Reliability of the imaging software in the preoperative planning of the open-wedge high tibial osteotomy

  • Yong Seuk Lee
  • Min Gyu Kim
  • Hae Won Byun
  • Sang Bum Kim
  • Jin Goo KimEmail author



The purpose of this study was to verify a recently developed picture-archiving and communications system-photoshop method by comparing reliabilities between real-size paper template and the PACS-photoshop methods in preoperative planning of open-wedge high tibial osteotomy.


A prospective case series was conducted, including patients with medial osteoarthritis undergoing open-wedge high tibial osteotomy. In the preoperative planning, the picture-archiving and communications system-photoshop method and real-size paper template method were used simultaneously in all patients. Preoperative hip–knee–ankle angle, height, and angle of the osteotomy were evaluated. The reliability of this newly devised method was evaluated, and the consistency between the two methods was also evaluated using intra-class correlation coefficient.


Using the picture-archiving and communications system-photoshop method, the mean correction angle and height of osteotomy gap of rater-1 were 11.7° ± 3.6° and 10.7 ± 3.6 mm, respectively. The mean correction angle and height of osteotomy gap of rater-2 were 12.0 ± 2.6 and 10.8 ± 3.6, respectively. The inter- and intra-rater reliabilities of the correction angle were 0.956 ~ 0.979 and 0.980 ~ 0.992, respectively. The inter- and intra-rater reliabilities of the height of the osteotomy gap were 0.968 ~ 0.985 and 0.971 ~ 0.994, respectively (p < 0.001). Using the real-size paper template method, the correction angle and height of the osteotomy gap were 11.5° ± 3.4° and 10.9 ± 3.8 mm, respectively. Using the picture-archiving and communications system-photoshop method, mean values of the correction angle and height of the osteotomy gap were 11.9° ± 3.6° and 10.8 ± 3.6 mm, respectively. Consistency between the two methods by comparing the means of the correction angle and the height of the osteotomy gap were 0.985 and 0.985, respectively (p < 0.001).


Use of the picture-archiving and communications system-photoshop method enables direct measurement of the height of the osteotomy gap with high reliability.

Level of evidence



High tibial osteotomy Preoperative planning Real-size paper template Imaging software Agreement 


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Yong Seuk Lee
    • 1
  • Min Gyu Kim
    • 2
  • Hae Won Byun
    • 3
  • Sang Bum Kim
    • 2
  • Jin Goo Kim
    • 2
    Email author
  1. 1.Department of Orthopedic SurgeryGachon University Gil HospitalInchonKorea
  2. 2.Department of Orthopedic Surgery, Seoul Paik HospitalInje UniversitySeoulKorea
  3. 3.School of Information TechnologySungshin Women’s UniversitySeoulKorea

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