Abstract
Purpose
To compare the incidence of correction loss and survival rate between closed-wedge and open-wedge high tibial osteotomies (CWHTO and OWHTO, respectively) in patients with osteopenic and normal bone.
Methods
Retrospective review was conducted for 115 CWHTOs and 119 OWHTOs performed in osteopenic patients [− 2.5 < Bone mineral density (BMD) T scores ≤ − 1] and 136 CWHTOs and 138 OWHTOs performed in normal patients (BMD T score > − 1) from 2012 to 2019. Demographics were not different between CW- and OWHTOs in osteopenic and normal patients (n.s., respectively). Radiographically, the mechanical axis (MA), medial proximal tibial angle (MPTA), and posterior tibial slope (PTS) were evaluated pre- and postoperatively (2 weeks after HTO). The occurrence of hinge fractures was investigated using radiographs taken on the operation day. The correction change was calculated as the last follow-up value minus postoperative MPTA. Correction loss was defined when the correction change was ≥ 3°. The survival rate (failure: correction loss) was investigated.
Results
There were no significant differences in the pre and postoperative MA, MPTA, PTS, and value changes between CW- and OWHTOs in osteopenic and normal patients (n.s., respectively); the incidence of unstable hinge fractures also did not differ significantly (CWHTO vs. OWHTO = 7 vs. 7.6% in osteopenic patients; 2.9 vs. 3.6% in normal patients; n.s., respectively). The average correction change (CWHTO = − 0.6°, OWHTO = − 1.3°, p = 0.007), incidence of correction loss (CWHTO = 1.7%, OWHTO = 9.2%, p = 0.019), and 5-year survival rates (CWHTO = 98.3%, OWHTO = 90.8%, p = 0.013) differed significantly in osteopenic patients; there were no significant differences in these results in normal patients (n.s., respectively).
Conclusion
CWHTO was more advantageous than OWHTO regarding the correction loss in osteopenic patients. Intra- and postoperative care that consider poor bone quality will be required when performing OWHTOs in osteopenic patients.
Level of evidence
III.
Similar content being viewed by others
References
Bae DK, Park CH, Kim EJ, Song SJ (2016) Medial cortical fractures in computer-assisted closing-wedge high tibial osteotomy. Knee 23(2):295–299
Belsey J, Diffo Kaze A, Jobson S, Faulkner J, Maas S, Khakha R et al (2019) Graft materials provide greater static strength to medial opening wedge high tibial osteotomy than when no graft is included. J Exp Orthop 6(1):13
Cheung WH, Miclau T, Chow SK, Yang FF, Alt V (2016) Fracture healing in osteoporotic bone. Injury 47(Suppl 2):S21-26
Cho YJ, Song SJ, Rhyu KH, Jang TS, Park CH (2018) Clinical and radiologic results after open-wedge high tibial osteotomy in haemophilic knee arthropathy with varus deformity. Haemophilia 24(5):792–799
Ensrud KE, Crandall CJ (2019) Bisphosphonates for postmenopausal osteoporosis. JAMA 322(20):2017–2018
Goshima K, Sawaguchi T, Shigemoto K, Iwai S, Fujita K, Kataoka T (2020) Plate removal without loss of correction after open-wedge high tibial osteotomy is possible when posterior cortex bone union reaches osteotomy gap center even in incompletely filled gaps. Knee Surg Sports Traumatol Arthrosc 28(6):1827–1834
Grant KD, Busse EC, Park DK, Baker KC (2018) Internal fixation of osteoporotic bone. J Am Acad Orthop Surg 26(5):166–174
Hernigou P, Giber D, Dubory A, Auregan JC (2020) Safety of simultaneous versus staged bilateral opening-wedge high tibial osteotomy with locked plate and immediate weight bearing. Int Orthop 44(1):109–117
Jung WH, Takeuchi R, Kim DH, 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(5):1380–1387
Kanchanomai C, Muanjan P, Phiphobmongkol V (2010) Stiffness and endurance of a locking compression plate fixed on fractured femur. J Appl Biomech 26(1):10–16
Kang BY, Lee DK, Kim HS, Wang JH (2022) How to achieve an optimal alignment in medial opening wedge high tibial osteotomy? Knee Surg Relat Res 34(1):3
Kaushal N, Vohora D, Jalali RK, Jha S (2018) Prevalence of osteoporosis and osteopenia in an apparently healthy Indian population—a cross-sectional retrospective study. Osteoporos Sarcopenia 4(2):53–60
