Analysis of the Factors Affecting Bone Union after Open-Wedge High Tibial Osteotomy and Graft Material for Lateral Cortex Fractures

Jin-Hyeok Seo; Do-Hun Kim; Seung-Suk Seo; Yeon-Gu Kim; Ok-Gul Kim; Beyoung-Yun Park

doi:10.4055/jkoa.2016.51.5.395

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Seo, Kim, Seo, Kim, Kim, and Park: Analysis of the Factors Affecting Bone Union after Open-Wedge High Tibial Osteotomy and Graft Material for Lateral Cortex Fractures

Original Article

Journal of the Korean Orthopaedic Association 2016; 51(5): 395-402.

Published online: 26 October 2016

DOI: https://doi.org/10.4055/jkoa.2016.51.5.395

Analysis of the Factors Affecting Bone Union after Open-Wedge High Tibial Osteotomy and Graft Material for Lateral Cortex Fractures

Jin-Hyeok Seo, M.D., Do-Hun Kim, M.D., Seung-Suk Seo, M.D., Yeon-Gu Kim, M.D., Ok-Gul Kim, M.D., Beyoung-Yun Park, M.D.

Department of Orthopedic Surgery, Bumin Hospital, Busan, Korea.

Correspondence to: Do-Hun Kim, M.D. Department of Orthopedic Surgery, Bumin Hospital, 59 Mandeok-daero, Buk-gu, Busan 46555, Korea. TEL: +82-51-330-3082, FAX: +82-51-330-3242, kdh7483@gmail.com

Received 7 March 2016 Revised 26 April 2016 Accepted 7 May 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to analyze patient factors including smoking, body mass index, correction angle, graft material, presence of lateral cortex fracture, and age for the effect on bone union after open-wedge high tibial osteotomy and the effect of graft material used for lateral cortex fractures.

Materials and Methods

This retrospective study was conducted on 54 patients and 58 cases with osteoarthritic change Kallgren-Lawrence grade 2 or less from May 2012 to June 2014. Average follow-up period was 22 months (14–38 months). The patients were divided into two groups according to patient related factors and graft materials (allograft, n=6; beta-tricalcium phosphate [β-TCP], n=6) used for lateral cortex fractures and were analyzed for the relationship with bone union after open-wedge high tibial osteotomy. Radiographic and clinic analyses were performed, and van Hemert grading was used for grading bone union at 6 weeks, 3 months, 6 months, and 1 year postoperatively.

Results

The non-smoking group and the group without lateral cortex fracture showed significantly higher bone union rates than the control group. No significant clinical or radiological difference was observed between the two groups in 12 cases and the allograft group showed significantly higher rates of union at 6 months and 1 year postoperatively according to the van Hemert grading.

Conclusion

Smoking and the presence of a lateral cortex fracture is a risk factor for nonunion in medial open-wedge high tibial osteotomy. The use of allograft material rather than β-TCP for lateral cortex fractures is thought to result in better bone union.

Keywords: knee, osteoarthritis, open wedge high tibial osteotomy, allografts, β-tricalcium phosphate

Figures and Tables

Table 1

Demographic Data of the Patients

Values are presented as number only or mean±standard deviation.

Table 2

Grading of van Hemert10)

TCP, tricalcium phosphate.

Table 3

Demographic Data and Surgical Factors in Patients with Bone Union Grade

Values are presented as mean±standard deviation. ^*This data is statistically significance. Postop., postoperative; BMI, body mass index; TCP, tricalcium phosphate.

Table 4

Demographic Data of Patients in the Allograft Group and β-TCP Group with Lateral Cortex Fracture

Values are presented as mean±standard deviation or number only. TCP, tricalcium phosphate; DM, diabetes mellitus; HTN, hypertension.

Table 5

Radiologic Assessment of the Allograft Group and β-TCP Group in Damaged Lateral Cortex

Values are presented as mean±standard deviation. TCP, tricalcium phosphate; FTA, femorotibial angle; MPTA, medial proximal tibial angle.

Table 6

Clinical Assessment of the Allograft Group and β-TCP Group in Damaged Lateral Cortex

Values are presented as mean±standard deviation. TCP, tricalcium phosphate; KOOS, knee injury and osteoarthritis outcome score; QOL, quality of life.

Table 7

Bone Union Grade of the Allograft Group and β-TCP Group in Damaged Lateral Cortex

Values are presented as mean±standard deviation. ^*This data is statistically significance. TCP, tricalcium phosphate; Postop., postoperative.

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

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