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Joint line convergence angle predicts outliers of coronal alignment in navigated open-wedge high tibial osteotomy

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Using a navigation system in open-wedge high tibial osteotomy (OWHTO) has higher accuracy than using the conventional method. However, unintentional over- and under-correction still exist. This study aimed to compare various factors related to over- and under-correction and to assess their predictive factors in the preoperative radiographs.

Materials and methods

This study involved 96 knees. The difference in the hip–knee–ankle angle (HKA) between the intraoperative navigation system and postoperative radiograph was termed navigation correction loss (NCL). Knees with absolute values of NCL (|NCL|) ≦ 1.5° and |NCL| > 1.5° were categorised into acceptable (n = 46) and outlier (n = 50) groups, respectively. The differences in joint line convergence angle (JLCA) between varus and valgus radiographs, varus JLCA, valgus JLCA, standing JLCA and standing HKA were compared between the two groups. Clinical results were evaluated using the American Knee Society (AKS) scores.

Results

The mean intraoperative HKA in the navigation system was − 3.8 ± 1.8°, and that in the postoperative standing radiograph was − 4.2 ± 2.5° (p = 0.033). Preoperative varus, valgus and standing JLCA were higher in the outlier group (p = 0.018, p = 0.020 and p = 0.001, respectively). Logistic regression analyses for preoperative factors of |NCL| ≦ 1.5° showed that standing JLCA was a determining factor, with an odds ratio of 1.334 (confidence interval was 1.087–1.637, p = 0.006). AKS score was higher in the acceptable group (p = 0.040) postoperatively.

Conclusions

Higher preoperative standing JLCA was the predictive factor of |NCL| > 1.5°. This factor reduced the rates of under- and over-correction and resulted in better AKS score in OWHTO.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan

    Masaki Tsuji, Yasushi Akamatsu, Hideo Kobayashi, Yutaka Inaba & Tomoyuki Saito

  2. Department of Orthopaedic Surgery, Yokohama City University Medical Center, 4-57 Urahunecho, Minami-ku, Yokohama, Japan

    Naoto Mitsugi

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  1. Masaki Tsuji
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Contributions

MT participated in the design of the study, performed the measurement and statistical analysis, and drafted and revised the manuscript. YA designed the study, analysed data, and drafted and revised the manuscript critically. HK revised the manuscript critically. NM revised the manuscript critically. YI revised the manuscript critically. TS participated in the design of the study and revised the manuscript critically. All the authors have read and approved the final manuscript for publication.

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Correspondence to Masaki Tsuji.

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Conflict of interest

Masaki Tsuji, Yasushi Akamatsu, Hideo Kobayashi, Naoto Mitsugi, Yutaka Inaba, and Tomoyuki Saito declare that they have no conflict of interests.

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This study was approved by the ethics committee of our hospital and complied with ethical standards.

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Informed consent was obtained from all patients prior to enrolment.

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Tsuji, M., Akamatsu, Y., Kobayashi, H. et al. Joint line convergence angle predicts outliers of coronal alignment in navigated open-wedge high tibial osteotomy. Arch Orthop Trauma Surg 140, 707–715 (2020). https://doi.org/10.1007/s00402-019-03245-0

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