Anna Young September 28, 2016
Both high tibial osteotomy (HTO) and distal femoral osteotomy (DFO) procedures aren’t always straightforward and may require an alternative method to be adopted when planning for surgery. Innovative software and services are available to simplify the planning process and increase predictability of the surgical outcome.

Digital pre-operative planning using digital x-rays allows orthopaedic surgeons to plan single-cut osteotomies of the proximal tibia or distal femur for relatively simple osteotomy cases, or multiple long bone cuts for more complex osteotomy cases. For some complex high tibial and distal femoral osteotomies, planning in 3D can enable the surgeons to more accurately visualise the procedure and enhance predictability.

Planning Single-Cut High Tibial & Distal Femoral Osteotomy in 2D

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Digital pre-operative planning software can automatically calculate measurements from basic inputs and adjustments by the user. The software should include multiple x-ray, including long leg, short leg and lateral which can be used for templating. Tools and wizards within the software will identify the anatomy and permit the images to be scaled, so in a few simple steps, the user is able to calculate the measurements, plan the osteotomy, view reduction and template fixation.

Planning Osteotomies Around the Knee in 3D

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Using CT or MRI images specifically for 3D osteotomy planning, the mechanical axes can be analysed using 3D reconstruction of the anatomy. This not only allows visualization and analysis of multi-planar deformities, but also full 3D correction of those deformities, enabling a detailed 3D plan and report to be generated. The plan can include a hinge to preserve the tibial slope, wedge / graft dimensions and approximate screw lengths for fixation. Based on an approved 3D plan, 3D printing can create patient-specific osteotomy instruments, which guide standard surgical instruments and enable the osteotomy to be performed according to the plan. Further, a reference for the plate and correction angle is generated, as these custom orthopaedic instruments guide the trajectory of the screws through the plate. The plate and guide holes must simply be aligned.

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