Reliability of Navigated Lower Limb Alignment in High Tibial Osteotomies

Author:

Goleski Patrick12,Warkentine Blaine13,Lo Darrick1,Gyuricza Cassie1,Kendoff Daniel14,Pearle Andrew D.1

Affiliation:

1. Orthopaedic Department, Hospital for Special Surgery, New York, New York

2. University of Michigan Medical School, Ann Arbor, Michigan

3. BrainLAB USA, Chicago, Illinois

4. Trauma Department, Hannover Medical School, Hannover, Germany

Abstract

BackgroundNavigation allows for determination of the mechanical axis of the lower extremity during high tibial osteotomy (HTO) procedures. The objectives of this study were to (1) evaluate the reliability of noninvasive registration with an image-free navigation system for HTO and (2) determine the accuracy of the navigation system to monitor changes in lower limb alignment as compared with alignment measured with a novel 3-dimensional computed tomography method.HypothesisNavigated limb alignment demonstrates good reliability and accuracy in all 3 planes.Study DesignDescriptive laboratory study.MethodsThirteen cadaver legs were used to examine the intra- and interobserver registration reliability of 3 observers. Initial coronal, sagittal, and axial alignment was measured on 6 legs, 3 times each, at intervals >36 hours. Navigated HTOs were then performed on all 13 legs, pre- and postoperative alignment was recorded, and data were compared with equivalent measures obtained by 3-dimensional computed tomography. Reliability and accuracy data were both analyzed using intraclass correlation coefficients with the following established thresholds: good, >0.75; fair, 0.4 to 0.75; and poor, <0.4.ResultsIntraclass correlation coefficients for intraobserver reliability were categorized as follows: varus-valgus, good; flexion-extension fair; and femoral-tibial rotation, poor. For interobserver reliability, results were varus-valgus, fair; flexion-extension, fair; and femoral-tibial rotation, poor. Intraclass correlation coefficients for navigation accuracy were varus-valgus, good; tibial slope, good; and tibial torsion, poor. Maximum differences in navigation-computed tomography measurements were Δ varus-valgus angle, 4.5°; Δ tibial slope, 8.8°; and Δ tibial torsion, 16.5°.Conclusion and Clinical RelevanceNavigation may be reliable and clinically useful for dynamic monitoring of coronal leg alignment but has limits in determination of sagittal and axial plane alignment.

Publisher

SAGE Publications

Subject

Physical Therapy, Sports Therapy and Rehabilitation,Orthopedics and Sports Medicine

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