Purpose
The purpose of this study was to examine the osteotomy gap filling rate with new bone
after open wedge high tibial osteotomy (HTO) without bone graft and the effects of
smoking, lateral hinge fracture, and early full weight bearing.
Methods
A prospective series (N = 70) of open wedge HTOs with the TomoFix plate (DePuy Synthes,
Umkirch, Germany) was performed. Radiologic follow-up examinations took place postoperatively,
after 6 and 12 weeks, and after 6, 12, and 18 months to measure osteotomy gap filling
at each follow-up. Bone healing was compared in smokers versus nonsmokers who underwent
open wedge HTOs with intact lateral hinges. Fractured lateral hinges were classified
according to the Takeuchi classification and separately analyzed regarding bone healing.
Patients were randomly assigned to undergo early (11 days) or standard (6 weeks) full–weight-bearing
rehabilitation.
Results
A delay in the osteotomy gap filling rate between smokers and nonsmokers could be
observed at all follow-up periods, but differences were not significant. A fracture
of the lateral hinge was found in 39% of the patients. A type I fracture was observed
in 14% of patients, a type II fracture was observed in 13%, and a type III fracture
was found in 6%. The highest increase in the osteotomy gap filling rate was observed
between 12 weeks and 6 months after surgery in patients with intact lateral hinges.
For patients with unstable type II fractures, the highest increase in the gap filling
rate was delayed until 6 to 12 months. Early full weight bearing had no effect on
the gap filling rate in any of the patient groups evaluated.
Conclusions
This study shows that osteotomy gap filling after open wedge HTO is delayed in smokers
and in patients in whom opening of the gap resulted in unstable lateral hinge fractures.
Early full weight bearing did not have a significant effect on the gap filling rate.
Level of Evidence
Level III, prognostic study.
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Article info
Publication history
Published online: October 23, 2014
Accepted:
August 26,
2014
Received:
June 13,
2013
Footnotes
S.S. and T.F. contributed equally as first authors to this work.
The authors report the following potential conflict of interest or source of funding: S.S. receives support from DGUV (Deutsche Gesetzliche Unfallversicherung) FR 150. The grant was with another focus. However, the patients and radiographs are from the supported (unpublished) study.
Identification
Copyright
© 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
