OsteotomyApp

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Osteotomy app
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Precise planning of deformity correction  taking into account lots of parameters leads to a predictable good result under-correction and overcorrection are known to be associated with inferior clinical outcomes 

The most common complications include postoperative malalignment and inaccurate bone cutting. Preoperative planing with very expensive software do exist but are no available to common Orthopaedic surgeon who plan a surgery in ever day practice. These problems can also be addressed by using  expensive computer assisted devices.The app intend to assists at preoperative planning the surgeon to perform deformity correction by realigning the mechanical axis to its anatomically normal position more accurately based on international literature data.

 

Mal alignment of the hip, knee, and ankle leads to premature cartilage damage and to development of degenerative arthritis of knee joint. Femoral and tibial osteotomies around the knee are established procedures for the restoration of the physiological load distribution of pressure at the knee joint. Accurate preoperative planning is mandatory to avoid under correction or overcorrection of axes or placing the joint-line in obliquity that ends to insufficient postoperative alignment.The majority of osteotomies are still planned and performed using conventional techniques drawing over transparent papers, cumbersome measurements etc. 

The app assists at preoperative correction planning by calculating  :

  • the amount of correction preoperatively by calculating the dimension of  wedge size , the correction angle and osteotomy gap opening or closing.
  • 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) ,Mid joint line (MJL) orientation.

-objectively the deviation or deformity in the frontal plane (varus or valgus) and differentiate the level of deformity (femoral and or tibial origin) and according to measured angles objectively suggest where indicated, medial or lateral, open or closed-wedge distal femur osteotomy or high-tibial osteotomy or double osteotomies  and avoiding unwanted obliquity of the joint line 

App allows he surgeon to 

  • change the planned mechanical axis to pass at the preferred percentage (Fujisawa point) after evaluation of the residual cartilage thickness left on the involved compartment.
  • select the location of hinge point of correction osteotomy for planning of varus or valgus corrections
  • evaluate in real time the success of intended osteotomy by evaluating the kinematic alignment of the knee (KAO), avoiding residual joint obliquity or malalignment. 
  • measure the correction angle adjusted due to ligament instability and preoperatively calculate the height of osteotomy gap opening.
  • pressing + or - button, one degree of correction is added or subtracted respectively and the second plane of osteotomy emerges and printed in screen real offering real time simulation of the wedge osteotomy
  • in an instant to comprehend in real time what parameters are affected and modify favourably the correction angle. All above mentioned angles and all limp axes are redrawn and updated accordingly for the given new correction angle. The drawn schematic gives the impression of settings  act as a whole interchangable interacting unit.

- dynamicaly preview and easily predict potential intraoperative errors,  that could emerge  and choose the optimal degree of correction without disruption kinematic alignment of the limp.

-to combine correction- Biplanar-, at coronal plane and  sagittal  plane (based on Hernigou 2001 calculations ) on tibia slope and provide the direction of the plane (ω angle) in which the osteotomy (open or closed) should be made ,the height the opening or closing wedge and the correction angle (Δ angle),

-to simulate, before real bone cuts are done and try different strategies in relation to the location, the type of osteotomy, the joint obliquity without to redraw in paper board countless drawings in an effort to achieve the optimal correction and mean while taking into account and balancing all influencing  preoperative factors. 

-real time dynamically change of mechanical axis lines, modify also  the  drawings of femur and the tibia and in instant depicting a precise preview of the whole preoperative plan for optimal results.

-categorisation of the deformities based to international literature normal references values, help to indicate to user the type of osteotomy.

- pressing the undo button user can easily return to previous stage and modify the selection of points or change the above mentioned parameter respectively.

-biplanar correction of a deformity namely in two planes: coronal  and sagittal Helpful feature in case tibia slope should also corrected. A new angle of correction namely delta angle  (Δ) of opening or closing  osteotomy- situated in the new plane omega (ω), the height of opening or closing osteotomy δDD’ is calculate. (Hernigou tables 2001).

This powerful features allow surgeon in an instant to comprehend in real time by updating  simultaneously all relevant parameters by changing the correction angle and thus helping to differentiate between a femoral and or tibial cause of  deformity and avoiding osteotomies that could  worse joint obliquity.

The real time kinematic evaluation done after correction of the deformity assist in real time the optimal angle selection for uneventful correction of deformity taking into account all factors that potentially affect the end result.

 Both proximal tibial head osteotomies (HTO = high-tibial osteotomy) and supracondylar femoral osteotomies (DFO = distal femur osteotomy) can be performed in additive technique (open-wedge) or subtractive technique (closed-wedge) be planned.

