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Bone healing on serial plain radiographs occurs slowly but adequately after medial opening wedge high tibial osteotomy without bone graft

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to prospectively investigate osteotomy gap filling rates on serial plain radiographs, and to evaluate whether alignment correction is maintained after medial opening wedge high tibial osteotomy (MOWHTO) using a locking plate without bone graft.

Methods

Between March 2014 and June 2017, MOWHTO was performed without bone graft regardless of gap size. Radiographs were taken preoperatively, postoperatively, at 1, 3, 6, 12, 18, and 24 months after surgery. Radiographic examinations included a weight bearing long-standing anteroposterior (AP) view of the whole lower extremity, as well as, the AP, lateral, and both oblique views of the knee. Bone healing was measured on the medial oblique view of the knee. The postoperative alignment correction and its maintenance were assessed using the three radiologic parameters of the weight-bearing line (WBL) ratio, the hip–knee–ankle angle (HKAA), and the medial proximal tibial angle (MPTA) on the weight-bearing long-standing AP view of the lower extremity.

Results

Fifty-two consecutive patients underwent MOWHTO, but three patients failed to follow-up for more than 24 months. A total of 49 patients were assessed in this study. The median opening gap height was 10.0 mm (IQR, 8.0–12.0; range, 7–20). On immediate post-operative radiographs, the mean gap filling was 31.4 ± 3.6%. After 1, 3, 6, 12, 18, and 24 months, the mean gap filling rates increased to 38.7 ± 4.4%, 51.4 ± 6.6%, 66.5 ± 5.1%, 84.8 ± 7.0%, 92.4 ± 5.6%, and 97.8 ± 2.3%, respectively. Statistical differences were observed between all the follow-up evaluations (P < 0.001). Statistical differences in the WBL ratio, HKAA, and MPTA were observed between preoperatively and 1 month after surgery (P < 0.001). The mean PTSA increased significantly from preoperatively to postoperatively (P < 0.001). However, no statistical differences were found between the post-operative follow-up radiographs performed for these four values.

Conclusion

MOWHTO using a locking plate without bone graft achieved at least 90% bone healing and had no loss in correction at 2 years postoperatively.

Level of Evidence

III.

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Acknowledgements

(1) This article was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (2019R1A2C2011563). (2) This research was supported by Hallym University Research Fund (202008).

Funding

None to declare.

Author information

Author notes

  1. Sung Jae Kim and Lich Thi Nguyen have contributed equally as first authors to this work.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7 Keunjaebong-gil, Hwaseong, Gyeonggi-do, 18450, Republic of Korea

    Sung Jae Kim, Lich Thi Nguyen, Young-Jin Seo, Dawoon Jung & Si Young Song

  2. Department of Orthopaedic Surgery, Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea

    Young-Soo Shin

  3. Department of Orthopaedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Republic of Korea

    Jeehyoung Kim

  4. School of Advanced Materials Science & Engineering, Sungkyunkwan University, Suwon, Republic of Korea

    Jae-Young Choi

Authors
  1. Sung Jae Kim
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  8. Si Young Song
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Contributions

SYS made the study design, wrote the manuscript, and performed the surgeries. SJK participated in the design of the study and interpretation of data. LTN participated in the interpretation of data and helped to draft the manuscript. YJS carried out radiologic measurement and acquisition of data. DJ carried out radiologic measurement and acquisition of data. YSS participated in interpretation of data. JK performed the statistical analysis and helped to write the manuscript. JYC participated in interpretation of data. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Si Young Song.

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Ethical approval

This study was approved by the Institutional Review Board of our institute (IRB no. 2014-020).

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Yes.

Conflict of interest

All authors have no conflicts of interests to be declared.

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Kim, S.J., Nguyen, L.T., Seo, YJ. et al. Bone healing on serial plain radiographs occurs slowly but adequately after medial opening wedge high tibial osteotomy without bone graft. Knee Surg Sports Traumatol Arthrosc 30, 993–1000 (2022). https://doi.org/10.1007/s00167-021-06506-x

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  • DOI: https://doi.org/10.1007/s00167-021-06506-x

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