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J Knee Surg 2024; 37(01): 049-055
DOI: 10.1055/a-1965-5631
Original Article

Use of Grafts on an Open Gap Is Advantageous for Preventing Correction Loss in 1-Week Staged Bilateral Open-Wedge High Tibial Osteotomies

Kyoung Ho Yoon
1   Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
,
Sang Jun Song
1   Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
,
Sung Hyun Hwang
1   Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
,
Cheol Hyun Jung
1   Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
,
Cheol Hee Park 
1   Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
› Author Affiliations Funding None.
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Abstract

One-week staged bilateral open-wedge high tibial osteotomies (OWHTOs) can be a safe procedure, with the added advantage of fast functional recovery, cost saving, and reduced hospital stay. However, there can be concerns about correction loss after 1-week staged OWHTOs because high loading is inevitably applied to osteotomy sites during postoperative weight bearing. Although leaving the osteotomy site with no grafts is possible in OWHTOs, the use of grafts can provide additional stability to the osteotomy site and prevent correction loss. We compared the amount and incidence of correction loss between 1-week staged bilateral OWHTOs with and without allogenic bone grafts. Seventy-five patients who underwent 1-week staged bilateral OWHTOs with a locking spacer plate (Nowmedipia, Seoul, Korea) by a single surgeon were retrospectively reviewed. Allogenic cancellous bone grafts were applied in 53 patients (group G; 106 knees, operated consecutively between 2012 and 2017) but not in 22 patients (group N; 44 knees, operated consecutively between 2017 and 2019). Demographics were similar between the groups. Radiographically, the mechanical axis (MA), medial proximal tibial angle (MPTA), and posterior tibial slope (PTS) were evaluated preoperatively and within 1 year postoperatively. Unstable hinge fracture was investigated using computed tomography in all cases. The incidence of correction loss (MPTA loss ≥ 3 degrees) was determined. There were no significant differences in the MA, MPTA, and PTS between the groups preoperatively and 2 weeks postoperatively. The incidence of unstable hinge fractures did not differ. The losses in MA, MPTA, and PTS during the first postoperative year were significantly greater in group N than in group G (MA, −5.5 vs. −2.3 degrees; MPTA, −3.0 vs. 0 degrees; PTS, −2.0 vs. −0.7 degrees; p < 0.05 on all parameters). The correction loss incidence was 6.6% (7/106) and 31.8% (14/44) in groups G and N, respectively (p < 0.001). Appropriate treatment is necessary to prevent correction loss in 1-week staged bilateral OWHTOs. Grafting, which provides additional stability to the osteotomy site, is a recommended method. Level of evidence is IV.

Keywords

knee - high tibial osteotomy - open-wedge - staged - correction loss

Ethics Approval

This study was approved by our Institutional Review Board (KHMC 17-11-046).


Informed Consent

Informed consent was obtained from all patients before commencing the review.




Publication History

Received: 05 July 2022

Accepted: 18 October 2022

Accepted Manuscript online:
21 October 2022

Article published online:
30 December 2022

© 2022. Thieme. All rights reserved.

