Abstract
BackgroundThe purpose of this study was to compare the degree of accuracy of coronal alignment correction with use of the “alignment adjustment under valgus stress technique” between expert and novice surgeons during medial opening-wedge high tibial osteotomy (MOWHTO).MethodsForty-eight patients who underwent MOWHTO performed by an expert surgeon (expert group) and 29 by a novice surgeon (novice group) were enrolled in analysis. During surgery, lower-extremity alignment was corrected using the “alignment adjustment under valgus stress technique”. Normocorrection was defined as a weight-bearing line ratio between 55 and 70% and the correction accuracy was compared between expert and novice groups using the ratio of normocorrection to outliers. The clinical outcomes were also compared using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 1 year after surgery.ResultsThe undercorrection rate was 14.6% in the expert group and 13.8% in the novice group, while the overcorrection rate was 2.1% in the expert group and 3.4% in the novice group. In the ratio of normocorrection to outliers, no difference was found between the two groups at the one-year follow-up visit (83.3% in the expert group vs. 82.8% in the novice group; p > 0.05). Also, no significant differences were seen in WOMAC subscores immediately preoperatively and at 1 year after surgery (all p > 0.05).ConclusionAdhering to the “alignment adjustment under valgus stress technique” protocol enabled novice surgeons to achieve similar surgical accuracy as that of an expert surgeon in coronal alignment during MOWHTO.Level of evidenceLevel III.
Highlights
The purpose of this study was to compare the degree of accuracy of coronal alignment correction with use of the “alignment adjustment under valgus stress technique” between expert and novice surgeons during medial opening-wedge high tibial osteotomy (MOWHTO)
The most important finding of this study was that a novice surgeon could achieve similar acceptable surgical accuracy to that of an expert surgeon in finding the acceptable correction range by applying “alignment adjustment under valgus stress technique” during MOWHTO
In the “alignment adjustment under valgus stress technique” protocol used in this study, the weight-bearing line (WBL) was shifted to the lateral side by applying valgus stress to offset the joint laxity and the amount of adjustment varied from patient to patient
Summary
The purpose of this study was to compare the degree of accuracy of coronal alignment correction with use of the “alignment adjustment under valgus stress technique” between expert and novice surgeons during medial opening-wedge high tibial osteotomy (MOWHTO). Medial opening-wedge high-tibial osteotomy (MOWHTO) is a widely used surgical treatment for medial compartment osteoarthritis (OA) of the knee with a varus deformity [1, 2], as well as isolated chondral defects in the medial compartment of the varus knee [3], osteonecrosis in the medial compartment [4], and posttraumatic arthritis and deformity [5, 6]. It shifts the weight-bearing load from the affected medial compartment to the relatively intact lateral compartment [7]. It can be difficult to attain appropriate alignment even with sufficient surgical experience in MOWHTO [13]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
