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May smokers and overweight patients be treated with a medial open-wedge HTO? Risk factors for non-union

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this retrospective study was to investigate the rate of non-union after medial open-wedge high tibial osteotomy (HTO) with the Tomofix® plate. In addition, risk factors with a possible influence on the development of a non-union were analysed.

Methods

Between 2006 and 2008, a total of 186 medial open-wedge HTOs were performed in 182 patients.

Results

Ten cases of non-union (5.4%) were recorded. Risk factors with a statistically significant influence on the development of a non-union included smoking, body mass index and fracture of the lateral cortical hinge. No influence was detected for the factors age, degree of correction, concomitant diseases, postoperative complications, drug use, additionally performed procedures and use of a temporary lag screw.

Conclusion

Within this study, it could be demonstrated that the rate of non-union in medial open-wedge HTO is not higher than in the lateral closed-wedge technique. Concerning the detected risk factors, the importance of the preservation of the lateral cortex is emphasised. In addition, it is necessary to discuss the risk of non-union with smokers and overweight patients when planning the therapy. Finally, it should be considered to perform iliac crest bone grafting in these high-risk patients a priori.

Level of evidence

IV.

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References

  1. Amendola A, Bonasia DE (2010) Results of high tibial osteotomy: review of the literature. Int Orthop 34:155–160

    Article  PubMed  Google Scholar 

  2. Aydogdu S, Cullu E, Arac N et al (2000) Prolonged peroneal nerve dysfunction after high tibial osteotomy: pre- and postoperative electrophysiological study. Knee Surg Sports Traumatol Arthrosc 8:305–308

    Article  CAS  PubMed  Google Scholar 

  3. Brown CW, Orme TJ, Richardson HD (1986) The rate of pseudarthrosis (surgical nonunion) in patients who are smokers and patients who are nonsmokers: a comparison study. Spine (Phila Pa 1976) 11:942–943

    CAS  Google Scholar 

  4. Cameron HU, Welsh RP, Jung YB, Noftall F (1993) Repair of nonunion of tibial osteotomy. Clin Orthop Relat Res 278:167–169

    Google Scholar 

  5. Cobb TK, Gabrielsen TA, Campbell DC 2nd et al (1994) Cigarette smoking and nonunion after ankle arthrodesis. Foot Ankle Int 15:64–67

    CAS  PubMed  Google Scholar 

  6. Coventry MB (1984) Upper tibial osteotomy. Clin Orthop Relat Res 182:46–52

    PubMed  Google Scholar 

  7. Coventry MB, Ilstrup DM, Wallrichs SL (1993) Proximal tibial osteotomy. A critical long-term study of eighty-seven cases. J Bone Joint Surg Am 75:196–201

    CAS  PubMed  Google Scholar 

  8. Gaasbeek RD, Welsing RT, Verdonschot N et al (2005) Accuracy and initial stability of open- and closed-wedge high tibial osteotomy: a cadaveric RSA study. Knee Surg Sports Traumatol Arthrosc 13:689–694

    Article  PubMed  Google Scholar 

  9. Galla M, Lobenhoffer P, Staubli AE (2006) Die valgisierende öffnende Umstellungsosteotomie der proximalen Tibia mit Plattenfixateur. In: Lobenhoffer P, Agneskirchner JD, Galla M (eds) Kniegelenknahe Osteotomien. Indikation, Planung, Operationstechnik mit Plattenfixateuren. Thieme, Stuttgart, pp 51–64

    Google Scholar 

  10. Green E, Lubahn JD, Evans J (2005) Risk factors, treatment, and outcomes associated with nonunion of the midshaft humerus fracture. J Surg Orthop Adv 14:64–72

    PubMed  Google Scholar 

  11. Hernigou P, Ma W (2001) Open wedge tibial osteotomy with acrylic bone cement as bone substitute. Knee 8:103–110

    Article  CAS  PubMed  Google Scholar 

  12. Hoogendoorn JM, Simmermacher RK, Schellekens PP, van der Werken C (2002) Rauchen ist nachteilig für die Heilung von Knochen und Weichteilen. Unfallchirurg 105:76–81

    Article  CAS  PubMed  Google Scholar 

  13. Hunt N, Watts M, Hayes D et al (2005) Closing wedge high tibial osteotomy: review of 374 cases. J Bone Joint Surg Br 87-B:346

    Google Scholar 

  14. King AR, Moran SL, Steinmann SP (2007) Humeral nonunion. Hand Clin 23:449–456

    Article  PubMed  Google Scholar 

  15. Lee C, Dorcil J, Radomisli TE (2004) Nonunion of the spine: a review. Clin Orthop Relat Res 419:71–75

    Article  PubMed  Google Scholar 

  16. Lobenhoffer P, Agneskirchner JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11:132–138

    PubMed  Google Scholar 

  17. Lobenhoffer P, Agneskirchner J, Zoch W (2004) Die öffnende valgisierende Osteotomie der proximalen Tibia mit Fixation durch einen medialen Plattenfixateur. Orthopade 33:153–160

    Article  CAS  PubMed  Google Scholar 

  18. Lobenhoffer P (2009) Die öffnende Tibiakopfosteotomie zur Behandlung der monokompartimentalen Gonarthrose. Arthroskopie 22:223–231

