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Open-wedge high tibial osteotomy: comparison between manual and computer-assisted techniques
R Iorio1, M Pagnottelli, A Vadalà
1Orthopaedic Unit and Kirk Kilgour Sports Injury Centre, S. Andrea Hospital, University of Rome Sapienza, Largo Olgiata 15, isola 75 edificio 3/2, 00123, Rome, RM, Italy.
Summary
Computer-assisted high tibial osteotomy (HTO) significantly improves deformity correction accuracy and reproducibility compared to conventional HTO. This navigated approach offers superior radiological outcomes for knee osteoarthritis, enhancing surgical precision.
Area of Science:
- Orthopedic surgery
- Biomechanical engineering
- Medical imaging
Background:
- Medial compartment osteoarthritis of the knee is often associated with varus deformity.
- Open-wedge high tibial osteotomy (HTO) is a surgical option to correct this alignment.
- Achieving precise mechanical axis and tibial slope correction is crucial for successful outcomes.
Purpose of the Study:
- To compare clinical and radiological outcomes of conventional versus computer-assisted (navigated) open-wedge high tibial osteotomy (HTO).
- To evaluate the accuracy and reproducibility of deformity correction in navigated HTO.
- To assess the achievement of target mechanical axis and posterior tibial slope correction.
Main Methods:
- Prospective follow-up of 27 knees in 24 patients with varus knee deformity undergoing HTO.
- Randomized division into two groups: conventional HTO (Group A) and navigated HTO (Group B).
- Clinical assessment using the American Knee Society Score and Modified Cincinnati Rating System; radiological evaluation with weight-bearing and specific knee radiographs.
Main Results:
- No statistical difference in clinical outcomes between the two groups.
- Navigated HTO (Group B) demonstrated significantly higher reproducibility in achieving the target mechanical axis (86% vs. 23%, p=0.0392).
- Navigated HTO achieved the desired posterior tibial slope modification in 100% of cases, compared to 24% in the conventional group (p=0.0021).
Conclusions:
- Computer-assisted navigation enhances the accuracy and reproducibility of deformity correction in high tibial osteotomy.
- Navigated HTO is a more precise technique for correcting varus knee alignment compared to the conventional method.
- This improved precision may lead to better long-term outcomes in patients with knee osteoarthritis.
