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Role of computer-assisted surgery in osteotomies around the knee

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

Abstract

Purpose

The goal of this article is to present our experience on navigation for osteotomies around the knee and especially osteotomies for coronal deformities. The first computer-assisted osteotomy was performed in March 2001 and since that time more than 1000 osteotomies have been performed in our department.

Methods

All the osteotomies were performed with the Orthopilot® device (B-Braun-Aesculap, Tuttlingen, Germany). The main indication was for genu varum deformities but several cases were operated for genu valgum. The surgical procedure as well as the indications and the rationale for each osteotomy (high tibial osteotomy—HTO, double-level osteotomy—DLO, femoral osteotomy—FO) are addressed in the article.

Results

The results are focused on several papers published by the authors since more than 10 years. Regarding HTO for genu varum, the preoperative goal (HKA angle: 184° ± 2°) was reached in 96 % of cases and the difference was statistically significant compared to the non-navigated series (71 %: p < 0.05). Regarding DLO for genu varum, the preoperative goal was reached in 92.7 % for the HKA angle and in 88.1 % for the medial proximal tibial mechanical angle (MPTMA). Regarding genu valgum deformity, the preoperative goal was achieved in 86.2 % of cases for the HKA angle and 100 % of cases for the MPTMA.

Conclusion

According to these results, one can say that, regardless the type of osteotomy, the procedure is reliable, reproducible and accurate. Since 15 years, all the osteotomies around the knee are navigated in our department. Provided that one uses a reproducible radiograph protocol, navigation allows to perform double-level osteotomies, both for genu varum and genu valgum, with optimal accuracy in order to avoid oblique joint line, which will be difficult to revise to TKA.

Level of evidence

IV.

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References

  1. Aglietti P, Menchetti PP (2000) Distal femoral varus osteotomy in the valgus osteoarthritic knee. Am J Knee Surg 13:89–95

    CAS  PubMed  Google Scholar 

  2. Babis GC, An KN, Chao EYS et al (2002) Double level osteotomy of the knee: a method to retain joint-line obliquity. J Bone Joint Surg Am 84:1380–1388

    Article  PubMed  Google Scholar 

  3. Benjamin A (1969) Double osteotomy for the painful knee in rheumatoid arthritis and osteoarthritis. J Bone Joint Surg Br 51:694–699

    CAS  PubMed  Google Scholar 

  4. Billings A, Scott DF, Camargo MP et al (2000) High tibial osteotomy with a calibrated osteotomy guide, rigid internal fixation and early motion. J Bone Joint Surg Am 82:70–79

    Article  CAS  PubMed  Google Scholar 

  5. Coventry MB, Ilstrup DM, Wallrichs SL (1993) Proximal tibial osteotomy: a critical long-term study of eighty-seven cases. J Bone Joint Surg Am 75:196–201

    Article  CAS  PubMed  Google Scholar 

  6. Finkelstein JA, Gross A, Davis A (1996) Varus osteotomy of the distal part of the femur. A survivorship analysis. J Bone Joint Surg Am 78:1348–1352

    Article  CAS  PubMed  Google Scholar 

  7. Haviv B, Bronak S, Thein R et al (2013) The results of corrective osteotomy for valgus arthritic knees. Knee Surg Sports Traumatol Arthrosc 21:49–56

    Article  PubMed  Google Scholar 

  8. Healy WL, Anglen JO, Wasilewski SA et al (1988) Distal femoral osteotomy. J Bone Joint Surg Am 70:102–109

    Article  CAS  PubMed  Google Scholar 

  9. Hernigou Ph, Medevielle D, Debeyre J et al (1987) Proximal tibial osteotomy for osteoarthritis with varus deformity: a 10 to 13-year follow-up study. J Bone Joint Surg Am 69:332–354

