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Published in N°275 - June/July 2018
Article viewed 195 times

"Patient-Specific" Cutting, Correction and Implant Positioning for High Tibial Osteotomy

By M. Ollivier, C. Jacquet, J-N. Argenson, X. Fletcher, S. Parratte in category TECHNIQUE
Institute of Movement and Locomotion, UMR CNRS 787/AMU --- Matthieu Ollivier, lecturer/consultant, Institute of Movement and Locomotion Department of Orthopaedics and Traumatology, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29 13274 Marseille, France [email protected] (publishable) Author for correspondence and requests for reprints.

In patients with limited osteoarthritis and a mechanical lower limb defect, a high tibial osteotomy (HTO) is the ideal conservative treatment[3]. Medial opening wedge HTO is becoming increasingly popular in France, with a considerably reduced interest in its lateral counterpart, which involves a hazardous osteotomy of the neck of fibula.

Introduction

In patients with limited osteoarthritis and a mechanical lower limb defect,[1] a high tibial osteotomy (HTO) is the ideal conservative treatment[3]. Medial opening wedge HTO is becoming increasingly popular in France, with a considerably reduced interest in its lateral counterpart, which involves a hazardous osteotomy of the neck of fibula. Regardless, the efficacy of HTO is dependent upon optimal angular correction in the frontal and sagittal planes,[3-6] and literature indicates a tendency towards under correction.[7-8] Likewise, protecting the lateral hinge of a medial opening osteotomy is key to ensuring accurate stabilization and correction of the mechanical axes of the leg.[9-11] Not yet having adopted navigation-guided HTO, which allows in-situ monitoring of the procedure, we thought it would be useful to develop patient-specific cutting guides for our osteotomies. We therefore focused on various ways in which our technique could be improved:

- Correction accuracy.
- Reliability in inexperienced hands.
- Hinge protection.
- Limiting the use of radioscopy.
- Reducing operating time.

 

Our PSI HTO procedure

Virtual osteotomy

For all patients eligible for an osteotomy using this technique, the surgeon must complete a request form stating the preoperative...

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