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Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach
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Assessing accuracy requirements in high tibial osteotomy: a theoretical, computer-based model using AP radiographs.

L D Jones1, C P Brown2, W Jackson2

  • 1Botnar Research Centre, NDORMS, University of Oxford, Windmill Road, Oxford, UK. luke.jones@ndorms.ox.ac.uk.

Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA
|April 9, 2016
PubMed
Summary

Achieving surgical accuracy in high tibial osteotomy (HTO) is crucial for successful knee arthritis treatment. This study found that a ±0.9 mm accuracy in medial wedge opening is theoretically needed, which may be difficult with current surgical systems.

Keywords:
AccuracyHigh tibial osteotomyModel

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Area of Science:

  • Orthopedic surgery
  • Biomechanical engineering

Background:

  • High tibial osteotomy (HTO) is a popular surgical treatment for medial compartment knee arthritis.
  • Preoperative planning aims to realign the weight-bearing line (WBL) using standing AP radiographs.
  • Clinical outcomes of HTO can be unpredictable, potentially due to inaccuracies in executing the surgical plan.

Purpose of the Study:

  • To determine the theoretical accuracy of medial wedge opening required for high tibial osteotomy (HTO).
  • To assess the precision needed to achieve a preoperative target for the weight-bearing line (WBL) on the tibial plateau.

Main Methods:

  • A theoretical 2-D osteotomy model was developed.
  • The model calculated the radiological wedge opening accuracy necessary to position the WBL at 62-66% of the tibial plateau width.

Main Results:

  • The theoretical medial wedge opening requires an accuracy of ±0.9 mm to achieve the preoperative WBL target on plane radiographs.
  • This level of precision is essential for accurate preoperative plan delivery.

Conclusions:

  • Current surgical systems may not reliably achieve the ±0.9 mm accuracy needed for HTO.
  • Improved surgical accuracy aids or patient stratification are necessary to enhance clinical outcomes in HTO.
  • Surgical accuracy is a critical factor for both short- and long-term results in HTO procedures.