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DOME TIBIAL OSTEOTOMY USING A NEW INSTRUMENTATION SYSTEM AND COMPUTER NAVIGATION

This study describes dome high tibial osteotomy and demonstrates its advantages over other methods.

Twenty-five dome tibial osteotomies were done in 23 patients. All procedures were performed using an instrumentation system that allows a precise dome osteotomy. Alignment was adjusted and confirmed using fluoroscopy and computer navigation. Fixation consisted of a lateral compression staple alone (6) and supplemented with a medial buttress plate (19). Rehabilitation included early range of motion and weight-bearing. Preoperative and postoperative range of motion, Lysholm and Knee society scores, plain radiographs, and long axis films were measured.

The average follow-up was 41 months (range 6 mo. - 70 mo.). The average postoperative ROM at last follow-up was 0 extension and 125 flexion. The average preoperative knee scores improved substantially after surgery (Lysholm: 57.2 vs 88; Knee Society pain 47 vs 96 Knee Society function: 67 vs 98. Three of the six cases done with a compression staples alone failed and were revised to total knees. Two patients had removal of hardware secondary to pain. There were three transient peroneal nerve palsies, five distal small vein clots, no pulmonary emboli, and two fibular non-unions. All tibial osteotomies healed with no patella infera. Proximal tibial osteotomy remains a difficult operation. However, dome osteotomy utilizes an anterior incision, allows accurate corrections that can be confirmed with navigation, preserves anatomy, allows early rehabilitation, and does not lead to patella infera. Postoperative union occurs rapidly as long as adequate fixation is utilized.

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