Kim JH, Lee DK, Park YB (2021) Computed tomography detects hinge fractures after medial opening wedge high tibial osteotomy: a systematic review. Arthroscopy 37(4):1337–1352
Lee J, Lee S, Jang S, Ryu OH (2013) Age-related changes in the prevalence of osteoporosis according to gender and skeletal site: the korea national health and nutrition examination survey 2008–2010. Endocrinol Metab (Seoul) 28(3):180–191
Marcheggiani Muccioli GM, Fratini S, Cammisa E, Vaccari V, Grassi A, Bragonzoni L et al (2019) Lateral closing wedge high tibial osteotomy for medial compartment arthrosis or overload. Clin Sports Med 38(3):375–386
Matsushita T, Watanabe S, Araki D, Nagai K, Hoshino Y, Kanzaki N et al (2021) Differences in preoperative planning for high-tibial osteotomy between the standing and supine positions. Knee Surg Relat Res 33(1):8
Meeson R, Moazen M, Sanghani-Kerai A, Osagie-Clouard L, Coathup M, Blunn G (2019) The influence of gap size on the development of fracture union with a micro external fixator. J Mech Behav Biomed Mater 99:161–168
Na YG, Kwak DS, Chong S, Kim TK (2019) Factors affecting stability after medial opening wedge high tibial osteotomy using locking plate: a cadaveric study. Knee 26(6):1313–1322
Pape D, Dueck K, Haag M, Lorbach O, Seil R, Madry H (2013) Wedge volume and osteotomy surface depend on surgical technique for high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 21(1):127–133
Park HJ, Kang SB, Chang MJ, Chang CB, Jung WH, Jin H (2021) Association of gap healing with angle of correction after opening-wedge high tibial osteotomy without bone grafting. Orthop J Sports Med 9(5):23259671211002290
Prodromos CC, Amendola A, Jakob RP (2015) High tibial osteotomy: indications, techniques, and postoperative management. Instr Course Lect 64:555–565
Qiao D, Liu X, Tu R, Zhang X, Qian X, Zhang H et al (2020) Gender-specific prevalence and influencing factors of osteopenia and osteoporosis in Chinese rural population: the henan rural cohort study. BMJ Open 10(1):e028593
Scott WN, Diduch DR, Long WJ (2018) Insall and Scott surgery of the knee, vol 1. Elsevier, Philadelphia, pp 374–387
Sivertsen EA, Vik J, Meland ASV, Nerhus TK (2021) The dugdale planning method for high tibial osteotomies underestimates the correction angle compared to the miniaci method. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-021-06663-z
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(11):3584–3598
Song SJ, Yoon KH, Park CH (2020) Patellofemoral cartilage degeneration after closed- and open-wedge high tibial osteotomy with large alignment correction. Am J Sports Med 48(11):2718–2725
Takeuchi R, Ishikawa H, Kumagai K, Yamaguchi Y, Chiba N, Akamatsu Y et al (2012) Fractures around the lateral cortical hinge after a medial opening-wedge high tibial osteotomy: a new classification of lateral hinge fracture. Arthroscopy 28(1):85–94
Funding
No external funding was used.
Author information
Authors and Affiliations
Contributions
The following authors have made substantial contributions to the followings: (1) the conception and design of the study (SJS, KHY, and CHP), provision of study materials or patients (SJS, KHY), acquisition of data (KIK, CHP), analysis and interpretation of data (KIK, CHP). (2) drafting the article (SJS, KHY, KIK and CHP), (3) final approval of the version to be submitted (SJS, KHY, KIK and CHP).
Corresponding author
Ethics declarations
Conflict of interest
No conflict of interest.
Ethical approval
This study was approved by the Institutional Review Board of Kyung Hee University Medical Center.
Informed consent
Informed consent was obtained from all patients before commencing the review.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Song, S.J., Yoon, K.H., Kim, K.I. et al. Closed-wedge high tibial osteotomy is more advantageous to maintain the correction than open-wedge high tibial osteotomy in osteopenic patients. Knee Surg Sports Traumatol Arthrosc 31, 1563–1570 (2023). https://doi.org/10.1007/s00167-022-07006-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-022-07006-2