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Navigated versus Conventional Technique in High Tibial Osteotomy: A Meta-Analysis Focusing on Weight Bearing Effect
Kyung Wook Nha, MD, PhD1,*, Young-Soo Shin, MD, PhD2,*, Hyuk Min Kwon, MD3, Jae Ang Sim, MD, PhD3, and Young Gon Na, MD3
1Department of Orthopedic Surgery, Inje University Ilsan Paik Hospital, Goyang; 2Department of Orthopedic Surgery, College of Medicine, Hallym University Hospital, Chuncheon; 3Department of Orthopedic Surgery, Gachon University Gil Medical Center, Incheon, Korea
Correspondence to: Young Gon Na, MD
Department of Orthopedic Surgery, Gachon University Gil Medical Center, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 21565, Korea
Tel: +82-32-460-3384, Fax: +82-32-461-3214
E-mail: orthonyg@gmail.com
*These authors contributed equally to this study.
Received: November 20, 2017; Revised: December 1, 2018; Accepted: February 8, 2019; Published online: March 18, 2019.
© Korean Knee Society. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Purpose: We aimed to determine whether navigated opening wedge high tibial osteotomy (HTO) is superior to the conventional technique in terms of accuracy of the coronal and sagittal alignment correction, functional outcome, and operative time.
Methods: Studies comparing navigated and conventional HTO were included in this meta-analysis. We compared the incidence of radiological outliers in coronal alignment and tibial slope maintenance, mean differences in functional outcome scales, and operative time. Subgroup analyses were performed on coronal alignment accuracy based on the intraoperative method of alignment confirmation: fluoroscopy vs. gap measurement method.
Results: Twelve studies were included: there were 434 knees in the navigated HTO studies and 405 knees in the conventional HTO studies. The risk of outlier was lower in navigated HTO than in conventional HTO; however, the difference was not significant when navigated HTO was compared with conventional HTO performed using the gap measurement method. Tibial slope maintenance was comparable or better in navigated HTO. No difference was found in the American Knee Society function and Lysholm scores. Navigated HTO necessitated a longer operative time of approximately 10 minutes.
Conclusions: The use of navigation in HTO can improve accuracy in both coronal and sagittal alignments, but its clinical benefit is unclear.
Keywords: Knee, Osteoarthritis, Tibia, Osteotomy, Computer-assisted surgery, Meta-analysis


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