CorectiAR app

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Deformities of the lower extremity can be addressed by various sort of ostotomies During classic osteotomies, the electrocatery wire under fluoroscopic control  examination, or sterile radiopaque grid placed beneath the patient’s leg intraoperatively or k wires or templates to monitor axial alignment of the leg, could help but are inaccurate 

Bone cutting One of the most required result is the accuracy of the procedure. All drill holes should be parallel in both the frontal and sagittal planes, and each bone cut with osteotom should also follow the same direction. An inappropriate drill or bone cut may cause problems, such as pin penetration of the tibial plateau or damage to the tibial neurovascular structures. With the use of navigation system, we can address this technical problems. App helps by the navigated to in real time th saw blade 

Deformity correction is the most difficult step. The navigation guidance enables the surgeon to perform deformity correction accurately. The alignment is achieved and the internal fixation implant is in place. During final correction in cases the osteotomy is complete especially the proximal tibia part could slip thus acidentally increasing or reducing the tibia slope which affects the outcome o correction. The real time in augmented reality of passive sensor helps the the surgeon to correct without repeating x-rays opposite cortical fracture, Tibial torsion is measure in real time so is if an accidental rotation of the distal part is done   the passive sensor sense this and the TT angle is changed

The benefit of computer-assisted navigation lies in the improved accuracy and precision of postoperative coronal and sagittal alignments. In addition, the navigation system can allow adjustment of the hinge axis position and reduce the risk of opposite cortical hinge fracture. Could be especially useful in Anterior cruciate ligament reconstruction combined with valgus tibial osteotomy (combined procedure) where registration could be more easily done by arthroscopic portals 

Our navigation system without needing a preoperative CT scan

displaye in real time and calculates all parameters , allowing the surgeon  to monitor the degree of corection data throughout the trial, aiding at  more complex osteotomies, such as combined femoral and tibial osteotomies (double-level osteotomy) for severe genu varum. 

During classical osteotomy techniques, it is very difficult to achieve exactly the defined preoperative objective planned over X-Rays.The lack of exact intraoperative real time control of the mechanical axis often results in post-operative malalignments, which is one reason for poor long term results. These problems can be addressed by using computer assisted surgery but are expensive and elaborate systems.

Osteotomy AR app is an App and that merges the operative field with Augmented Reality and offers intraoperative assisted quidance during Osteotomies. After intraoperative registration app offers in AR:

 - real time measurement of the deformities, navigational guidance of correction, and planning of the osteotomy. The osteotomy wedge size, joint line orientation, and tibial plateau slope are monitored.

-in real time  the result of changing parameters, eg, the orientation of the osteotomy plane. The angle of the osteotomy in the plane and the distance of the osteotomy plane to the tibial plateau can be accurately assessed predicted and seen before real osteotomy is done. 

- to see the mechanical axis and its position which is updated accordingly given , by  changing the planned mechanical axis to pass at the preferred percentage (Fujisawa point) and monitor in AR in real time its  location  while in operative field. 

- to select the spatial location of hinge axis of correction  osteotomy by changing the degree of correction in AR  the planes of osteotomy offering spatial simulation of the wedge osteotomy in AR allowing intraoperatively in an instant to comprehend what parameters could be modified favourably.

-  powerful calculations in a instant of the mechanical axis deviation (in mm) MAD, anatomical and mechanical femoral axes angle (aMFA), mechanical lateral proximal femoral angle (mLPFA), mechanical lateral distal femoral angle(mLDFA), joint line convergence angle (JLCA), mechanical medial proximal tibial angle (mMPTA), mechanical lateral distal tibial angle (mLDTA), Hip Knee Ankle line (HKA) and Mid joint line (MJL) orientation that gives the surgeon valuable objective intraoperatively informations.

- an evaluation  in real time of  the success of intended osteotomy by evaluating the kinematic alignment of the knee (KAO)  avoiding residual joint obliquity or malalignment.

- a navigating guidance of saw bone blade, surgeon is able to monitor the position and orientation of saw blade in Augmented Reality minimizing the risk of intraoperative technical pitfalls and achieve a safe and accurate osteotomy.

- errors to be discovered and corrected during the surgery, enabling the surgeon to achieve an optimally balanced leg alignment. Osteotomy wedge size, joint line orientation, and tibial plateau slope are monitored during correction. The app works as a whole interchangable interacting unit in AR which allows to modify in instant parameters. 

- to combine correction- Biplanar-, at coronal plane (a angle) and sagittal plane (β angle) by real time measuring the previous angles, tibia slope, tibia torsion and provides the direction of the the osteotomy plane (ω angle) in which (open or closed) should be made, the height the opening or closing of the wedge and the correction angle (Δ angle) which values are update in real time continuously.

-to  try intaroperatively, before real bone cuts are done different strategies in relation to the location, the type of osteotomy, the joint obliquity.

Reference 

1. Hernigou J et all Computer Navigation Technique for Simultaneous Total Knee Arthroplasty and Opening Wedge High Tibial Osteotomy in Patients with Large Tibial Varus Deformity Surg Tech Internal. 2020 Nov 28;37:265-274.

2. Sang Jun Song et all  Computer-Assisted Navigation in High Tibial Osteotomy Clin Orth Surg 2016 Dec;8(4):349-357.

3. Schröter S, et all  Surgical accuracy in high tibial osteotomy: coronal equivalence of computer navigation and gap measurement. Knee Surg Sports Traumatol Arthrosc. 2016;24:3410­-7. 

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Category: Utilities
Deformities of the lower extremity can be addressed by various sort of ostotomies During classic osteotomies, the electrocatery wire under fluoroscopic control examination, or sterile radiopaque grid placed beneath the patient’s leg intraoperatively or k wires or templates to monitor axial alignment of the leg, could help but are inaccurate Bone cutting One of the most required result is the accuracy of the procedure. All drill holes should be parallel in both the frontal and sagittal planes, and each bone cut with osteotom should also follow the same direction. An inappropriate drill or bone...

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