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

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Abstract

Purposes

We sought to determine the usefulness and the disadvantages of the navigation in medial opening wedge high tibial osteotomy (MOWHTO) compared to the conventional technique, in terms of target coronal alignment achievement, tibial slope maintenance, radiation exposure and operative time.

Methods

We retrospectively compared 40 knees treated with navigated MOWHTO by one surgeon with 20 knees treated with conventional MOWHTO by another surgeon. Screw length of the plate was predetermined using validated simple algorithms only in the navigation group to facilitate the operation. The acceptable range of the postoperative coronal alignment was defined as 2°–6° of the mechanical tibiofemoral angle (mTFA) and 55 %–70 % of the weight loading line coordinate (WLL). The proportion of the coronal alignment outlier, posterior tibial slope change, fluoroscopy time and operative time were compared.

Results

The coronal alignment outliers were fewer in the navigation group, but the differences were not significant (mTFA outlier 18 % vs. 30 %, p = 0.326; WLL outlier 20 % vs. 30 %, p = 0.519). Tibial slope was maintained in the navigation group (+0.3°, p = 0.732), whereas increased in the conventional group (+3°, p < 0.001). The fluoroscopy time was shorter in the navigation group (10.4 seconds vs. 24.8 seconds, p < 0.001). The operative time was comparable in both groups (41.3 minutes vs. 39.2 minutes, p = 0.232).

Conclusions

The use of navigation can improve tibial slope maintenance and reduce radiation exposure in MOWHTO, without considerable extension of operative time by optimising the surgical technique.

Level of evidence

Level III, retrospective comparative study.

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Acknowledgments

Each author certifies that his or her institution has approved the human protocol for this investigation, and that all investigations were conducted in conformity with ethical principles of research, and that informed consent was obtained. This work was performed at the Joint Reconstruction Center, Seoul National University Bundang Hospital.

Funding

No financial support was provided for this study.

Conflict of interest

Dr. Kim received research funding from Smith & Nephew and B.Braun Aesculap, and is a design consultant for Smith & Nephew and B.Braun Aesculap. None of the other authors (YGN, SHE, SJK, MJC) have relevant conflicts of interest to declare.

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Authors and Affiliations

  1. Joint Reconstruction Center, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea

    Young Gon Na, Sang Hwa Eom, Seok Jin Kim, Moon Jong Chang & Tae Kyun Kim

  2. Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea

    Tae Kyun Kim

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  1. Young Gon Na
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  2. Sang Hwa Eom
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  3. Seok Jin Kim
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  4. Moon Jong Chang
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Correspondence to Tae Kyun Kim.

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Na, Y.G., Eom, S.H., Kim, S.J. et al. The use of navigation in medial opening wedge high tibial osteotomy can improve tibial slope maintenance and reduce radiation exposure. International Orthopaedics (SICOT) 40, 499–507 (2016). https://doi.org/10.1007/s00264-015-2880-x

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  • DOI: https://doi.org/10.1007/s00264-015-2880-x

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