Lateral hinge fracture delays healing of the osteotomy gap in opening wedge high tibial osteotomy with a beta-tricalcium phosphate block

• Published in: The knee Vol. 27; no. 1; pp. 192 - 197
• Main Authors: Kumagai, Ken, Yamada, Shunsuke, Nejima, Shuntaro, Muramatsu, Shuntaro, Akamatsu, Yasushi, Inaba, Yutaka
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.01.2020; Elsevier Limited
• Subjects: Aged; Arthritis; Biocompatibility; Biocompatible Materials - administration & dosage; Biomechanics; Body mass index; Bone grafts; Bone healing; Bone Substitutes - administration & dosage; Bone Transplantation - methods; Calcium phosphates; Calcium Phosphates - administration & dosage; Female; Fracture Healing; Fractures; Humans; Knee; Lateral hinge fracture; Male; Middle Aged; Opening wedge high tibial osteotomy; Orthopedics; Osteoarthritis, Knee - diagnostic imaging; Osteoarthritis, Knee - physiopathology; Osteoarthritis, Knee - surgery; Osteotomy; Osteotomy - adverse effects; Osteotomy - methods; Porosity; Skin & tissue grafts; Statistical analysis; Studies; Surgery; Synthetic bone grafting; Tibia - diagnostic imaging; Tibia - injuries; Tibia - surgery; Tibial Fractures - diagnostic imaging; Tibial Fractures - etiology; Tibial Fractures - physiopathology; Tricalcium phosphate; Japan; Opening wedge high tibial osteotomy; Bone healing; Synthetic bone grafting; Lateral hinge fracture
• ISSN: 0968-0160; 1873-5800; 1873-5800
• DOI: 10.1016/j.knee.2019.10.027

The purpose of this study was to investigate the healing process of synthetic bone grafts in opening wedge high tibial osteotomy (OWHTO) and to identify the factors that affect bone healing in OWHTO. It was hypothesized that lateral hinge fracture (LHF) is associated with delayed bone healing after OWHTO with synthetic bone grafting. The subjects included 350 knees of 283 patients who underwent OWHTO using two wedged blocks of beta-tricalcium phosphate (β-TCP) with 60% porosity. The healing of the osteotomy gap using a radiologic rating system for OWHTO with synthetic bone grafts and the presence of an LHF were assessed up to postoperative 24 months. LHFs were found in 49 knees (14%). The osteotomy gap showed slower progression of radiographic healing with an LHF than without an LHF (P < .05). In the knees with LHFs, initial radiographic change in the osteotomy gap was observed almost at the same time as healing of the LHF. Multivariate logistic regression analysis identified LHF as the factor preventing the progression of bone healing (OR = 46.78, P < .05). LHF is associated with delayed bone healing after OWHTO with synthetic bone grafting.