Medial Open Wedge High Tibial Osteotomy: Can Delayed or Nonunion Be Predicted?

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• 作者：Albert H. van Houten MD (1)
  Petra J. C. Heesterbeek PhD (1)
  Ronald J. van Heerwaarden MD ; PhD (2)
  Tony G. van Tienen MD ; PhD (3)
  Ate B. Wymenga MD ; PhD (1)
  
• 刊名：Clinical Orthopaedics and Related Research?
• 出版年：2014
• 出版时间：April 2014
• 年：2014
• 卷：472
• 期：4
• 页码：1217-1223
• 全文大小：400 KB
• 参考文献：1. Agneskirchner JD, Freiling D, Hurschler C, Lobenhoffer P. Primary stability of four different implants for opening wedge high tibial osteotomy. / Knee Surg Sports Traumatol Arthrosc. 2006;14:291-00. CrossRef
  2. Brinkman JM, Lobenhoffer P, Agneskirchner JD, Staubli AE, Wymenga AB, van Heerwaarden RJ. Osteotomies around the knee: patient selection, stability of fixation and bone healing in high tibial osteotomies. / J Bone Joint Surg Br. 2008;90:1548-557. CrossRef
  3. Brosset T, Pasquier G, Migaud H, Gougeon F. Opening wedge high tibial osteotomy performed without filling the defect but with locking plate fixation (TomoFix) and early weight-bearing: prospective evaluation of bone union, precision and maintenance of correction in 51 cases. / Orthop Traumatol Surg Res. 2011;97:705-11. CrossRef
  4. Brouwer RW, Bierma-Zeinstra SM, van Raaij TM, Verhaar JA. Osteotomy for medial compartment arthritis of the knee using a closing wedge or an opening wedge controlled by a Puddu plate. A one-year randomised, controlled study. / J Bone Joint Surg Br. 2006;88:1454-459. CrossRef
  5. Brown CW, Orme TJ, Richardson HD. The rate of pseudarthrosis (surgical nonunion) in patients who are smokers and patients who are nonsmokers: a comparison study. / Spine. 1986;11:942-43. CrossRef
  6. El-Assal MA, Khalifa YE, Abdel-Hamid MM, Said HG, Bakr HM. Opening-wedge high tibial osteotomy without bone graft. / Knee Surg Sports Traumatol Arthrosc. 2010;18:961-66. CrossRef
  7. Gaasbeek RD, Sonneveld H, van Heerwaarden RJ, Jacobs WC, Wymenga AB. Distal tuberosity osteotomy in open wedge high tibial osteotomy can prevent patella infera: a new technique. / Knee. 2004;11:457-61. CrossRef
  8. Lobenhoffer P, Agneskirchner J, Zoch W. [Open valgus alignment osteotomy of the proximal tibia with fixation by medial plate fixator] [in German]. / Der Orthopade. 2004;33:153-60. CrossRef
  9. Luites JW, Brinkman JM, Wymenga AB, van Heerwaarden RJ. Fixation stability of opening- versus closing-wedge high tibial osteotomy: a randomised clinical trial using radiostereometry. / J Bone Joint Surg Br. 2009;91:1459-465. CrossRef
  10. Meidinger G, Imhoff AB, Paul J, Kirchhoff C, Sauerschnig M, Hinterwimmer S. May smokers and overweight patients be treated with a medial open-wedge HTO? Risk factors for non-union. / Knee Surg Sports Traumatol Arthrosc. 2011;19:333-39. CrossRef
  11. Miniaci A, Ballmer FT, Ballmer PM, Jakob RP. Proximal tibial osteotomy. A new fixation device. / Clin Orthop Relat Res. 1989;246:250-59.
  12. Niemeyer P, Koestler W, Kaehny C, Kreuz PC, Brooks CJ, Strohm PC, Helwig P, Suedkamp NP. Two-year results of open-wedge high tibial osteotomy with fixation by medial plate fixator for medial compartment arthritis with varus malalignment of the knee. / Arthroscopy. 2008;24:796-04. CrossRef
  13. Panjabi MM, Walter SD, Karuda M, White AA, Lawson JP. Correlations of radiographic analysis of healing fractures with strength: a statistical analysis of experimental osteotomies. / J Orthop Res. 1985;3:212-18. CrossRef
  14. RajaIzaham RM, AbdulKadir MR, AbdulRashid AH, Hossain MG, Kamarul T. Finite element analysis of Puddu and Tomofix plate fixation for open wedge high tibial osteotomy. / Injury. 2012;43:898-02. CrossRef
  15. Sloan A, Hussain I, Maqsood M, Eremin O, El-Sheemy M. The effects of smoking on fracture healing. / Surgeon. 2010;8:111-16. CrossRef
  16. Spahn G. Complications in high tibial (medial opening wedge) osteotomy. / Arch Orthop Trauma Surg. 2004;124:649-53. CrossRef
  17. Staubli AE, De Simoni C, Babst R, Lobenhoffer P. TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia—early results in 92 cases. / Injury. 2003;34 Suppl 2:B55-2. CrossRef
  18. Staubli AE, Jacob HA. Evolution of open-wedge high-tibial osteotomy: experience with a special angular stable device for internal fixation without interposition material. / Int Orthop. 2010;34:167-72. CrossRef
  19. Stoffel K, Stachowiak G, Kuster M. Open wedge high tibial osteotomy: biomechanical investigation of the modified Arthrex Osteotomy Plate (Puddu Plate) and the TomoFix Plate. / Clin Biomech (Bristol, Avon). 2004;19:944-50. CrossRef
  20. van den Bekerom MP, Patt TW, Kleinhout MY, van der Vis HM, Albers GH. Early complications after high tibial osteotomy: a comparison of two techniques. / J Knee Surg. 2008;21:68-4. CrossRef
  21. van Hemert WL, Willems K, Anderson PG, van Heerwaarden RJ, Wymenga AB. Tricalcium phosphate granules or rigid wedge preforms in open wedge high tibial osteotomy: a radiological study with a new evaluation system. / Knee. 2004;11:451-56. CrossRef
  22. van Raaij TM, Brouwer RW, de Vlieger R, Reijman M, Verhaar JA. Opposite cortical fracture in high tibial osteotomy: lateral closing compared to the medial opening-wedge technique. / Acta Orthop. 2008;79:508-14. CrossRef
  23. Warden SJ, Morris HG, Crossley KM, Brukner PD, Bennell KL. Delayed- and non-union following opening wedge high tibial osteotomy: surgeons-results from 182 completed cases. / Knee Surg Sports Traumatol Arthrosc. 2005;13:34-7. CrossRef
  24. Whelan DB, Bhandari M, Stephen D, Kreder H, McKee MD, Zdero R, Schemitsch EH. Development of the radiographic union score for tibial fractures for the assessment of tibial fracture healing after intramedullary fixation. / J Trauma. 2010;68:629-32. CrossRef
  