    Article  Google Scholar 

  19. Miller BS, Dorsey WO, Bryant CR, Austin JC (2005) The effect of lateral cortex disruption and repair on the stability of the medial opening wedge high tibial osteotomy. Am J Sports Med 33:1552–1557

    Article  PubMed  Google Scholar 

  20. Miller BS, Downie B, McDonough EB, Wojtys EM (2009) Complications after medial opening wedge high tibial osteotomy. Arthroscopy 25:639–646

    Article  PubMed  Google Scholar 

  21. Naudie D, Bourne RB, Rorabeck CH, Bourne TJ (1999) The Install Award. Survivorship of the high tibial valgus osteotomy. A 10- to -22-year followup study. Clin Orthop Relat Res 367:18–27

    Article  PubMed  Google Scholar 

  22. Noyes FR, Mayfield W, Barber-Westin SD et al (2006) Opening wedge high tibial osteotomy: an operative technique and rehabilitation program to decrease complications and promote early union and function. Am J Sports Med 34:1262–1273

    Article  PubMed  Google Scholar 

  23. Pape D, Adam F, Rupp S et al (2004) Stabilität, Knochenheilung und Korrekturverlust nach valgisierender Tibiakopfumstellung. Eine Röntgenstereometrieanalyse. Orthopäde 33:208–217

    Article  CAS  PubMed  Google Scholar 

  24. Reischl N, Wahl P, Jacobi M et al (2009) Infections after high tibial open wedge osteotomy: a case control study. Arch Orthop Trauma Surg 129:1483–1487

    Article  PubMed  Google Scholar 

  25. Rodriguez-Merchan EC, Forriol F (2004) Nonunion: general principles and experimental data. Clin Orthop Relat Res 419:4–12

    Article  PubMed  Google Scholar 

  26. Runkel M, Rommens PM (2000) Pseudarthrosen. Unfallchirurg 103:51–63

    Article  CAS  PubMed  Google Scholar 

  27. Seide K, Wenzl ME, Wolter D, Jürgens C (2001) Posttraumatische Pseudarthrosen und Fehlstellungen des distalen Unterschenkels. Trauma und Berufskrankheit 4:301–304

    Article  Google Scholar 

  28. Spahn G (2004) Complications in high tibial (medial opening wedge) osteotomy. Arch Orthop Trauma Surg 124:649–653

    Article  PubMed  Google Scholar 

  29. Sprenger TR, Doerzbacher JF (2003) Tibial osteotomy for the treatment of varus gonarthrosis. Survival and failure analysis to 22 years. J Bone Joint Surg Am 85-A:469–474

    PubMed  Google Scholar 

  30. Staubli AE, De Simoni C, Babst R, Lobenhoffer P (2003) TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia–early results in 92 cases. Injury 34(Suppl 2):B55–B62

    Article  PubMed  Google Scholar 

  31. Takeuchi R, Ishikawa H, Aratake M et al (2009) Medial opening wedge high tibial osteotomy with early full weight bearing. Arthroscopy 25:46–53

    Article  PubMed  Google Scholar 

  32. Tjornstrand B, Hagstedt B, Persson BM (1978) Results of surgical treatment for non-union after high tibial osteotomy in osteoarthritis of the knee. J Bone Joint Surg Am 60:973–977

    CAS  PubMed  Google Scholar 

  33. Tunggal JA, Higgins GA, Waddell JP (2010) Complications of closing wedge high tibial osteotomy. Int Orthop 34:255–261

    Article  PubMed  Google Scholar 

  34. Valkering KP, van den Bekerom MP, Kappelhoff FM, Albers GH (2009) Complications after tomofix medial opening wedge high tibial osteotomy. J Knee Surg 22:218–225

    Article  PubMed  Google Scholar 

  35. van den Bekerom MP, Patt TW, Kleinhout MY et al (2008) Early complications after high tibial osteotomy: a comparison of two techniques. J Knee Surg 21:68–74

    PubMed  Google Scholar 

  36. Warden SJ, Morris HG, Crossley KM et al (2005) Delayed- and non-union following opening wedge high tibial osteotomy: surgeons’ results from 182 completed cases. Knee Surg Sports Traumatol Arthrosc 13:34–37

    Article  PubMed  Google Scholar 

  37. World Health Organisation (2000) WHO consultation on obesity. Obesity: preventing and managing the global epidemic. Geneva, Switzerland: WHO Technical Report Series 894

  38. Yacobucci GN, Cocking MR (2008) Union of medial opening-wedge high tibial osteotomy using a corticocancellous proximal tibial wedge allograft. Am J Sports Med 36:713–719

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Connollystraße 32, 80809, Munich, Germany

    Gebhart Meidinger, Andreas B. Imhoff, Martin Sauerschnig & Stefan Hinterwimmer

  2. Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany

    Jochen Paul

  3. Department of Orthopedics, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany

    Chlodwig Kirchhoff

Authors
  1. Gebhart Meidinger
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  2. Andreas B. Imhoff
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  3. Jochen Paul
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  4. Chlodwig Kirchhoff
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  5. Martin Sauerschnig
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  6. Stefan Hinterwimmer
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Correspondence to Andreas B. Imhoff.

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Meidinger, G., Imhoff, A.B., Paul, J. et al. May smokers and overweight patients be treated with a medial open-wedge HTO? Risk factors for non-union. Knee Surg Sports Traumatol Arthrosc 19, 333–339 (2011). https://doi.org/10.1007/s00167-010-1335-6

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