Evaluating the Effectiveness of a Structural Allograft in Medial Open Wedge High Tibial Osteotomy in Patients With and Without a Lateral Hinge Fracture

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Abstract

Background:

A lateral hinge fracture is a common complication in medial open wedge high tibial osteotomy (MOWHTO) and is associated with delayed union or nonunion. A comparison of outcomes between patients with or without a lateral hinge fracture after MOWHTO with a structural allograft has not been investigated.

Purpose:

To validate the outcomes of MOWHTO with a structural allograft, especially in the presence of a lateral hinge fracture.

Study Design:

Case series; Level of evidence, 4.

Methods:

We conducted a single-surgeon cohort study at a tertiary referral hospital between April 2017 and August 2022 and included patients who had undergone MOWHTO with a structural allograft for isolated medial compartment osteoarthritis with genu varum. We compared the incidence of delayed union or nonunion events and functional scores between patients with a lateral hinge fracture and those without using the Fisher exact test and independent t test.

Results:

A total of 88 MOWHTO procedures (77 patients) were analyzed. The overall incidence of lateral hinge fractures was 29.5% (n = 26), including type I (n = 20 [22.7%]) and type II (n = 6 [6.8%]). Notably, 42.3% (n = 11) of these fractures had not been detected intraoperatively but during the follow-up visits. The overall Knee Society Score (KSS), Knee Society Score–Function (KSS-F), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were 90.0 ± 10.0, 93.4 ± 10.8, and 93.8 ± 7.1 points, respectively. None of the patients had delayed union or nonunion, and none underwent a reoperation because of bony union problems. The functional scores (KSS, KSS-F, and WOMAC) were not different between patients who had a lateral hinge fracture and those who did not ( P > .05).

Conclusion:

The routine use of a structural allograft was associated with satisfactory outcomes after MOWHTO, regardless of whether there was a lateral hinge fracture.

Related collections

Most cited references 30

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P E Ballmer, Anthony Miniaci, F Ballmer … (1989)

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Fractures around the lateral cortical hinge after a medial opening-wedge high tibial osteotomy: a new classification of lateral hinge fracture.

Ryohei Takeuchi, Hiroyuki Ishikawa, Ken Kumagai … (2012)

The purpose of this study was to determine the frequency of lateral hinge fractures after opening-wedge high tibial osteotomy and investigate the patterns of fracture and their clinical outcome. We analyzed 104 knees in 93 patients with a mean age of 68 ± 7 years. Of the knees, 74 were diagnosed as having primary osteoarthritis and 30 with osteonecrosis. The mean follow-up period was 41 months. Lateral hinge fractures were classified as follows: type I, the fracture reaches just proximal to or within the tibiofibular joint; type II, the fracture reaches the distal portion of the proximal tibiofibular joint; and type III, a lateral plateau fracture. A standard postoperative rehabilitation protocol was used for type I fractures, 3 of 5 patients with type II fractures were treated with non-weight bearing, and type III fractures were treated with non-weight bearing until visible callus formation. The Knee Society scores for the knee and for function showed improvement from 49 ± 11 to 91 ± 7.7 points and from 62 ± 13 to 95 ± 8.2 points, respectively. Lateral cortex fractures were observed in 26 knees (25%): 19 type I, 5 type II, and 2 type III. In the type II fracture group, 2 of 5 patients were judged to have a delayed bone union. There were 2 cases of infection (2%) and 1 case of traumatic neuroma (1%) but no instances of implant failure, nonunion, or deep vein thrombosis among our patient cohort. High tibial osteotomy patients treated with a combination of TomoFix (Synthes, Bettlach, Switzerland) and bone substitute were able to walk with full weight bearing 2 weeks after surgery. No complications were seen in 19 patients with type I fractures. Of 5 patients with type II fractures, 2 had delayed unions with a correction loss of 3° and 7°, respectively. Level IV, therapeutic case series. Copyright © 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

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Author and article information

Journal

Journal ID (nlm-ta): Orthop J Sports Med

Journal ID (iso-abbrev): Orthop J Sports Med

Journal ID (publisher-id): OJS

Journal ID (hwp): spojs

Title: Orthopaedic Journal of Sports Medicine

Publisher: SAGE Publications (Sage CA: Los Angeles, CA )

ISSN (Electronic): 2325-9671

Publication date (Electronic): 16 October 2024

Publication date Collection: October 2024

Volume: 12

Issue: 10

Electronic Location Identifier: 23259671241277827

Affiliations

[* ]Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan

[† ]Department of Orthopedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

[3-23259671241277827]Investigation performed at the Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan

Author notes

[*] [‡ ]Shang-Wen Tsai, MD, Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, 11217, Taiwan (email: swtsai.vghtpe@ 123456gmail.com ).

Article

Publisher ID: 10.1177_23259671241277827

DOI: 10.1177/23259671241277827

PMC ID: 11483804

PubMed ID: 39421042

SO-VID: 53bf79d8-9c42-483f-b22c-022e30e26a5a

License:

This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License ( https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access page ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

History

Date received : 17 March 2024

Date accepted : 4 April 2024

Custom metadata

cover-date October 2024

typesetter ts1

Keywords: knee,osteotomy,allograft,bone graft,high tibial osteotomy,lateral hinge fracture,open wedge

Data availability:

Keywords: knee, osteotomy, allograft, bone graft, high tibial osteotomy, lateral hinge fracture, open wedge