    Article  CAS  PubMed  Google Scholar 

  10. Hungerford DS, Krackow KA (1985) Total joint arthroplasty of the knee. Clin Orthop 192:23–30

    Google Scholar 

  11. Jackson JP, Waugh W (1961) Tibial osteotomy for osteoarthritis of the knee. J Bone Joint Surg Br 43:746–751

    PubMed  Google Scholar 

  12. Jenny JY, Tavan A, Jenny G et al (1998) Taux de survie à long terme des ostéotomies tibiales de valgisation pour gonarthrose. Rev Chir Orthop 84:350–357

    CAS  PubMed  Google Scholar 

  13. Johnson EW Jr, Bodell LS (1981) Corrective supracondylar osteotomy for painful genu valgum. Mayo Clin Proc 56:87–92

    PubMed  Google Scholar 

  14. Judet R, Dupuis JF, Honnard F et al (1964) Désaxations et arthroses du genou. Le genu varum de l’adulte. Indications thérapeutiques, résultats. Rev Chir Orthop 13:1–28

    Google Scholar 

  15. Kapandji IA (1974) Physiologie articulaire. Fascicule II quatrième édition: membre inférieur. Maloine, Paris, p 104

    Google Scholar 

  16. Lerat JL (2000) Ostéotomies dans la gonarthrose. Cahiers d’enseignement de la SOFCOT 2000. Elsevier, Paris, pp 165–201

    Google Scholar 

  17. Lootvoet L, Massinon A, Rossillon R et al (1993) Ostéotomie tibiale haute de valgisation pour gonarthrose sur genu varum: à propos d’une série de 193 cas revus après 6 à 10 ans de recul. Rev Chir Orthop 79:375–384

    CAS  PubMed  Google Scholar 

  18. Marin Morales LA, Gomez Navalon LA, Zorrilla Ribot P, Salido Valle JA (2000) Treatment of osteoarthritis of the knee with valgus deformity by means of varus osteotomy. Acta Orthop Belg 66:272–278

    CAS  PubMed  Google Scholar 

  19. Martres S, Servien E, Aït Si Selmi T et al (2004) Double ostéotomie: indication dans la gonarthrose. Rev Chir Orthop 90(suppl no 6):2S137–2S138

    Google Scholar 

  20. Mathews J, Cobb AG, Richardson S, Bentley G (1998) Distal femoral osteotomy for lateral compartment osteoarthritis of the knee. Orthopedics 21:437–440

    CAS  PubMed  Google Scholar 

  21. Merle d’Aubigné R, Ramadier JO (1961) Arthrose du genou et surcharge articulaire. Acta Orthop Belg 27:365–375

    Google Scholar 

  22. Papachristou G, Plessas S, Sourlas J et al (2006) Deterioration of long-term results following high tibial osteotomy in patients under 60 years of age. Int Orthop 30:406–408

    Google Scholar 

  23. Picard F, Leitner F, Raoult A et al (1999) Computer assisted knee arthroplasty. In: Jerosch J, Nichol K, Peikenkam K (eds) Reschnergestützte Verfahren in Orthopädie und Unfallchirurgie. Steinkopff, Darmstadt, pp 461–471

    Chapter  Google Scholar 

  24. Ramadier JO, Buard JE, Lortat-Jacob A et al (1982) Mesure radiologique des déformations frontales du genou. Procédé du profil vrai radiologique. Rev Chir Orthop 68:75–78

    CAS  PubMed  Google Scholar 

  25. Rinonapoli E, Mancini GB, Corvaglia A et al (1998) Tibial osteotomy for varus gonarthrosis. A 0 to 21-year follow-up study. Clin Orthop 353:185–193

    Article  Google Scholar 

  26. Saragaglia D, Blaysat M, Inman D, Mercier N (2011) Outcome of opening wedge high tibial osteotomy augmented with a Biosorb® wedge and fixed with a plate and screws in 124 patients with a mean of 10 years follow-up. Int Orthop 35:1151–1156

    Article  PubMed  Google Scholar 

  27. Saragaglia D, Chedal-Bornu B (2014) Computer-assisted osteotomy for valgus knees: medium-term results of 29 cases. Orthop Traumatol Surg Res 100:527–530

