Skip to main content

Advertisement

SpringerLink
Log in

Vancomycin-soaked femoral head allograft in opening wedge high tibia osteotomy enables earlier postoperative recovery and reduces infection rates compared to allogenic bone chips

  • KNEE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To investigate the benefits of vancomycin-soaked femoral head allograft versus allogenic bone chips as an osteotomy gap filler in reducing infection rates and perioperative pain control after medial opening wedge high tibial osteotomy (MOW-HTO).

Methods

Retrospective analysis of 114 knees that underwent MOW-HTO between 2013 and 2020. Osteotomy gaps were filled with vancomycin-soaked femoral head allograft (Study Group) or allogenic bone chips (Control Group). Both groups received systemic antibiotics. Perioperative parameters studied included pain, blood loss, length of stay, postoperative day (POD1) pain scores at rest, with activity as well as ambulatory distance. Patients in the Study Group were also followed up prospectively and clinical outcome scores, namely Knee Society Score, Oxford knee score (OKS) and Physical and Mental Component of the Short-Form 36 Questionnaire (PCS and MCS, respectively). Statistical analyses using Student’s T-test were performed between the groups.

Results

Patients of the study group had significantly better POD1 visual analogue scale (VAS) at rest (0.9 ± 1.6 vs 2.9 ± 1.2, p < 0.001) as well as when active (3.0 ± 1.9 vs 5.8 ± 1.5, p < 0.001). A greater proportion of patients in the study group ambulated on POD 1, (90.6% vs 26.0%, p < 0.001). Of those who ambulated on POD1, study group patients managed to cover a greater ambulatory distance (13.9 ± 7.4 m vs 8.4 ± 9.3 m, p < 0.05). The proportion of study group patients requiring patient-controlled analgesia (PCA) was also significantly less compared to the control group (32.8% vs 58.0%, p < 0.05). Of those requiring PCA, the amount of morphine requirement was also significantly reduced in the group with vancomycin-soaked allograft (8.7 ± 8.1 mg vs 23.9 ± 33.0 mg, p < 0.05). The study group also had a reduced length of stay (3.5 ± 2.0 days vs 5.5 ± 2.6 days, p < 0.001). Patients in the study group demonstrated significant improvement in Knee Society Knee Score (KSKS), OKS, PCS and MCS at 12 months postoperatively. The study group had a significantly reduced incidence of superficial wound infections compared to the control group (3.1% vs 18.0%, p < 0.05).

Conclusion

Vancomycin-soaked femoral head allograft reduced superficial and deep wound infections in MOW-HTO. It was also effective in reducing postoperative pain, thereby enabling early ambulation and shorter hospital stays.

Level of evidence

Retrospective comparative study, III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Anagnostakos K, Mosser P, Kohn D (2013) Infections after high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 21:161–169

    Article  PubMed  Google Scholar 

  2. Chan YH (2003) Biostatistics 104: correlational analysis. Singap Med J 44:614–619

    CAS  Google Scholar 

  3. Dodson V, Majmundar N, Swantic V, Assina R (2019) The effect of prophylactic vancomycin powder on infections following spinal surgeries: a systematic review. Neurosurg Focus 46:E11

    Article  PubMed  Google Scholar 

  4. Figueroa F, Figueroa D, Calvo R, Vaisman A, Espregueira-Mendes J (2021) Vancomycin presoaking of hamstring autografts to prevent infection in anterior cruciate ligament reconstruction: a narrative review. EFORT Open Rev 6:211–216

    Article  PubMed  PubMed Central  Google Scholar 

  5. Finkemeier CG (2002) Bone-grafting and bone-graft substitutes. J Bone Jt Surg Am 84:454–464

    Article  Google Scholar 

  6. Grayson JE, Grant GD, Dukie S, Vertullo CJ (2011) The in vitro elution characteristics of vancomycin from tendons. Clin Orthop Relat Res 469:2948–2952

    Article  PubMed  PubMed Central  Google Scholar 

  7. Zuiderbaan HA, van der List JP, Kleeblad LJ, Appelboom P, Kort NP, Pearle AD, Rademakers MV (2016) Modern indications, results, and global trends in the use of unicompartmental knee arthroplasty and high tibial osteotomy in the treatment of isolated medial compartment osteoarthritis. Am J Orthop (Belle Mead NJ) 45:E355–E361

    Google Scholar 

  8. Han S-B, In Y, Oh KJ, Song KY, Yun ST, Jang K-M (2019) Complications associated with medial opening-wedge high tibial osteotomy using a locking plate: a multicenter study. J Arthroplasty 34:439–445

