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Early experience of lateral hinge fracture during medial opening-wedge high tibial osteotomy: incidence and clinical outcomes

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

Lateral hinge fracture (LHF) during a medial opening-wedge high tibial osteotomy (MOWHTO) is considered to be the main cause of instability, further displacement, loss of correction, malunion, and nonunion. The purposes of this study were to evaluate whether the incidence of LHFs during MOWHTOs has decreased as the number of cases performed over time has increased, and whether the radiographic and clinical outcomes of patients with LHFs were worse than those of patients without LHFs.

Materials and methods

During the period of July 2013 to January 2017, 132 MOWHTOs were performed by a single surgeon using a locking plate (TomoFix®, DePuySynthes, Solothurn, Switzerland) for the treatment of medial compartment osteoarthritis, with LHFs postoperatively detected in 32 knees (24.2%). To evaluate trends in the incidence of LHFs occurring during MOWHTOs over time, all 132 cases were divided chronologically into four groups of 33 cases and compared. The time for bony union and loss of correction were compared between the LHF group and the non-LHF group using an osteotomy filling index, hip–knee–ankle (HKA) angles, medial proximal tibial angles (MPTA), weight-bearing line (WBL) ratios, and posterior tibial slope (PTS) angles on radiographs. Clinical outcomes were also compared using the Knee Society Scores (KSS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores 1 year post-surgery.

Results

The incidence of LHFs in each group of 33 cases did not decrease over time (21.2%, 27.3%, 24.2%, and 24.2%, respectively, p = 0.954). The time to union was significantly different between the non-LHF group (5.0 months) and the LHF group (7.3 months) (p < 0.001). However, there were no immediate or 1-year postoperative differences in the HKA angles, MPTAs, WBL ratios, or PTS angles between the non-LHF and LHF groups (all p > 0.05). The KSS and WOMAC scores were significantly improved in both groups (all p < 0.001) 1 year post-surgery, without any differences between the groups (p = 0.997 and p = 0.122, respectively).

Conclusions

LHFs during MOWHTO procedures occurred consistently, with a similar incidence over time. Although patients with LHFs required more time to bony union, they showed similarly favorable radiographic and clinical results as the patients without LHFs 1 year after surgery.

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Funding

There was no external funding source in this investigation.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

    Kwang Yun Song

  2. Department of Orthopaedic Surgery, St. Paul’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

    In Jun Koh

  3. Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Korea

    Man Soo Kim, Nam Yong Choi, Ji Hwan Jeong & Yong In

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  1. Kwang Yun Song
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Correspondence to Yong In.

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Song, K.Y., Koh, I.J., Kim, M.S. et al. Early experience of lateral hinge fracture during medial opening-wedge high tibial osteotomy: incidence and clinical outcomes. Arch Orthop Trauma Surg 140, 161–169 (2020). https://doi.org/10.1007/s00402-019-03237-0

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  • DOI: https://doi.org/10.1007/s00402-019-03237-0

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