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Www.sori.com.au Sydney Australia SORI The Accuracy and Advantages of Computer Navigation in High Tibial Osteotomy Kinzel Vera FRACS Parker David A FRACS.

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Presentation on theme: "Www.sori.com.au Sydney Australia SORI The Accuracy and Advantages of Computer Navigation in High Tibial Osteotomy Kinzel Vera FRACS Parker David A FRACS."— Presentation transcript:

1 www.sori.com.au Sydney Australia SORI The Accuracy and Advantages of Computer Navigation in High Tibial Osteotomy Kinzel Vera FRACS Parker David A FRACS Hanson Curtis MD Scholes Corey PhD Coolican Myles RJ FRACS 1 Sydney Orthopaedic Research Institute Australian Orthopaedic Association 70 th Annual Scientific Meeting Adelaide, 2010

2 www.sori.com.au Conflict of interest We have no conflict of interest to report

3 www.sori.com.au High tibial osteotomy (HTO) Used to correct lower limb malalignment Used to correct lower limb malalignment Alter mechanical axis of the lower limb Alter mechanical axis of the lower limb Treatment for knee OA Treatment for knee OA Unload damaged compartment Unload damaged compartment Transfer load to healthy cartilage Transfer load to healthy cartilage

4 www.sori.com.au HTO Planning and assessment Long-leg x-ray Long-leg x-ray Pre and post-op Intraoperative Intraoperative Jig-CW Rod or cables Fluroscopy Limitations Limitations Accuracy Radiation Inconvenience

5 www.sori.com.au Computer navigation Increasing use in orthopaedic surgery Increasing use in orthopaedic surgery Accuracy and reliability Accuracy and reliability Established in arthroplasty past 4 years Established in arthroplasty past 4 years Real time information on coronal & sagittal plane alignment Real time information on coronal & sagittal plane alignment Utilised in osteotomy past 4 years Utilised in osteotomy past 4 years

6 www.sori.com.au TKR Navigation Usage in Australia* *Source: Stryker Australia

7 www.sori.com.au Aim Compare the accuracy of the traditional form of preoperative assessment with intraoperative and postoperative assessment of the alignment utilising a computer-based navigation system. Compare the accuracy of the traditional form of preoperative assessment with intraoperative and postoperative assessment of the alignment utilising a computer-based navigation system.

8 www.sori.com.au Methods 20 Patients ( 2 female, 18 male) 20 Patients ( 2 female, 18 male) Average Age: 50.4 Average Age: 50.4 All varus alignment - HTO medial opening wedge All varus alignment - HTO medial opening wedge

9 www.sori.com.au Methods Preop Preop Long leg standing A-P xray Long leg standing A-P xray Measured mechanical axis Measured mechanical axis

10 www.sori.com.au Methods Intraop Intraop Percutaneous insertion of femoral and tibial tracker pins & registration of hip

11 www.sori.com.au Methods Intraop Intraop Arthroscopic registration of intraarticular landmarks via standard portals

12 www.sori.com.au Methods Intraop Intraop Registration of external landmarks Registration of external landmarks Osteotomy performed under continuous measurements via navigation until desired alignment achieved Osteotomy performed under continuous measurements via navigation until desired alignment achieved

13 www.sori.com.au Methods Intraop Intraop femoral head allograft and plate fixation femoral head allograft and plate fixation

14 www.sori.com.au Methods Postop Postop long leg standing A-P xrays long leg standing A-P xrays at 6 months postop. at 6 months postop.

15 www.sori.com.au Average lower limb alignment measured with x-ray and navigation Varus Valgus * * Significantly different to navigation (p<0.05)

16 www.sori.com.au Individual differences in alignment measurements pre and post-operatively

17 www.sori.com.au Discussion Navigation assisted surgery Navigation assisted surgery is becoming more popular in is becoming more popular in orthopaedic procedures orthopaedic procedures  This study demonstrates that use of navigation in osteotomy use of navigation in osteotomy yields result comparable but not yields result comparable but not identical to those using identical to those using long Leg X Rays alone long Leg X Rays alone

18 www.sori.com.au Conclusion Navigation is Navigation is Safe Safe Reliable. Reliable. Real time information Real time information Useful for dynamic Useful for dynamic monitoring during monitoring during lower limb osteotomies lower limb osteotomies

19 www.sori.com.au Conclusion Navigation provides comparable information Navigation provides comparable information in determining existing malalignment in determining existing malalignment postoperative correction in the coronal axis when compared to traditional methods postoperative correction in the coronal axis when compared to traditional methods

20 www.sori.com.au Thank you

21 www.sori.com.au Lower limb alignment measured with x-ray and navigation Varus Valgus

22 www.sori.com.au Differences in alignment measurements pre and post-operatively * * Significant difference between pre-op and post-op (p<0.05)

23 www.sori.com.au Differences in future measurements of alignment (+/- Prediction intervals)


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