A computer simulation study for preserving the tibial posterior slope in open-wedge high tibial osteotomy
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ORIGINAL ARTICLE
A computer simulation study for preserving the tibial posterior slope in open‑wedge high tibial osteotomy Mitsuru Hanada1 · Kensuke Hotta1 · Yukihiro Matsuyama1 Received: 25 November 2019 / Accepted: 11 May 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Objective To measure the medial opening gap and examine a technique for preserving the tibial posterior slope (TPS) in open-wedge high tibial osteotomy (OWHTO) using computer-simulated three-dimensional (3D) surgery. Materials and methods This study included 24 symptomatic knees from 20 patients (7 men and 13 women; mean age, 67.9 years; range 54–89 years). Digital imaging and communications from computed tomography examination were applied to a 3D picture software program, and several anatomical landmarks were registered. Then, computer simulation of OWHTO as a virtual surgery was performed: the correction angle was decided to make the femorotibial angle 170°, and the TPS did not differ between pre- and postplanification. The distance between the proximal and distal cortices of the medial tibia was measured at three points, which were the anterior (AD), posterior (PD), and longest (LD) distance sites in the sagittal plane, using the 3D view, and the ratios of AD/PD and AD/LD were measured. The anteromedial opening gap was compared to the posteromedial gap and the longest distance gap at the osteotomy site. Spearman’s rank correlation coefficient test was used in statistical analysis. Results Mean AD/PD was 0.740 ± 0.051 (range 0.651–0.850), and mean AD/LD was 0.652 ± 0.040 (range 0.571–0.768). The correction angle was not associated with the values of both AD/PD and AD/LD. Conclusions Difference in AD/PD and AD/LD between each patient was regarded as a significant variation. Therefore, preoperative planification with 3D computer simulation to measure AD/PD and AD/LD may be helpful to avoid a significant increase in TPS. Keywords Computer simulation · 3-Dimensional model · Tibia · Tibial posterior slope · Open-wedge high tibial osteotomy
Introduction High tibial osteotomy (HTO) is commonly performed for osteoarthritis of the knee located in the medial compartment. Previously, various techniques of HTO were provided and evaluated. The two major operative methods, namely closedwedge (CW) and open-wedge (OW) HTO, are universally performed to correct lower extremity malalignment in the coronal plane. First, CWHTO was reported by Coventry [1, 2] and used to treat knee osteoarthritis of the medial compartment. Then, OWHTO became an established surgical procedure and has been frequently used recently. * Mitsuru Hanada [email protected] 1
Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1‑20‑1 Handayama, Higashi‑ku, Hamamatsu 431‑3192, Japan
OWHTO has several advantages over CWHTO, such as it does not need fibular osteotomy, has less risk of neurovascular injury, preserves bone stock, and allows easy adjustment of alignment correction [3–6]. In addition, orthopedic surgeons have sugge
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