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333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Ogawa H, Matsumoto K, Sengoku M. et al. Clinical course and outcomes of simultaneous-versus staged-bilateral medial opening wedge high tibial osteotomy. Asia Pac J Sports Med Arthrosc Rehabil Technol 2020; 23: 13-17
    PubMedGoogle Scholar
  • 2 Song IS, Kwon J. Analysis of changes in tibial torsion angle on open-wedge high tibial osteotomy depending on the osteotomy level. Knee Surg Relat Res 2022; 34 (01) 17
    CrossrefPubMedGoogle Scholar
  • 3 Kim JH, Jung WH, Jeon SS, Kim JH. Combination of cylindrical autologous bone grafting technique with a metallic block insertion in open-wedge high tibial osteotomy. Arthrosc Tech 2021; 10 (02) e367-e373
    CrossrefPubMedGoogle Scholar
  • 4 Hernigou P, Giber D, Dubory A, Auregan JC. Safety of simultaneous versus staged bilateral opening-wedge high tibial osteotomy with locked plate and immediate weight bearing. Int Orthop 2020; 44 (01) 109-117
    CrossrefPubMedGoogle Scholar
  • 5 Belsey J, Diffo Kaze A, Jobson S. et al. Graft materials provide greater static strength to medial opening wedge high tibial osteotomy than when no graft is included. J Exp Orthop 2019; 6 (01) 13
    CrossrefPubMedGoogle Scholar
  • 6 Neirynck J, van Beek N, Claes T, Claes S, Bartholomeeusen S. Simultaneous bilateral opening-wedge high tibial osteotomy with structural allograft impaction results in excellent early recovery and pain reduction similar unilateral osteotomy. Knee 2021; 30: 283-290
    CrossrefPubMedGoogle Scholar
  • 7 Alosh H, Shah RP, Courtney PM, Virk S, Israelite CL. One-week staged bilateral total knee arthroplasty protocol: a safety comparison of intended and completed surgeries. J Arthroplasty 2014; 29 (06) 1176-1180
    CrossrefPubMedGoogle Scholar
  • 8 Courtney PM, Melnic CM, Alosh H, Shah RP, Nelson CL, Israelite CL. Is bilateral total knee arthroplasty staged at a one-week interval safe? A matched case control study. J Arthroplasty 2014; 29 (10) 1946-1949
    CrossrefPubMedGoogle Scholar
  • 9 Han JH, Kim HJ, Song JG. et al. Is bone grafting necessary in opening wedge high tibial osteotomy? A meta-analysis of radiological outcomes. Knee Surg Relat Res 2015; 27 (04) 207-220
    CrossrefPubMedGoogle Scholar
  • 10 Lobenhoffer P, Agneskirchner JD. Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2003; 11 (03) 132-138
    CrossrefPubMedGoogle Scholar
  • 11 Zorzi AR, da Silva HG, Muszkat C, Marques LC, Cliquet Jr A, de Miranda JB. Opening-wedge high tibial osteotomy with and without bone graft. Artif Organs 2011; 35 (03) 301-307
    CrossrefPubMedGoogle Scholar
  • 12 Kim SJ, Nguyen LT, Seo YJ. et al. Bone healing on serial plain radiographs occurs slowly but adequately after medial opening wedge high tibial osteotomy without bone graft. Knee Surg Sports Traumatol Arthrosc 2022; 30 (03) 993-1000
    CrossrefPubMedGoogle Scholar
  • 13 Park HJ, Kang SB, Chang MJ, Chang CB, Jung WH, Jin H. Association of gap healing with angle of correction after opening-wedge high tibial osteotomy without bone grafting. Orthop J Sports Med 2021; 9 (05) 23259671 211002289
    PubMedGoogle Scholar
  • 14 Takeuchi R, Aratake M, Bito H. et al. Simultaneous bilateral opening-wedge high tibial osteotomy with early full weight-bearing exercise. Knee Surg Sports Traumatol Arthrosc 2008; 16 (11) 1030-1037
    CrossrefPubMedGoogle Scholar
  • 15 Goshima K, Sawaguchi T, Shigemoto K, Iwai S, Fujita K, Kataoka T. Plate removal without loss of correction after open-wedge high tibial osteotomy is possible when posterior cortex bone union reaches osteotomy gap center even in incompletely filled gaps. Knee Surg Sports Traumatol Arthrosc 2020; 28 (06) 1827-1834
    CrossrefPubMedGoogle Scholar
  • 16 Eriksen EF. Treatment of osteopenia. Rev Endocr Metab Disord 2012; 13 (03) 209-223
    CrossrefPubMedGoogle Scholar
  • 17 Snyder S. Bisphosphonates for osteopenia in postmenopausal women. JAMA 2020; 323 (11) 1096
