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High rates of outliers in computer-assisted high tibial osteotomy with excellent mid-term outcomes

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

A Correction to this article was published on 03 February 2022

This article has been updated

Abstract

Purpose

The primary aim was to evaluate the accuracy of navigation in opening wedge high tibial osteotomy (HTO). The secondary aim was to examine mid-term outcomes after HTO.

Methods

Inclusion criteria were patients with medial compartment knee osteoarthritis who underwent computer-assisted HTOs. Mechanical axis (MA), percentage MA (%MA), and change in posterior tibial slope (ΔPTS) were displayed on the navigation screen. Radiographic examinations included hip–knee–ankle (HKA) angle, medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), and PTS. Preoperative and 5 weeks postoperative standing radiographs of the whole lower extremity and knee were used. Clinical evaluations were performed using American Knee Society knee score and function score both preoperatively and at last follow-up. Radiographic evaluations were performed by orthopedic surgeons. Intraoperative navigation after osteotomy and postoperative standing radiograph were compared. MA (HKA), %MA, and ΔPTS were compared. Outliers were defined as > 3° in MA, > 10% in %MA, and > 10° in ΔPTS. Outlier and non-outlier groups were compared. The rate of conversion to arthroplasty was examined.

Results

This study involved 38 patients (44 knees) and last follow-up was at a mean of 5 years (range, 1–9 years). Mean American Knee Society knee score and function score improved significantly from 59 to 69 preoperatively to 95 and 85 at last follow-up, respectively. Absolute values of mean errors for MA, %MA, and ΔPTS were 2.1°, 9.3%, 1.2°, respectively. Outlier rates were 18% in MA, 39% in %MA, and 5% in ΔPTS. No significant factors were found in MA and ΔPTS. In %MA, preoperative JLCA was significantly higher in the outlier group compared to the non-outlier group. No knees underwent conversion to total knee arthroplasty. No differences in outcomes were found between outlier and non-outlier groups.

Conclusion

Although rates of outlier values in computer-assisted opening wedge HTO were high, mid-term outcomes were excellent.

Level of evidence

IV.

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Data availability

All data related to this case report are contained within the manuscript.

Change history

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan

    Masahiro Hasegawa, Yohei Naito, Shine Tone & Akihiro Sudo

Authors
  1. Masahiro Hasegawa
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  2. Yohei Naito
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  3. Shine Tone
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  4. Akihiro Sudo
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Contributions

MH was the main investigator and wrote the manuscript. YN and ST helped with data analysis. AS helped with the interpretation of the data and results.

Corresponding author

Correspondence to Masahiro Hasegawa.

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Conflict of interest

The authors declare that they have no conflicts of interest in the authorship and publication of this contribution.

Ethical approval

Ethical approval for the present study was obtained from the institutional review board of Mie University (Study no. H2021-111).

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We applied Opt-out method to obtain consent on this study using homepage of our institution.

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The original online version of this article was revised: Duplicated text in Article Copyright Holdername corrected.

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Hasegawa, M., Naito, Y., Tone, S. et al. High rates of outliers in computer-assisted high tibial osteotomy with excellent mid-term outcomes. Knee Surg Sports Traumatol Arthrosc 31, 399–405 (2023). https://doi.org/10.1007/s00167-021-06788-1

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  • DOI: https://doi.org/10.1007/s00167-021-06788-1

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