Abstract
Background It is unclear whether computer navigation can improve the accuracy and reliability of targeted lower limb alignment correction following open-wedge high tibial osteotomy (HTO). This meta-analysis was designed to compare the accuracy and reliability of limb alignment correction between computer navigated and conventional open-wedge HTOs. Methods Studies that compared postoperative coronal alignment, including mechanical axis (MA) and weight bearing line (WBL) ratio, outliers of alignment correction, and change in tibial posterior slope, following open-wedge HTO performed using computer navigated and conventional methods were included. Results Ten studies were included in the meta-analysis. The MA (0.93°; 95% confidence interval [CI]: 0.45–1.41°; P < 0.001) and WBL ratio (1.5%; 95% CI: 0.03–2.98%; P = 0.048) were significantly greater for computer navigated HTO than for conventional HTO. Outliers of alignment correction after surgery were significantly lower in patients who underwent computer navigated HTO than in those who underwent conventional HTO (odds ratio: 0.25; 95% CI: 0.08–0.79; P = 0.02). Changes in posterior tibial slope from before to after surgery, however, were similar for the two approaches. Conclusion Computer navigated HTO resulted in slightly more valgus postoperative alignment and effectively reduced outliers of alignment correction but had no effect on change in posterior tibial slope when compared with conventional HTO.
Highlights
Open-wedge high tibial osteotomy (HTO) is easier to perform and is more adjustable for alignment correction than closed-wedge HTO; it has the advantage of avoiding the complications associated with closed-wedge HTO, such as peroneal nerve palsy [1, 2]
Computer navigation has been shown to be effective for accurate restoration of neutral alignment in patients undergoing total knee arthroplasty (TKA) [8], suggesting that computer navigation may be utilized to determine the intraoperative adequacy of alignment correction during open-wedge HTO [9]
These findings indicated that computer navigated HTO resulted in slightly more valgus coronal alignment than conventional HTO
Summary
Open-wedge high tibial osteotomy (HTO) is easier to perform and is more adjustable for alignment correction than closed-wedge HTO; it has the advantage of avoiding the complications associated with closed-wedge HTO, such as peroneal nerve palsy [1, 2]. Previous studies comparing computer navigated and conventional open-wedge HTOs have shown conflicting results It is unclear whether computer navigation can improve the accuracy and reliability of targeted lower limb alignment correction following open-wedge high tibial osteotomy (HTO). This meta-analysis was designed to compare the accuracy and reliability of limb alignment correction between computer navigated and conventional open-wedge HTOs. Methods. Studies that compared postoperative coronal alignment, including mechanical axis (MA) and weight bearing line (WBL) ratio, outliers of alignment correction, and change in tibial posterior slope, following open-wedge HTO performed using computer navigated and conventional methods were included.
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