    CrossrefPubMedGoogle Scholar
  • 18 Sivertsen EA, Vik J, Meland ASV, Nerhus TK. The Dugdale planning method for high tibial osteotomies underestimates the correction angle compared to the Miniaci method. Knee Surg Sports Traumatol Arthrosc 2023; 31 (04) 1507-1514
    CrossrefPubMedGoogle Scholar
  • 19 Fujisawa Y, Masuhara K, Shiomi S. The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am 1979; 10 (03) 585-608
    CrossrefPubMedGoogle Scholar
  • 20 Kang BY, Lee DK, Kim HS, Wang JH. How to achieve an optimal alignment in medial opening wedge high tibial osteotomy?. Knee Surg Relat Res 2022; 34 (01) 3
    CrossrefPubMedGoogle Scholar
  • 21 Song SJ, Yoon KH, Park CH. Patellofemoral cartilage degeneration after closed- and open-wedge high tibial osteotomy with large alignment correction. Am J Sports Med 2020; 48 (11) 2718-2725
    CrossrefPubMedGoogle Scholar
  • 22 Lee YS. Editorial commentary: tibial slope should be naturally maintained by proper posterior cortical osteotomy and gap distraction in open-wedge high tibial osteotomy. Arthroscopy 2021; 37 (07) 2189-2190
    CrossrefPubMedGoogle Scholar
  • 23 Ryu DJ, Wang JH. Editorial commentary: posterolateral malposition of the cortical hinge during medial open-wedge high tibial osteotomy increases posterior tibial slope: incomplete posterior osteotomy may shift the hinge from lateral to posterolateral. Arthroscopy 2021; 37 (07) 2202-2203
    CrossrefPubMedGoogle Scholar
  • 24 Giesinger JM, Hamilton DF, Jost B, Behrend H, Giesinger K. WOMAC, EQ-5D and Knee Society score thresholds for treatment success after total knee arthroplasty. J Arthroplasty 2015; 30 (12) 2154-2158
    CrossrefPubMedGoogle Scholar
  • 25 Cho YJ, Song SJ, Rhyu KH, Jang TS, Park CH. Clinical and radiologic results after open-wedge high tibial osteotomy in haemophilic knee arthropathy with varus deformity. Haemophilia 2018; 24 (05) 792-799
    CrossrefPubMedGoogle Scholar
  • 26 Bae DK, Park CH, Kim EJ, Song SJ. Medial cortical fractures in computer-assisted closing-wedge high tibial osteotomy. Knee 2016; 23 (02) 295-299
    CrossrefPubMedGoogle Scholar
  • 27 Takeuchi R, Ishikawa H, Kumagai K. et al. Fractures around the lateral cortical hinge after a medial opening-wedge high tibial osteotomy: a new classification of lateral hinge fracture. Arthroscopy 2012; 28 (01) 85-94
    CrossrefPubMedGoogle Scholar
  • 28 Kim JH, Lee DK, Park YB. Computed tomography detects hinge fractures after medial opening wedge high tibial osteotomy: a systematic review. Arthroscopy 2021; 37 (04) 1337-1352
    CrossrefPubMedGoogle Scholar
  • 29 Song SJ, Lee HW, Kim KI, Park CH. Appropriate determination of the surgical transepicondylar axis can be achieved following distal femur resection in navigation-assisted total knee arthroplasty. Knee Surg Relat Res 2021; 33 (01) 41
    CrossrefPubMedGoogle Scholar
  • 30 Sischek EL, Birmingham TB, Leitch KM, Martin R, Willits K, Giffin JR. Staged medial opening wedge high tibial osteotomy for bilateral varus gonarthrosis: biomechanical and clinical outcomes. Knee Surg Sports Traumatol Arthrosc 2014; 22 (11) 2672-2681
    CrossrefPubMedGoogle Scholar
  • 31 Lee OS, Ahn S, Lee YS. Effect and safety of early weight-bearing on the outcome after open-wedge high tibial osteotomy: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2017; 137 (07) 903-911
    CrossrefPubMedGoogle Scholar
  • 32 Chen YN, Chuang CH, Yang TH. et al. Computational comparison of different plating strategies in medial open-wedge high tibial osteotomy with lateral hinge fractures. J Orthop Surg Res 2020; 15 (01) 409
    CrossrefPubMedGoogle Scholar
  • 33 Nha KW, Shin MJ, Suh DW, Nam YJ, Kim KS, Kyung BS. Uniplane medial opening wedge high tibial osteotomy relative to a biplane osteotomy can reduce the incidence of lateral-hinge fracture. Knee Surg Sports Traumatol Arthrosc 2020; 28 (05) 1436-1444
    CrossrefPubMedGoogle Scholar