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

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Medial opening wedge high tibial osteotomy (MOW HTO) is now a successful operation with a range of indications, requiring an individualised approach to the choice of intended correction. This manuscript introduces the concept of surgical accuracy as the absolute deviation of the achieved correction from the intended correction, where small values represent greater accuracy. Surgical accuracy is compared in a randomised controlled trial (RCT) between gap measurement and computer navigation groups.

Methods

This was a prospective RCT conducted over 3 years of 120 consecutive patients with varus malalignment and medial compartment osteoarthritis, who underwent MOW HTO. All procedures were planned with digital software. Patients were randomly assigned into gap measurement or computer navigation groups. Coronal plane alignment was judged using the mechanical tibiofemoral angle (mTFA), before and after surgery. Absolute (positive) values were calculated for surgical accuracy in each individual case.

Results

There was no significant difference in the mean intended correction between groups. The achieved mTFA revealed a small under-correction in both groups. This was attributed to a failure to account for saw blade thickness (gap measurement) and over-compensation for weight bearing (computer navigation). Surgical accuracy was 1.7° ± 1.2° (gap measurement) compared to 2.1° ± 1.4° (computer navigation) without statistical significance. The difference in tibial slope increases of 2.7° ± 3.9° (gap measurement) and 2.1° ± 3.9° (computer navigation) had statistical significance (P < 0.001) but magnitude (0.6°) without clinical relevance.

Conclusion

Surgical accuracy as described here is a new way to judge achieved alignment following knee osteotomy for individual cases. This work is clinically relevant because coronal surgical accuracy was not superior in either group. Therefore, the increased expense and surgical time associated with navigated MOW HTO is not supported, because meticulously conducted gap measurement yields equivalent surgical accuracy.

Level of evidence

I.

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Acknowledgments

The gratitude of the authors goes to the participants who have made this study possible. Furthermore, the authors would particularly like to thank the staff of the radiology department at the BG Trauma Center Tübingen.

Grant

Supported by DGUV (Deutsche Gesetzliche Unfallversicherung) FR150.

Author information

Authors and Affiliations

  1. Department of Traumatology and Reconstructive Surgery, BG Traumacenter Tübingen, University of Tübingen, Schnarrenbergstr. 95, Tübingen, Germany

    S. Schröter, C. Ihle, S. Döbele, U. Stöckle & A. Ateschrang

  2. Department of Orthopaedics, Queen Elizabeth Hospital, Gateshead, UK

    D. W. Elson

Authors
  1. S. Schröter
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  2. C. Ihle
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Corresponding author

Correspondence to D. W. Elson.

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Conflict of interest

SS is a member of the AO Joint Preservation and Osteotomy Expert Group. DWE is chairman of the United Kingdom Knee Osteotomy Registry, steering committee. The other authors have no conflicts of interest to declare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Additional information

The study was performed with approval from the ethical committee at the University of Tübingen (142/2008MPG2). This is trial number DRKS00005614, included in the German register for clinical trials (approved primary register of the WHO network).

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Schröter, S., Ihle, C., Elson, D.W. et al. Surgical accuracy in high tibial osteotomy: coronal equivalence of computer navigation and gap measurement. Knee Surg Sports Traumatol Arthrosc 24, 3410–3417 (2016). https://doi.org/10.1007/s00167-016-3983-7

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  • DOI: https://doi.org/10.1007/s00167-016-3983-7

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