Comparison of computer-assisted navigated technology and conventional technology in high tibial osteotomy (HTO): a meta-analysis.

Background: Though some studies have reported navigated high tibial osteotomy (HTO) is a useful procedure to correct knee deformity. There is still great controversy whether navigated HTO can achieve better accuracy of limb alignment and greater clinical outcomes. Current meta-analysis was conducted to investigate whether better radiographic outcomes and clinical outcomes could be acquired in navigated HTO compared with the conventional procedure.

Method: We conducted a literature search in the electronic databases, including Medline, Embase, the Cochrane Library, and Web of Science. We identified studies published before August 2020. We also checked the references of the related articles for any relevant studies. We strictly followed the Preferred Reporting Items for Systematics reviews and Meta-Analysis (PRISMA) guidelines in this review. This research was performed using Review Manager 5.4 software.

Results: Fourteen articles were included, involving 1399 knees. Our meta-analysis indicated that patients undergoing navigated HTO had significantly better outcomes in outliers of aimed limb alignment (RD=-0.24, 95% CI: =-0.34 to -0.13,  < 0.01), outliers of aimed tibial posterior slope (TPS) (RD=-0.41, 95% CI: -0.51 to -0.30,  < 0.01), Range of Motion (ROM) (MD = 6.37, 95%CI: 0.83-11.91,  = 0.02), and American knee society knee score (AKS knee score) (MD = 3.88, 95%CI: 1.37-6.39,  = 0.002). No significant differences were found in Lysholm score (MD = 1.30, 95%CI: -0.31 to 2.90,  = 0.11), American knee society function score (AKS function score) (RD = 1.42, 95%CI: -0.15 to 2.99,  = 0.08), complications (RD=-0.01, 95% CI: = -0.05 to 0.04,  = 0.77), delayed union (RD=-0.01, 95% CI: = -0.02 to 0.03,  = 0.59), and reoperation (RD = 0, 95% CI: -0.09 to 0.10,  = 0.98) between the two groups. The operation time in the navigated group was 15.46 min longer than in the conventional group.

Conclusion: Navigated HTO provided more accurate and reproducible radiographic outcomes in the correction of the malalignment than conventional techniques, and there is no difference in the risk of complications compared with conventional HTO. However, it is unclear whether navigation HTO can achieve better clinical results. More randomized controlled trials (RCTs) with high quality, large sample size, and sufficient follow-up period are required.