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Clinical efficacy of preoperative 3D planning for reducing surgical errors during open‐wedge high tibial osteotomy
Author(s) -
Kuriyama Shinichi,
Morimoto Naoki,
Shimoto Takeshi,
Takemoto Mitsuru,
Nakamura Shinichiro,
Nishitani Kohei,
Ito Hiromu,
Matsuda Shuichi,
Higaki Hidehiko
Publication year - 2019
Publication title -
journal of orthopaedic research®
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.041
H-Index - 155
eISSN - 1554-527X
pISSN - 0736-0266
DOI - 10.1002/jor.24263
Subject(s) - high tibial osteotomy , sagittal plane , coronal plane , osteotomy , medicine , varus deformity , nuclear medicine , deformity , orthodontics , surgery , osteoarthritis , anatomy , alternative medicine , pathology
Increases in posterior tibial slope (PTS) with open‐wedge high tibial osteotomy (OWHTO) are often related to two surgical errors: Symmetric opening of the osteotomy gap and a tendency to open the gap from the anteromedial direction. The study objective was to define trends in these two errors using computer simulation and clinical effects of their countermeasures. First, 60 knees with varus deformity were assessed with three‐dimensional (3D) planning using computed tomography to allow for the mechanical axis to pass through a point at 62.5% of the width of the tibial plateau, defined as the weight‐bearing line percentage (WBL%). Anterior and posterior widths of the opening gap to maintain PTS were measured. The effect on PTS when osteotomy gaps were opened from the anteromedial direction up to 30° was evaluated. Mean anterior width ( y ) was 6.6 mm (range, 2.2–10.9) and mean posterior width ( x ) was 9.1 mm (range, 3.9–15.7), which can be expressed as y = 0.75 x − 0.24. Opening gaps from the anteromedial direction at 10°, 20°, and 30° led to a mean PTS increase of 1.9°, 3.9°, and 5.6°, respectively. In most cases, WBL% with anteromedial opening at 30° passed through a point at less than 60%. In 47 knees that underwent OWHTO using 3D planning, postoperative coronal and sagittal bone corrections were mostly accurate. However, postoperative WBL% was negatively correlated with correction angle because of difficulties in predicting medial joint tightness. Preoperative 3D planning for OWHTO can reduce surgical errors, but postoperative WBL% remains variable. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res