Advertisement

International Orthopaedics

, Volume 38, Issue 1, pp 55–60 | Cite as

Does obesity and nicotine abuse influence the outcome and complication rate after open-wedge high tibial osteotomy? A retrospective evaluation of five hundred and thirty three patients

  • Stephanie Floerkemeier
  • Alex E. Staubli
  • Steffen Schroeter
  • Sabine Goldhahn
  • Philipp Lobenhoffer
Original Paper

Abstract

Purpose

Nicotine abuse and obesity are well-known factors leading to common post-operative complications. However, their influence on the outcome after high tibial osteotomy is controversial. Thus, the aim of this study was to evaluate their effect on the clinical outcome with particular regard to bone non-union and local complications.

Methods

The functional outcome after open-wedge high tibial osteotomy using the TomoFix® plate was assessed by means of the 12-item Oxford knee score in a multicentre study. In addition the intra- and post-operative complications were determined.

Results

Of 533 eligible patients, 386 were interviewed after a mean follow-up of 3.6 years. The median Oxford knee score was 43 points (max. 48 points). Six per cent of these patients experienced at least one local post-operative complication. Patients with a body mass index (BMI) of up to 25 and between 25 and 30 had a higher mean score by 3.5 and 1.8 points, respectively, compared with those having a BMI of more than 30 showing a score of 37.5. No correlation was observed between smoking and the functional outcome. Smoking habits, BMI, the absolute patient weight and the interaction term between smoking and BMI were not significant with reference to the complication rate.

Conclusions

This study reveals favourable mid-term results after high tibial osteotomy in varus osteoarthritis even in patients who smoked and obese patients. The indication in patients with a BMI above 30 should be handled with care due to the slightly inferior outcome, although the complication rate was not increased in these patients.

Keywords

High tibial osteotomy Medial osteoarthritis Oxford knee score TomoFix Smoking Obesity 

