and tibial slope. The relative errors of the pre- and postoperative WBL percentage and tibial slope averaged 4.9% and 4.1%, respectively. Conclusion. Instead of using navigator systems, this study integrated 2D and 3D preoperative planning to create a PSI guide that could most likely render the outcomes close to the planning. The PSI guide is a precise procedure that is time-saving, radiation-reducing, and relatively easy to use. Precise osteotomy and good short-term results were achieved with the PSI guide.

Feasibility and 3D Planning of a Novel Patient-Specific Instrumentation Technique in Medial Opening-Wedge High Tibial Osteotomy

2020 ◽  
Author(s):  
Wouter Van Genechten ◽  
Wouter Van Tilborg ◽  
Maxim Van den Bempt ◽  
Annemieke Van Haver ◽  
Peter Verdonk
Keyword(s):  
High Tibial Osteotomy ◽  
Lower Limb ◽  
Strong Correlation ◽  
Intraoperative Complications ◽  
Patient Specific ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Patient Specific Instrumentation ◽  
Novel Approach ◽  
Wedge High Tibial Osteotomy

AbstractA novel approach for opening-wedge high tibial osteotomy (OWHTO) with patient-specific instrumentation (PSI) was evaluated for its safety, feasibility, and accuracy. Next, the mechanical medial proximal tibial angle (mMPTA) was assessed as a potential planning angle by investigating the relation with the mechanical femorotibial angle (mFTA). Ten OWHTO cases were 3D planned using the mMPTA and operated with a customized 3D-printed wedge and cast which resembled the intended osteotomy opening. Patients were closely monitored for intraoperative and postoperative complications up to 1 year after surgery. Radiological assessment was conducted on full leg standing radiographs and supine lower limb computed tomography-scans preoperatively and 3 months after surgery. No intraoperative complications or logistical issues during PSI processing were observed. Absolute accuracy outcomes showed a correction error of 1.3° ± 1.1 mMPTA and 0.9° ± 0.6 mFTA with all osteotomies falling in (−2°; + 2°) mFTA around the target. The mMPTA and mFTA were found to have a strong correlation in both 3D (r = 0.842, p = 0.002) and 2D (r = 0.766, p = 0.01) imaging for effective correction. The study confirmed the development of a safe and feasible PSI technique in OWHTO with excellent accuracy outcomes. The strong correlation between the mMPTA and mFTA indicated that soft tissue changes after OWHTO are of minor significance to the final alignment in ligament-stable patients. Finally, the mMPTA was found to be a reliable planning angle in 3D software for obtaining the intended lower limb realignment and its use can therefore be recommended in modern OWHTO planning.

scholarly journals Patient-specific instrumentation (PSI) Referencing High Tibial Osteotomy Technological Transfer and Education: protocol for a double-blind, randomised controlled trial (PROTECTED HTO Trial)

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e041129
Author(s):  
Lawrence Chun Man Lau ◽  
Elvis Chun Sing Chui ◽  
Jason Chi Ho Fan ◽  
Gene Chi Wai Man ◽  
Yuk Wah Hung ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Knee Osteoarthritis ◽  
High Tibial Osteotomy ◽  
Controlled Trial ◽  
Patient Specific ◽  
Tibial Osteotomy ◽  
Double Blind ◽  
Patient Specific Instrumentation ◽  
3D Printed ◽  
Randomised Controlled

IntroductionHigh tibial osteotomy (HTO) is a treatment of choice for active adult with knee osteoarthritis. With advancement in CT imaging with three-dimensional (3D) model reconstruction, virtual planning and 3D printing, patient-specific instrumentation (PSI) in form of cutting jigs is employed to improve surgical accuracy and outcome of HTO. The aim of this randomised controlled trial (RCT) is to explore the surgical outcomes of HTO for the treatment of medial compartment knee osteoarthritis with or without a 3D printed patient-specific jig.Methods and analysisA double-blind RCT will be conducted with patients and outcome assessors blinded to treatment allocation. This meant that neither the patients nor the outcome assessors would know the actual treatment allocated during the trial. Thirty-six patients with symptomatic medial compartment knee osteoarthritis fulfilling our inclusion criteria will be invited to participate the study. Participants will be randomly allocated to one of two groups (1:1 ratio): operation with 3D printed patient-specific jig or operation without jig. Measurements will be taken before surgery (baseline) and at postoperatively (6, 12 and 24 months). The primary outcome includes radiological accuracy of osteotomy. Secondary outcomes include a change in knee function from baseline to postoperatively as measured by three questionnaires: Knee Society Scores (Knee Scores and Functional Scores), Oxford Knee Scores and pain visual analogue scale (VAS) score.Ethics and disseminationEthical approval has been obtained from the Joint Chinese University of Hong Kong – New Territories East Cluster Clinical Research Ethics Committee (CREC no. 2019.050), in accordance with the Declaration of Helsinki. The results will be presented at international scientific meetings and through publications in peer-reviewed journals.Trial registration numberNCT04000672; Pre-results.

scholarly journals Minimally Invasive High Tibial Osteotomy Using a Patient-Specific Cutting Guide

2021 ◽  
Vol 10 (2) ◽  
pp. e431-e435
Author(s):  
Hamid Rahmatullah Bin Abd Razak ◽  
Christophe Jacquet ◽  
Adrian J. Wilson ◽  
Raghbir S. Khakha ◽  
Kristian Kley ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
High Tibial Osteotomy ◽  
Patient Specific ◽  
Tibial Osteotomy ◽  
Cutting Guide

scholarly journals Osteonecrosis of the Femoral Medial Condyle Due to Leg Length Discrepancy After A Traffic Accident

2020 ◽  
Vol 14 (1) ◽  
pp. 135-139
Author(s):  
Wataru Kusano ◽  
Takatomo Mine ◽  
Koichiro Ihara ◽  
Hiroyuki Kawamura ◽  
Michio Shinohara ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Traffic Accident ◽  
Cartilage Damage ◽  
Leg Length Discrepancy ◽  
Osteoarthritis Of The Knee ◽  
Tibial Osteotomy ◽  
Leg Length ◽  
Medial Condyle ◽  
Length Discrepancy ◽  
Spontaneous Osteonecrosis

Untreated leg length discrepancy can cause spontaneous osteonecrosis of the knee, which is associated with subchondral insufficiency fractures of the knee and progression or onset of osteoarthritis of the knee. Spontaneous osteonecrosis of the knee can be secondary to cartilage loss or additional subchondral changes. A 40-year-old female underwent opening-wedge high tibial osteotomy and osteochondral grafting for osteonecrosis of the femoral medial condyle and osteoarthritis of the knee caused by leg length discrepancy after a traffic accident. High tibial osteotomy and cartilage restoration are often considered for the treatment of knee osteonecrosis with cartilage damage in younger patients.

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