Introduction: Longterm results after valgisational high tibial osteotomy in gonarthrosis depend of the exact correction of the weight bearing line. This line should intersect the knee joint line at 30-40% lateral of the tibia plateau center (Fujisawa 1979). An undercorrection with a remaining varus-axis leads as well as a too generous overcorrection to a fast progress of the gonarthrosis. Intra-operatively the correction of the axis clinically can only be estimated in an insufficient way with the conventional technique or more precisely, but exposing the patient to a very high radiation. The imageless, kinematic navigation offers real-time data during the operation to the surgeon, independent from the rotation and under functional load. Materials and Methods: Up to now more than 150 patients with an average age of 54 years (min. 16 years/ max. 80 years) have been treated because of varus gonarthrosis with valgisational high tibial osteotomies with support of an imageless navigation system (OrthoPilot~R, B. Braun Aesculap, Tuttlingen, Germany). After preoperative planning, intra-operative referencing and comparison of the axis deformity with preoperatively performed long-leg X-rays, the high tibial osteotomy has been performed in closing-wedge technique and with support of imageless navigation. The system shows the ligament situation, the functional weight bearing line under loading conditions linked to the Fujisawa-calculation. Intra-operatively the height of the osteotomy-wedge was computed and the run of the saw in the bone is virtually displayed. A pathological tibial slope could be corrected under navigation control.
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