Open Access, Peer-reviewed
pISSN 1226-2102
eISSN 2005-8918
    J Korean Orthop Assoc. 2016 Oct;51(5):395-402. Korean.
    Published online Oct 26, 2016.
    https://doi.org/10.4055/jkoa.2016.51.5.395
    Copyright © 2016 by The Korean Orthopaedic Association
    Original Article

    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. and 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, Email: kdh7483@gmail.com
    Received March 07, 2016; Revised April 26, 2016; Accepted May 07, 2016.

    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

    Tables

    Table 1
    Demographic Data of the Patients

    Table 2
    Grading of van Hemert10)

    Table 3
    Demographic Data and Surgical Factors in Patients with Bone Union Grade

    Table 4
    Demographic Data of Patients in the Allograft Group and β-TCP Group with Lateral Cortex Fracture

    Table 5
    Radiologic Assessment of the Allograft Group and β-TCP Group in Damaged Lateral Cortex

    Table 6
    Clinical Assessment of the Allograft Group and β-TCP Group in Damaged Lateral Cortex

    Table 7
    Bone Union Grade of the Allograft Group and β-TCP Group in Damaged Lateral Cortex

    Notes

    CONFLICTS OF INTEREST:The authors have nothing to disclose.

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    MeSH Terms
    Allografts
    Body Mass Index
    Follow-Up Studies
    Humans
    Knee
    Osteoarthritis
    Osteotomy*
    Retrospective Studies
    Risk Factors
    Smoke
    Smoking
    Transplants*
    Metrics
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