• 作者单位：Albert H. van Houten MD (1)
  Petra J. C. Heesterbeek PhD (1)
  Ronald J. van Heerwaarden MD, PhD (2)
  Tony G. van Tienen MD, PhD (3)
  Ate B. Wymenga MD, PhD (1)
  
  1. Sint Maartenskliniek, Nijmegen, Hengstdal 3, 6522 JV, Nijmegen, The Netherlands
  2. Limb Reconstruction Center, Maartenskliniek Woerden, Woerden, The Netherlands
  3. Kliniek ViaSana, Mill and Radboud University Medical Centre, Mill, The Netherlands
  
• ISSN：1528-1132

文摘

Background The opening wedge approach to high tibial osteotomy (HTO) is perceived to have some advantages relative to the closing wedge approach but it may be associated with delayed and nonunions. Because nonunions evolve over months, it would be advantageous to be able to identify risk factors for and early predictors of nonunion after medial opening wedge HTO. Questions/purposes We sought to determine whether (1) preoperatively identifiable patient factors, including tobacco use, body mass index > 30 kg/m2, and degree of correction, are associated with nonunion, and (2) a modified Radiographic Union Score for Tibial Fractures (RUST) score, taken at 6 weeks and 3 months, would be predictive for delayed or nonunion after medial opening wedge HTO. Methods The medical records and radiographs of 185 patients, 21 bilateral cases, treated with a medial open wedge HTO using the TomoFix? device were retrospectively evaluated. For all patients, demographic data regarding risk factors were collected from their records. Diagnosis for delayed or nonunion was already done earlier for standard medical care by the orthopaedic surgeon based on clinical and radiographic grounds. For the retrospective radiographic evaluation, a modified RUST score was used in which each tibial cortex is scored by one observer. Logistic regression analysis was used to identify preoperative and postoperative predictive factors for developing delayed or nonunion. In the series, a total of 19 patients (9.2%) developed clinically delayed/nonunion of whom 10 patients (4.9%) developed a nonunion. Results Smoking was identified as a risk factor for developing delayed/nonunion (19% for smokers versus 5.4% for nonsmokers; p = 0.005; odds ratio, 4.1; 95% confidence interval, 1.5-0.7). By contrast, body mass index, lateral cortical hinge fracture, age, infection, and degree of correction were not risk factors. Patients with delayed/nonunion had lower RUST scores at all time points when a radiograph was taken compared with the total study group. Conclusions The RUST score at 6 weeks and 3 months after surgery and the use of tobacco were identified as predictive factors for development of delayed union and nonunion after open wedge HTO. Based on these results, we now actively try to stop patients from smoking and these data are helpful in doing that. The RUST score may be of use to identify which patients are at risk for developing a delayed union so that interventions may be offered earlier in the course of care. Level of Evidence Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.