Opening wedge high tibial osteotomy: navigation system compared to the conventional technique in a controlled clinical study

Abstract

Purpose This study aimed to verify if the navigation system used in high tibial osteotomy (HTO) adds precision to the procedure regarding mechanical axis correction and prevention of tibial slope increases. Methods In this historically controlled study, patients with medial osteoarthrosis and genuvarum underwent HTO between 2004 and 2012; the first 20 were operated with the conventional technique, using pre-planning correction by the Dugdale method and 18 further patients were operated with the navigation system introduced in our hospital. Results The two groups were similar for pre-operative mechanical axis (mean 8.10±3.14 for the control and 6.60± 2.50 for the navigated group), pre-operative tibial slope (mean 8.95±3.47 versus 8.17±3.11, respectively) and Lyshom score (40.85±15.46 and 44.83±16.86). After surgery, the control group presented mean mechanical axis of 3.35±3.27, tibial slope of 13.75±3.75 and Lyshom score of 87.60±11.12. The navigated group showed a postoperative mechanical axis mean of 3.06±1.70, tibial slope of 10.11±0.18 and Lyshom score of 91.94±11.61. Conclusions The navigation system allowed a significantly better control of tibial slope. Patients operated with the navigation system had significantly better Lysholm scores.

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.…”

“…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

“…More sophisticated statistical representations include the coefficient of variance [35] or outlier rates around a defined tolerance [14,34]. Ribeiro et al [35] demonstrated a higher variance for the control group (97 %), compared to their navigated group (58 %), a finding not emulated here, with no difference between groups and low standard deviation. The 3.0° tolerance set by Gebhard et al [14] was achieved in 85 % of their recruited patients.…”

“…This study's navigated group demonstrated the same slope increase (2.1°). The gap measurement slope increase of 2.7° is closer to the navigated group than the control group from Ribeiro et al [35]. Iorio et al [20] present favourable accuracy in a small, navigated group when compared to fluoroscopic confirmation.…”

Comparative Study of Opening-Wedge High Tibial Osteotomy With and Without a Combined Computed Tomography–Based and Image-Free Navigation System

“…17 Previous researchers reported that use of image-free navigation systems improved the intraoperative technique. [17][18][19][20][21][22] These systems can be monitored 2-or 3-dimensionally in real time. Meanwhile, a computed tomography (CT)ebased navigation system, which is related to both accurate preoperative planning and accurate intraoperative technique, has already been used to plan the osteotomy plane preoperatively and to insert guide wires on the virtual osteotomy plane on-screen intraoperatively in closedwedge high tibial osteotomy.…”