Are navigation systems accurate enough to predict the correction angle during high tibial osteotomy? Comparison of navigation systems with 3-dimensional computed tomography and standing radiographs.
BACKGROUND
Unpredicted overcorrection of the mechanical axis can occur during navigation-assisted high tibial osteotomy (HTO). It is not clear whether the erroneous overcorrection stems from the navigation system itself or from other causes.


OBJECTIVE
To evaluate the accuracy of the navigation system in HTO by comparing the change in the femorotibial angle provided by the navigation system with the bony correction angle of the proximal tibia on 3-dimensional computed tomography (3D CT) and with the change in mechanical femorotibial alignment on standing whole-leg radiographs.


METHODS
Cohort study (diagnosis); Level of evidence, 2.


METHODS
A total of 16 knees underwent navigation-assisted HTO, and their alignment data were obtained before and after correction. For comparison, preoperative and follow-up standing whole-leg anteroposterior radiographs, lateral knee radiographs, and preoperative and postoperative 3D CT scans were taken. The medial proximal tibial angle (MPTA), posterior tibial slope, and mechanical femorotibial angle (mFTA) were measured in these images, and the 3 coronal and 3 sagittal correction angles were compared with each other.


RESULTS
In the coronal plane, the mean correction angle of the navigation system was 9.3° ± 2.0° valgus (range, 6°-13°), and the mean MPTA on 3D CT increased 9.7° ± 2.0° (range, 6.7°-13.8°) after correction. The mean correction angle of the mFTA on standing radiographs was 11.9° ± 3.2° valgus (range, 6.9°-16.5°). There was no statistical significance between the navigation system and 3D CT (P = .187), but there was a statistically significant difference between the navigation system and standing radiographs (P = .001). The results of the correction angle in the sagittal plane were similar to those in the coronal plane.


CONCLUSIONS
The correction of the femorotibial angle by the navigation system was not different from the bony correction angle on 3D CT. There was a discrepancy between the correction angle of the navigation system and that of the standing radiograph.


CONCLUSIONS
Surgeons must be cautious about the tension of soft tissue, even when using the navigation system during HTO.
Joon Ho Wang, Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, #81, Irwon-Ro, Gangnam-gu, Seoul, 135-710, Korea. mdwang88@gmail.com.
Bong Soo
BS
Kyung
Jae Gyoon
JG
Kim
Ki-Mo
KM
Jang
Minho
M
Chang
Young-Wan
YW
Moon
Jin Hwan
JH
Ahn
Joon Ho
JH
Wang
D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013977:Tibia / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed
accuracy; computer-assisted surgery; correction angle; high tibial osteotomy; navigation