Open-wedge high tibial osteotomy: comparison between manual and computer-assisted techniques

Abstract

Therapeutic study, Level II.

The use of navigation in medial opening wedge high tibial osteotomy can improve tibial slope maintenance and reduce radiation exposure

“…There was an only minimal change in the tibial slope in the navigation group, whereas it increased by 3°in the conventional group. This finding agreed with three of the previous studies [10][11][12]18], but did not agree with that of another report [13]. It has generally been accepted that the posterior tibial slope increases after medial opening wedge HTO [23][24][25], as we observed in our conventional group.…”

“…Similar to the experience of the use of navigation in the total knee arthroplasty, longer operative time has been suggested as a typical disadvantage of navigated HTO, owing to tracker fixation registration, compared to the conventional surgery [10,12,14]. The authors recently reported a novel method to estimate the length of the proximal screws of the plate, using a pre-operative plain radiograph, which has so far functioned well in our navigated medial opening wedge HTO series [21].…”

“…Most of the previous studies that compared the results of navigated HTO with those after the conventional method reported that the navigated group achieved more accurate coronal alignment with less frequent outliers than the conventional group [10][11][12][13][14][15][16]. However, a concerning incidence of outliers is still reported even in navigated HTO, with a wide range, from 0 to 35 % [7,10,12,[14][15][16][17]. Whether the use of navigation improves sagittal alignment is still controversial [11][12][13]18].…”

“…However, a concerning incidence of outliers is still reported even in navigated HTO, with a wide range, from 0 to 35 % [7,10,12,[14][15][16][17]. Whether the use of navigation improves sagittal alignment is still controversial [11][12][13]18]. In addition, a theoretical advantage of the navigation is the potential to reduce radiation exposure, which has not yet been rigorously investigated [19,20].…”

Surgical accuracy in high tibial osteotomy: coronal equivalence of computer navigation and gap measurement

“…However, closer scrutiny reveals methodological deficiencies such as historical control groups [34], undefined intended corrections [27,34], variable chronology of radiological follow-up [16,27] and small sample sizes [20]. Navigated surgery is time consuming and expensive [27], so justification should be sought from improved surgical accuracy.…”