Smoking and obesity influence the risk of nonunion in lateral opening wedge, closing wedge and torsional distal femoral osteotomies

Liska, Franz; Haller, Bernhard; Voß, Andreas; Mehl, Julian; Imhoff, Florian B.; Willinger, Lukas; Imhoff, Andreas B.

doi:10.1007/s00167-017-4754-9

Cited by 27 publications

(20 citation statements)

References 34 publications

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“…For clarification, further studies in a larger collective correlating fracture morphology and cortical fracture location to a mediolateral dislocation are warranted. A loss of correction was shown in 5.3% in patients with a medial cortical fracture, a complication known after hinge fractures in high tibial osteotomy with an incidence between 1 and 15% [ 16 , 28 , 32 , 33 ] and varising DFO of the valgus knee with an heterogenous incidence of 3–23% [ 8 , 14 , 25 , 54 ].…”

Section: Discussionmentioning

confidence: 99%

“…While the favourable postoperative outcomes reported in the literature have increased the popularity of the femoral lateral closing (CW) wedge technique [ 2 , 15 , 25 , 35 , 43 , 44 ], recent investigations are aimed to identify reasons for failures [ 13 ]. Hinge fractures in distal femoral osteotomies (DFO)—resulting in increased rotational movement across the osteotomy plane [ 3 , 41 ]—may explain a considerable number of delayed unions or losses of correction reported [ 4 , 6 , 8 , 9 , 14 , 25 , 54 ]. While technical factors and vulnerable anatomical zones associated with an increased risk of hinge fractures have been reported for HTO [ 16 , 31 – 33 , 49 ], medial closing wedge (MCW) DFO [ 21 , 39 ] and LOW-DFO [ 53 ], the only report investigating hinge fractures in LCW-DFO to-date was performed in a relatively small collective and could not identify any risk factors [ 36 ].…”

Section: Introductionmentioning

confidence: 99%

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Dislocated hinge fractures are associated with malunion after lateral closing wedge distal femoral osteotomy

Rupp

Winkler

Lutz

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose To evaluate the incidence, morphology, and associated complications of medial cortical hinge fractures after lateral closing wedge distal femoral osteotomy (LCW-DFO) for varus malalignment and to identify constitutional and technical factors predisposing for hinge fracture and consecutive complications. Methods Seventy-nine consecutive patients with a mean age of 47 ± 12 years who underwent LCW-DFO for symptomatic varus malalignment at the authors’ institution between 01/2007 and 03/2018 with a minimum of 2-year postoperative time interval were enrolled in this retrospective observational study. Demographic and surgical data were collected. Measurements evaluating the osteotomy cut (length, wedge height, hinge angle) and the location of the hinge (craniocaudal and mediolateral orientation, relation to the adductor tubercle) were conducted on postoperative anterior–posterior knee radiographs and the incidence and morphology of medial cortical hinge fractures was assessed. A risk factor analysis of constitutional and technical factors predisposing for the incidence of a medial cortical hinge fracture and consecutive complications was conducted. Results The incidence of medial cortical hinge fractures was 48%. The most frequent morphological type was an extension fracture type (68%), followed by a proximal (21%) and distal fracture type (11%). An increased length of the osteotomy in mm (53.1 ± 10.9 vs. 57.7 ± 9.6; p = 0.049), an increased height of the excised wedge in mm (6.5 ± 1.9 vs. 7.9 ± 3; p = 0.040) as well as a hinge location in the medial sector of an established sector grid (p = 0.049) were shown to significantly predispose for the incidence of a medial cortical hinge fracture. The incidence of malunion after hinge fracture (14%) was significantly increased after mediolateral dislocation of the medial cortical bone > 2 mm (p < 0.05). Conclusion Medial cortical hinge fractures after LCW-DFO are a common finding. An increased risk of sustaining a hinge fracture has to be expected with increasing osteotomy wedge height and a hinge position close to the medial cortex. Furthermore, dislocation of a medial hinge fracture > 2 mm was associated with malunion and should, therefore, be avoided. Level of evidence Prognostic study; Level IV.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dislocated hinge fractures are associated with malunion after lateral closing wedge distal femoral osteotomy

Rupp

Winkler

Lutz

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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“…Variable selection was based on a causal path diagram that was created using the directed acyclic graph (DAG) approach. 38 Covariates were selected based on recent literature on HTO, 15,28 known prognostic factors for functional outcomes in KA, 7,31,42,49 and hypothesized relationships. With the DAG approach, an a priori model of the postulated relationships between the exposure (HTO), outcome variable of interest (RTW), and covariates was established.…”

