Coronal Alignment Correction and Maintenance of Tibial Slope in Opening-Wedge Valgus High Tibial Osteotomy Using a 4-Reference Kirschner Wire Technique: A Cadaveric Study

Intraoperative Angle Measurement of Anatomical Structures: A Systematic Review

Ensuring precise angle measurement during surgical correction of orientation-related deformities is crucial for optimal postoperative outcomes, yet there is a lack of an ideal commercial solution. Current measurement sensors and instrumentation have limitations that make their use context-specific, demanding a methodical evaluation of the field. A systematic review was carried out in March 2023. Studies reporting technologies and validation methods for intraoperative angular measurement of anatomical structures were analyzed. A total of 32 studies were included, 17 focused on image-based technologies (6 fluoroscopy, 4 camera-based tracking, and 7 CT-based), while 15 explored non-image-based technologies (6 manual instruments and 9 inertial sensor-based instruments). Image-based technologies offer better accuracy and 3D capabilities but pose challenges like additional equipment, increased radiation exposure, time, and cost. Non-image-based technologies are cost-effective but may be influenced by the surgeon's perception and require careful calibration. Nevertheless, the choice of the proper technology should take into consideration the influence of the expected error in the surgery, surgery type, and radiation dose limit. This comprehensive review serves as a valuable guide for surgeons seeking precise angle measurements intraoperatively. It not only explores the performance and application of existing technologies but also aids in the future development of innovative solutions.

Kirschner Wire Reference Technique in Open-Wedge High Tibial Osteotomy

Open-wedge high tibial osteotomy is a common procedure to treat young adult and adult patients with symptomatic varus malalignment. The purpose of the high tibial osteotomy is to shift the mechanical load from the medial compartment to the lateral compartment. There are several methods to determine the correct alignment, such as the cable method, the gap measurement method, the navigator system, or the patient-specific cutting guide method. The cable and gap measurement techniques are easy to use, but the results of these techniques are unpredictable. The navigator and patient-specific cutting guide methods have high accuracy in attaining the desired correction alignment, but they are quite costly. We propose a technique we call the Kirschner wire reference method, which is easy to use to achieve the desired alignment correction, without requiring specialized or expensive equipment.