The app intend to assists at preoperative planning the surgeon to perform deformity correction by realigning the mechanical axis to its anatomically normal position more accurately.

Allows to differentiate between a femoral and a tibial cause of malalignment and to avoid instability taken into account dynamic preview simultaneouslally

The optimal correction is calculated by an easy and handy way by the aid of app preoperative planning and helps

  Restoring the mechanical axis by osteotomies around knee is easily calculated and presented on screen. In addition by measuring  Hip Knee Ankle line (HKA) and Mid joint line (MJL) orientation.App allows to evaluate in real time the success of intended osteotomy by evaluating the kinematic alignment of the knee (KAO), avoiding residual joint obliquity or malalignment.The preoperative planning methods outlined can be applied to both closed- and open-wedge osteotomies to normalize knee joint angles and the orientation of the midjoint line.  Depending on the determined opening angle and the length of the osteotomy cut (mediolateral diameter of the osteotomy) the corresponding opening height can be derived

This powerful features allow surgeon. By drawing schematically the femur and the tibia  while in the meantime changing the lines dynamically and parameters as a whole interchangable interacting system gives at the surgeon a precise and assist in real time thus selecting the optimal angle without disruption kinematic alignment or accidentally affecting joint obliquity

   All information received from the software output must be clinically reviewed regarding its plausibility before patient treatment!  App indicated for assisting healthcare professionals. Clinical judgment and experience are required to properly use the software.These instructions alone do not replace in depth training in planning for osteotomies. It only serves as a general guideline.

Any influence the operators in making decisions during operation remains Surgeons own responsibility and experience. A surgeon must always rely on his or her own professional clinical judgement when deciding whether to use a particular technique when treating a particular patient. App does not dispense medical advice. The software is not for primary image interpretation. It is recommended that surgeons must be trained in the use before using it in real surgery.

Reference

  1. Miniaci A, FT Ballmer, PM Ballmer, RP Jakob.  “Proximal tibial osteotomy: a new fixation device.” Clin Orthop Relat Res (246) (1989): 250–9. 
  2. Müller W. “High Tibial Osteotomy, European Instructional Course Lectures.” The British Editorial Society of Bone and Joint Surgery 5 (2001): 194–200. 
  3. Paley D. Principles of Deformity Correction. Berlin, Heidelberg: Springer. 2002. 
  4. Ruedi T, R Buckley, C Moran. AO/ASIF Principles of Fracture Management. New York: Thieme. 2007.
  5. Hernigou P, Medevielle D, Debeyre J, et al (1987) Proximal tibial osteotomy for osteoarthritis with varus deformity: A ten to thirteen-year follow-up study. J Bone Joint Surg Am; 69(3):332–354.
  6. Fujisawa Y, Masuhara K, Shiomi S (1979) The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am; 10(3):585–608.
  7. Brown G, Amendola A (2000) Radiographic evaluation and preoperative planning for high tibial osteotomies. Operative echn Sports Med; 8:2–14.
  8. Jacobi M, Jakob RP (2005) Open wedge osteotomy in the treatment of medial osteoarthritis of the knee. Tech Knee Surg; 4(2):70–78.
  9. Hernigou P (2002) Open wedge tibial osteotomy: combined coronal and sagittal correction. Knee; 9(1):15–20.
  10. Schroter S, Gunzel J, Freude T, et al. Precision in the planning of open wedge HTO. Z Orthop Unfall, 2012, 150: 368–373. 
  11. Book - Philipp Lobenhoffer Ronald J van Heerwaarden Alex E Staubli Roland P Jakob Osteotomies around the Knee Indications—Planning—Surgical techniques using plate fixators AO publication Thieme   ISBN 978-3-13-147531-2

http://www.orthopractis.com

https://apps.apple.com/gr/app/osteotomyapp/id1541531012?l=en

https://youtu.be/XbIP4ViibAk

https://youtu.be/vd6T2YTNM9U    

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Precise planning of deformity correction taking into account lots of parameters leads to a predictable good result under-correction and overcorrection are known to be associated with inferior clinical outcomes The most common complications include postoperative malalignment and inaccurate bone cutting. Preoperative planing with very expensive software do exist but are no available to common Orthopaedic surgeon who plan a surgery in ever day practice. These problems can also be addressed by using expensive computer assisted devices.The app intend to assists at preoperative planning the surgeon to perform deformity correction by realigning the mechanical...

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