    Article  PubMed  Google Scholar 

  9. Heckmann ND, Mayfield CK, Culvern CN, Oakes DA, Lieberman JR, Valle CJD (2019) Systematic review and meta-analysis of intrawound vancomycin in total hip and total knee arthroplasty: a call for a prospective randomized trial. J Arthroplasty 34:1815–1822

    Article  PubMed  Google Scholar 

  10. Jung W-H, Chun C-W, Lee J-H, Ha J-H, Kim J-H, Jeong J-H (2013) Comparative study of medial opening-wedge high tibial osteotomy using 2 different implants. Arthroscopy 29:1063–1071

    Article  PubMed  Google Scholar 

  11. Jung W-H, Takeuchi R, Kim D-H, Nag R (2020) Faster union rate and better clinical outcomes using autologous bone graft after medial opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 28:1380–1387

    Article  PubMed  Google Scholar 

  12. Kawata M, Jo T, Taketomi S, Inui H, Yamagami R, Matsui H, Fushimi K, Yasunaga H, Tanaka S (2021) Type of bone graft and primary diagnosis were associated with nosocomial surgical site infection after high tibial osteotomy: analysis of a national database. Knee Surg Sports Traumatol Arthrosc 29:429–436

    Article  PubMed  Google Scholar 

  13. Koh IJ, Kim MW, Kim JH, Han SY, In Y (2015) Trends in high tibial osteotomy and knee arthroplasty utilizations and demographics in Korea from 2009 to 2013. J Arthroplasty 30:939–944

    Article  PubMed  Google Scholar 

  14. 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 Jt Surg Am 92(Suppl 1 Pt 2):197–207

    Article  Google Scholar 

  15. Kuremsky MA, Schaller TM, Hall CC, Roehr BA, Masonis JL (2010) Comparison of autograft vs allograft in opening-wedge high tibial osteotomy. J Arthroplasty 25:951–957

    Article  PubMed  Google Scholar 

  16. Lei Y-T, Xie J-W, Huang Q, Huang W, Pei F-X (2021) Benefits of early ambulation within 24 h after total knee arthroplasty: a multicenter retrospective cohort study in China. Mil Med Res 8:17

    PubMed  PubMed Central  Google Scholar 

  17. Lemans JVC, Öner FC, Wijdicks SPJ, Ekkelenkamp MB, Vogely HC, Kruyt MC (2019) The efficacy of intrawound vancomycin powder and povidone-iodine irrigation to prevent surgical site infections in complex instrumented spine surgery. Spine J 19:1648–1656

    Article  PubMed  Google Scholar 

  18. Matziolis G, Brodt S, Böhle S, Kirschberg J, Jacob B, Röhner E (2020) Intraarticular vancomycin powder is effective in preventing infections following total hip and knee arthroplasty. Sci Rep 10:13053

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Morris J, Grant A, Kulkarni R, Doma K, Harris A, Hazratwala K (2019) Early results of medial opening wedge high tibial osteotomy using an intraosseous implant with accelerated rehabilitation. Eur J Orthop Surg Traumatol 29:147–156

    Article  PubMed  Google Scholar 

  20. Noyes FR, Goebel SX, West J (2005) Opening wedge tibial osteotomy: the 3-triangle method to correct axial alignment and tibial slope. Am J Sports Med 33:378–387

    Article  PubMed  Google Scholar 

  21. Offerhaus C, Balke M, Hente J, Gehling M, Blendl S, Höher J (2019) Vancomycin pre-soaking of the graft reduces postoperative infection rate without increasing risk of graft failure and arthrofibrosis in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 27:3014–3021

    Article  PubMed  Google Scholar 

  22. Pérez-Prieto D, Torres-Claramunt R, Gelber PE, Shehata TMA, Pelfort X, Monllau JC (2016) Autograft soaking in vancomycin reduces the risk of infection after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 24:2724–2728

    Article  PubMed  Google Scholar 

  23. Polacek M, Nyegaard CP, Høien F (2020) Day-case opening wedge high tibial osteotomy with intraosseous PEEK implant. Arthrosc Sports Med Rehabil 2:e145–e151

    Article  PubMed  PubMed Central  Google Scholar 

  24. Pornrattanamaneewong C, Numkanisorn S, Chareancholvanich K, Harnroongroj T (2012) A retrospective analysis of medial opening wedge high tibial osteotomy for varus osteoarthritic knee. Indian J Orthop 46:455–461