Section: Methodsmentioning

confidence: 99%

Predictors of Return to Work After High Tibial Osteotomy: The Importance of Being a Breadwinner

Hoorntje

Kuijer

Ginneken

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: Limited evidence exists on patient-relevant outcomes after high tibial osteotomy (HTO), including return to work (RTW). Furthermore, prognostic factors for RTW have never been described. Purpose: To investigate the extent and timing of RTW in the largest HTO cohort investigated for RTW to date and to identify prognostic factors for RTW after HTO. Study Design: Cohort study; Level of evidence, 3. Methods: Consecutive patients who underwent HTO between 2012 and 2015 were included. Patients received a questionnaire at a mean follow-up of 3.6 years. Questions were asked pre- and postoperatively regarding work status, job title, working hours, preoperative sick leave, employment status, and whether patients were their family’s breadwinner. The validated Work Rehabilitation Questionnaire (WORQ) was used to assess difficulty with knee-demanding activities. Prognostic factors for RTW were analyzed using a logistic regression model. Covariates were selected based on univariate analysis and a directed acyclic graph. Results: We identified 402 consecutive patients who underwent HTO, of whom 349 were included. Preoperatively, 299 patients worked, of whom 284 (95%) achieved RTW and 255 (90%) returned within 6 months. Patients reported significant postoperative improvements in performing knee-demanding activities. Being the family’s breadwinner was the strongest predictor of RTW (odds ratio [OR], 2.92; 95% confidence interval [CI], 1.27-6.69). In contrast, preoperative sick leave was associated with lower odds of RTW (OR, 0.20; 95% CI, 0.08-0.46). Conclusion: After HTO, 95% of patients were able to RTW, of whom 9 of 10 returned within 6 months. Breadwinners were more likely to RTW, and patients with preoperative sick leave were less likely to RTW within 6 months. These findings may be used to improve preoperative counseling and expectation management and thereby enhance work-related outcomes after HTO.

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“…There are likely other factors that affect bone union after CWHTO. For example, the relationship between smoking and the time of bone union after distal femoral osteotomy 6 or OWHTO 7 has been reported. In our study, one smoker was in group D, three in Group E. Other factors may influence bone union besides smoking.…”

Section: Discussionmentioning

confidence: 99%

The factors affecting the timing of bone union after closing-wedge high tibial osteotomy

Kawai

Kawashima

et al. 2020

Journal of Clinical Orthopaedics and Trauma

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Objective: Closing-wedge high tibial osteotomy (CWHTO) for medial osteoarthritis of the knee is one of the effective osteotomy methods, especially for patients with cartilage damage of the patellofemoral joint, flexion contracture, and requiring a large correction angle.While the bone union at the osteotomy site is finally obtained after CWHTO, there are often differences in the period of the bone union. The purpose of the present study is to investigate the factors affecting the timing of bone union after CWHTO. Methods: 16 cases of CWHTO were included; they were performed by the same surgeon using precisely the same implants. Among 16 cases in the present study, nobody used low-intensity pulsed ultrasound (LIPUS) within three months after the operation. The patients were divided into two Groups using Plane X-ray and CT within three months after surgery: Group D (8 knees; bone healing was not seen at all) and Group E (8 knees; bone healing was seen). Results: There were no significant differences in mean age between the two groups, but body mass index (BMI) and bone mineral density (BMD) were significantly higher in Group D (p < 0.05). Conclusion:The present study suggests that BMI and BMD may affect the timing of bone union after CWHTO. Background: Closing-wedge high tibial osteotomy (CWHTO) for medial osteoarthritis of the knee is one of the effective osteotomy methods. The frequency of selecting CWHTO in our hospital in Japan is high, especially for patients with cartilage damage of the patellofemoral joint, flexion contracture, and requiring a large correction angle. On the other hand, while the bone union at the osteotomy site is obtained with both procedures, there are often differences in bone union time for CWHTO compared to Opening-wedge high tibial osteotomy (OWHTO). This difference might affect the early clinical outcome of the operations. We hypothesized that there is some factor to affect bone healing of CWHTO for individual patients. Purpose: To investigate the factors affecting the timing of bone union after CWHTO.

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Smoking and obesity influence the risk of nonunion in lateral opening wedge, closing wedge and torsional distal femoral osteotomies

Abstract: Level IV.

Cited by 27 publications

References 34 publications

Dislocated hinge fractures are associated with malunion after lateral closing wedge distal femoral osteotomy

Dislocated hinge fractures are associated with malunion after lateral closing wedge distal femoral osteotomy

Predictors of Return to Work After High Tibial Osteotomy: The Importance of Being a Breadwinner

The factors affecting the timing of bone union after closing-wedge high tibial osteotomy

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