    Article  CAS  PubMed  Google Scholar 

  28. Saragaglia D, Mercier N, Colle PE (2010) Computer-assisted osteotomies for genu varum deformity: which osteotomy for which varus? Int Orthop 34:185–190

    Article  PubMed  Google Scholar 

  29. Saragaglia D, Blaysat M, Mercier N, Grimaldi M (2012) Results of forty two computer-assisted double level osteotomies for severe genu varum deformity. Int Orthop 36:999–1003

    Article  PubMed  Google Scholar 

  30. Saragaglia D, Picard F (2004) Computer assisted implantation of total knee endoprosthesis with no preoperative imaging: the kinematic model. In: Stiehl JB, Konerman WH, Haaker RG (eds) Navigation and robotics in total joint and spine surgery. Springer, Berlin Heidelberg, pp 226–233

    Chapter  Google Scholar 

  31. Saragaglia D, Picard F, Chaussard C et al (2001) Mise en place des prothèses totales du genou assistée par ordinateur: comparaison avec la technique conventionnelle. Résultats d’une étude prospective randomisée de 50 cas. Rev Chir Orthop 87:18–28

    CAS  PubMed  Google Scholar 

  32. Saragaglia D, Pradel Ph, Picard F (2004) L’ostéotomie de valgisation assistée par ordinateur dans le genu varum arthrosique: résultats radiologiques d’une étude cas-témoin de 56 cas. E-mémoires de l’Académie Nationale de Chirurgie 3:21–25. http://www.bium.univ-paris5.fr/acad-chirurgie

  33. Saragaglia D, Roberts J (2005) Navigated osteotomies around the knee in 170 patients with osteoarthritis secondary to genu varum. Orthopaedics 28(Suppl10):S1269–S1274

    Google Scholar 

  34. Sternheim A, Garbedian S, Backstein D (2011) Distal femoral varus osteotomy: unloading the lateral compartment: long-term follow-up of 45 medial closing wedge osteotomies. Orthopedics 34:e488–e490

    PubMed  Google Scholar 

  35. Yasuda K, Majima T, Tsuchida T et al (1992) A ten to 15 year follow-up observation of high tibial osteotomy in medial compartment osteoarthrosis. Clin Orthop 282:186–195

    Google Scholar 

  36. Zarrouk A, Bouzidi R, Karray B et al (2010) Distal femoral varus osteotomy outcome: is associated femoropatellar osteoarthritis consequential? Orthop Traumatol Surg Res 96:632–636

    Article  CAS  PubMed  Google Scholar 

  37. Zilber S, Larrouy M, Sedel L et al (2004) Distal femoral varus osteotomy for symptomatic genu valgum: long-term results and review of the literature. Rev Chir Orthop 90:659–665

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, 38130, Échirolles, France

    D. Saragaglia, B. Chedal-Bornu, R. C. Rouchy, B. Rubens-Duval, R. Mader & R. Pailhé

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  1. D. Saragaglia
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  2. B. Chedal-Bornu
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  3. R. C. Rouchy
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  4. B. Rubens-Duval
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  5. R. Mader
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  6. R. Pailhé
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Correspondence to D. Saragaglia.

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The authors declare that they have no conflict of interest.

Funding

No funds were received to do this research. D. Saragaglia receives royalties from B-Braun related to the e-Motion Knee Prosthesis. The other authors had, sometimes, financial support for attending orthopaedics meetings.

Ethical approval

This article, compilation of several published studies, does not need approval from the local ethics committee.

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Informed consent was obtained from all individual participants included in the study.

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Saragaglia, D., Chedal-Bornu, B., Rouchy, R.C. et al. Role of computer-assisted surgery in osteotomies around the knee. Knee Surg Sports Traumatol Arthrosc 24, 3387–3395 (2016). https://doi.org/10.1007/s00167-016-4302-z

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