    Article  PubMed  PubMed Central  Google Scholar 

  25. Reischl N, Wahl P, Jacobi M, Clerc S, Gautier E, Jakob RP (2009) Infections after high tibial open wedge osteotomy: a case control study. Arch Orthop Trauma Surg 129:1483–1487

    Article  PubMed  Google Scholar 

  26. Ruzbarsky JJ, Arner JW, Dornan GJ, Provencher MT, Vidal AF (2021) Tibial slope can be maintained during medial opening-wedge proximal tibial osteotomy with sagittally oriented hinge, posterior plate position, and knee hyperextension: a Cadaveric Study. Arthroscopy 37:2181–2188

    Article  PubMed  Google Scholar 

  27. Rybak MJ, Lomaestro BM, Rotschafer JC, Moellering RC, Craig WA, Billeter M, Dalovisio JR, Levine DP (2009) Vancomycin therapeutic guidelines: a summary of consensus recommendations from the infectious diseases Society of America, the American Society of Health-System Pharmacists, and the Society of Infectious Diseases Pharmacists. Clin Infect Dis 49:325–327

    Article  PubMed  Google Scholar 

  28. Seo S-S, Kim O-G, Seo J-H, Kim D-H, Kim Y-G, Lee I-S (2016) Complications and short-term outcomes of medial opening wedge high tibial osteotomy using a locking plate for medial osteoarthritis of the knee. Knee Surg Relat Res 28:289–296

    Article  PubMed  PubMed Central  Google Scholar 

  29. Sidhu R, Moatshe G, Firth A, Litchfield R, Getgood A (2021) Low rates of serious complications but high rates of hardware removal after high tibial osteotomy with Tomofix locking plate. Knee Surg Sports Traumatol Arthrosc 29:3361–3367

    Article  PubMed  Google Scholar 

  30. Slevin O, Ayeni OR, Hinterwimmer S, Tischer T, Feucht MJ, Hirschmann MT (2016) The role of bone void fillers in medial opening wedge high tibial osteotomy: a systematic review. Knee Surg Sports Traumatol Arthrosc 24:3584–3598

    Article  PubMed  Google Scholar 

  31. Spahn G (2004) Complications in high tibial (medial opening wedge) osteotomy. Arch Orthop Trauma Surg 124:649–653

    Article  PubMed  Google Scholar 

  32. Stukenborg-Colsman C, Wirth CJ, Lazovic D, Wefer A (2001) High tibial osteotomy versus unicompartmental joint replacement in unicompartmental knee joint osteoarthritis: 7–10-year follow-up prospective randomised study. Knee 8:187–194

    Article  CAS  PubMed  Google Scholar 

  33. Van Genechten W, Van den Bempt M, Van Tilborg W, Bartholomeeusen S, Van Den Bogaert G, Claes T, Claes S (2020) Structural allograft impaction enables fast rehabilitation in opening-wedge high tibial osteotomy: a consecutive case series with one year follow-up. Knee Surg Sports Traumatol Arthrosc 28:3747–3757

    Article  PubMed  Google Scholar 

  34. Woodacre T, Ricketts M, Evans JT, Pavlou G, Schranz P, Hockings M, Toms A (2016) Complications associated with opening wedge high tibial osteotomy—a review of the literature and of 15 years of experience. Knee 23:276–282

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

No funding was available for this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore

    Don Thong Siang Koh & Kong Hwee Lee

Authors
  1. Don Thong Siang Koh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kong Hwee Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Both DTSK and KHL were involved in the conceptualization, methodology, datacuration, formal analysis, investigation as well as writing, reviewing and editing the manuscript. KHL provided supervision for this study.

Corresponding author

Correspondence to Don Thong Siang Koh.

Ethics declarations

Conflict of interest

The authors declare that no conflicts of interests.

Ethical approval

This single centre retrospective study was approved by the hospital’s ethics committee (CIRB:2020/2705) and carried out in accordance with the ethical standards established in the 1964 Declaration of Helsinki.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Koh, D.T.S., Lee, K.H. Vancomycin-soaked femoral head allograft in opening wedge high tibia osteotomy enables earlier postoperative recovery and reduces infection rates compared to allogenic bone chips. Knee Surg Sports Traumatol Arthrosc 30, 4054–4062 (2022). https://doi.org/10.1007/s00167-022-06885-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-022-06885-9

Keywords

Search

Navigation