References

  1. 1.
    Agneskirchner JD, Hurschler C, Wrann CD, Lobenhoffer P (2007) The effects of valgus medial opening wedge high tibial osteotomy on articular cartilage pressure of the knee: a biomechanical study. Arthroscopy 23(8):852–861PubMedCrossRefGoogle Scholar
  2. 2.
    Amendola A, Bonasia DE (2010) Results of high tibial osteotomy: review of the literature. Int Orthop 34(2):155–160PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Benzakour T, Hefti A, Lemseffer M, El Ahmadi JD, Bouyarmane H, Benzakour A (2010) High tibial osteotomy for medial osteoarthritis of the knee: 15 years follow-up. Int Orthop 34(2):209–215PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Birmingham TB, Giffin JR, Chesworth BM, Bryant DM, Litchfield RB, Willits K, Jenkyn TR, Fowler PJ (2009) Medial opening wedge high tibial osteotomy: a prospective cohort study of gait, radiographic, and patient-reported outcomes. Arthritis Rheum 61(5):648–657PubMedCrossRefGoogle Scholar
  5. 5.
    Brinkman JM, Luites JW, Wymenga AB, van Heerwaarden RJ (2010) Early full weight bearing is safe in open-wedge high tibial osteotomy. Acta Orthop 81(2):193–198PubMedCrossRefGoogle Scholar
  6. 6.
    Brosset T, Pasquier G, Migaud H, Gougeon F (2011) Opening wedge high tibial osteotomy performed without filling the defect but with locking plate fixation (TomoFix) and early weight-bearing: prospective evaluation of bone union, precision and maintenance of correction in 51 cases. Orthop Traumatol Surg Res 97(7):705–711PubMedCrossRefGoogle Scholar
  7. 7.
    Fini M, Giavaresi G, Salamanna F, Veronesi F, Martini L, De Mattei M, Tschon M (2011) Harmful lifestyles on orthopedic implantation surgery: a descriptive review on alcohol and tobacco use. J Bone Miner Metab 29(6):633–644PubMedCrossRefGoogle Scholar
  8. 8.
    Hubbard VS (2000) Defining overweight and obesity: what are the issues? Am J Clin Nutr 72(5):1067–1068PubMedGoogle Scholar
  9. 9.
    Kolb W, Guhlmann H, Windisch C, Koller H, Grützner P, Kolb K (2010) Opening-wedge high tibial osteotomy with a locked low-profile plate: surgical technique. J Bone Joint Surg Am 92(Suppl 1 Pt 2):197–207PubMedGoogle Scholar
  10. 10.
    Lawrence RC, Helmick CG, Arnett FC, Deyo RA, Felson DT, Giannini EH, Heyse SP, Hirsch R, Hochberg MC, Hunder GG, Liang MH, Pillemer SR, Steen VD, Wolfe F (1998) Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum 41(5):778–799PubMedCrossRefGoogle Scholar
  11. 11.
    Lobenhoffer P, Agneskirchner JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11(3):132–138PubMedGoogle Scholar
  12. 12.
    Luites JW, Brinkman JM, Wymenga AB, van Heerwaarden RJ (2009) Fixation stability of opening- versus closing-wedge high tibial osteotomy: a randomised clinical trial using radiostereometry. J Bone Joint Surg Br 91(11):1459–1465PubMedCrossRefGoogle Scholar
  13. 13.
    Meidinger G, Imhoff AB, Paul J, Kirchhoff C, Sauerschnig M, Hinterwimmer S (2011) May smokers and overweight patients be treated with a medial open-wedge HTO? Risk factors for non-union. Knee Surg Sports Traumatol Arthrosc 19(3):333–339PubMedCrossRefGoogle Scholar
  14. 14.
    Miller BS, Downie B, McDonough EB, Wojtys EM (2009) Complications after medial opening wedge high tibial osteotomy. Arthroscopy 25(6):639–646PubMedCrossRefGoogle Scholar
  15. 15.
    Murray DW, Fitzpatrick R, Rogers K, Pandit H, Beard DJ, Carr AJ, Dawson J (2007) The use of the Oxford hip and knee scores. J Bone Joint Surg Br 89(8):1010–1014PubMedCrossRefGoogle Scholar
  16. 16.
    Naal FD, Impellizzeri FM, Sieverding M, Loibl M, von Knoch F, Mannion AF, Leunig M, Munzinger U (2009) The 12-item Oxford Knee Score: cross-cultural adaptation into German and assessment of its psychometric properties in patients with osteoarthritis of the knee. Osteoarthritis Cartilage 17(1):49–52PubMedCrossRefGoogle Scholar
  17. 17.
    Nelissen EM, van Langelaan EJ, Nelissen RG (2010) Stability of medial opening wedge high tibial osteotomy: a failure analysis. Int Orthop 34(2):217–223PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD (2001) The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA 286(2):188–195PubMedCrossRefGoogle Scholar
  19. 19.
    Sikorski JM, Sikorska JZ (2011) Relative risk of different operations for medial compartment osteoarthritis of the knee. Orthopedics 34(12):e847–e854PubMedGoogle Scholar
  20. 20.
    Sloan A, Hussain I, Maqsood M, Eremin O, El-Sheemy M (2010) The effects of smoking on fracture healing. Surgeon 8(2):111–116PubMedCrossRefGoogle Scholar
  21. 21.
    Spahn G, Hofmann GO, von Engelhardt LV, Li M, Neubauer H, Klinger HM (2011) The impact of a high tibial valgus osteotomy and unicondylar medial arthroplasty on the treatment for knee osteoarthritis: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 21(1):96–112PubMedCrossRefGoogle Scholar
  22. 22.
    Takeuchi R, Ishikawa H, Kumagai K, Yamaguchi Y, Chiba N, Akamatsu Y, Saito T (2011) Fractures around the lateral cortical hinge after a medial opening-wedge high tibial osteotomy: a new classification of lateral hinge fracture. Arthroscopy 28(1):85–94PubMedCrossRefGoogle Scholar
  23. 23.
    Valkering KP, van den Bekerom MP, Kappelhoff FM, Albers GH (2009) Complications after tomofix medial opening wedge high tibial osteotomy. J Knee Surg 22(3):218–225PubMedCrossRefGoogle Scholar
  24. 24.
    Wagner IJ, Szpalski C, Allen RJ Jr, Davidson EH, Canizares O, Saadeh PB, Warren SM (2012) Obesity impairs wound closure through a vasculogenic mechanism. Wound Repair Regen 20(4):512–522PubMedGoogle Scholar
  25. 25.
    Wroblewski BM, Siney PD, Fleming PA (2007) Increasing patients’ body mass. Are the criteria for testing stemmed femoral components in total hip arthroplasty still valid? Proc Inst Mech Eng H 221(8):959–961PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Stephanie Floerkemeier
    • 1
  • Alex E. Staubli
    • 2
  • Steffen Schroeter
    • 3
  • Sabine Goldhahn
    • 4
  • Philipp Lobenhoffer
    • 5
  1. 1.Department of Orthopaedic SurgeryHanover Medical SchoolHanoverGermany
  2. 2.Private Clinic Sonnmatt LuzernLucerneSwitzerland
  3. 3.BG Unfallklinik TübingenTübingenGermany
  4. 4.AO Clinical Investigation and DocumentationAO FoundationDübendorfSwitzerland
  5. 5.Sports Clinic GermanyHanoverGermany

Personalised recommendations