THE PLANE RADIOGRAPH OF THE KNEE FOR HIGH TIBIAL OSTEOTOMY ASSESSMENT IS IN CONTRAST TO STANDING ALIGNMENT VIRTUALLY ELABORATED HANDLING BASED PRE-OPERATION PLANNING

High Tibial Osteotomy (HTO) is a popular approach among contemporary corrective lower extremity procedures. As a surgical method in the HTO, the Open-Wedge High Tibial Osteotomy (OWHTO) preserves leg length, avoids dissection near the nerve and allows for fine-tuning of the angle by gradually inserting a wedge into a tibia. Nowadays, the gold standard approach to the OWHTO is based on the patient’s Long-Leg Radiograph (LLR) assessment. These standard weight bearing views of the lower extremity have their own practical advantages. This study aims to closely look at existing gold standard OWHTO planning method and assess its accuracy compared to a true patient’s weight bearing posture. The study attempts to introduce a method which can be used as a template for the HTO planning and has less weakness than the existing method. This method will assess the lower limb weight bearing three-dimensionally using a patient specific Computer Tomography (CT) data. The method has been validated using a Standing Alignment Virtually Elaborated Handling (SAVEH) of the lower limb using fluoroscopy giving an in vivo dynamic weight bearing analysis of the knee. The outcome of typical examples on assessment of the natural mechanical axis of the knee using proposed method has shown more accuracy than common two-dimensional LLR image control method. The study concluded that looking at the OWHTO without any address of the real three-dimensional orientation of the knee bones specially during standing phase of gait may be a missing point of view on OWHTO surgery.