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      A New Preoperative Planning Technique Can Reduce Radiation Exposure During the Performance of Medial Opening-Wedge High Tibial Osteotomy

      , MD, , MD, , BA, , BA, , MD, MSc, FRCS

      HSS Journal

      Springer US

      high tibial osteotomy, bone hinge, preoperative planning, knee

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          Abstract

          Background

          Medial opening-wedge high tibial osteotomy (HTO) is one of the most common and effective HTO techniques, in which the proximal tibia is cut medially, leaving an intact lateral hinge of bone that can be opened to a variable amount for the desired correction, but the technical complications of lateral cortex fracture and intra-articular fracture are well described. The lateral bone hinge for medial opening-wedge HTO is crucial. If the hinge is too small, the tibia can fracture and become unstable, requiring further fixation. If the hinge is too large, the osteotomy can propagate into the joint as an intra-articular fracture when opening the osteotomy.

          Purpose

          We propose a new technique that utilizes digital preoperative templating to improve the accuracy of the cut. Preoperative digital templating may allow the surgeon to reproducibly obtain a lateral bone hinge of 10 mm, while also reducing radiation exposure relative to the traditional fluoroscopically assisted technique.

          Methods

          Ten cadaver extremities from five cadavers were matched into pairs and randomized into two groups: those with and without preoperative templating. The templating protocol measures the distance between two points on the medial and lateral cortices, and 20 mm is subtracted to determine the depth of the saw cut (10 mm for the hinge and another 10 mm because the proximal tibia is oval in shape). The control method was done by making the cut using fluoroscopy with tactile feedback. Postoperative computed tomography scans were obtained of all legs to measure the width of the lateral bone hinge. Intraoperative fluoroscopy used during both techniques and the numbers of fluoroscopy shots were recorded.

          Results

          We found neither the treatment group with preoperative planning nor the control group with the conventional technique had bone hinge widths that were different from the ideal 10 mm. The average hinge widths for the treatment and control groups were 11.2 and 11.5 mm, respectively. However, the treatment group was exposed to significantly less intraoperative fluoroscopy during the osteotomy cut. The average total number of fluoroscopy shots was 2.2 in the treatment group versus 6.3 for the control group.

          Conclusions

          This new preoperative planning technique achieves similar accuracy of the lateral bone hinge when compared to current methods but exposes the patient, surgeon, and staff to significantly less intraoperative radiation.

          Electronic supplementary material

          The online version of this article (10.1007/s11420-017-9591-3) contains supplementary material, which is available to authorized users.

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          Author and article information

          Contributors
          marxr@hss.edu
          Journal
          HSS J
          HSS J
          HSS Journal
          Springer US (New York )
          1556-3316
          1556-3324
          26 December 2017
          October 2018
          : 14
          : 3
          : 251-257
          Affiliations
          ISNI 0000 0001 2285 8823, GRID grid.239915.5, Hospital for Special Surgery, ; 535 East 70th Street, New York, NY 10021 USA
          Article
          PMC6148587 PMC6148587 6148587 9591
          10.1007/s11420-017-9591-3
          6148587
          30258329
          © Hospital for Special Surgery 2017
          Funding
          Funded by: Synthes
          Categories
          Original Article
          Custom metadata
          © Hospital for Special Surgery 2018

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