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Effect of hardware removal and second-look arthroscopy after open-wedge high tibial osteotomy

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

Abstract

Introduction

Open-wedge high tibial osteotomy (OWHTO) is the standard and safe procedure for medial compartment osteoarthritis. Although hardware removal (HWR) is performed after post-OWHTO bone union, the effects of HWR on OWHTO have been rarely reported. We hypothesised that HWR would improve range of motion (ROM) and implant-related complications. Thus, this study aimed to investigate the effects of HWR on postoperative ROM, the Japan Orthopaedic Association (JOA) score/visual analogue scale (VAS) score and hardware-related complications after OWHTO.

Methods

Patients who underwent OWHTO between January 2016 and June 2018 and HWR were retrospectively reviewed. To perform OWHTO, locking plates and prosthetic bone were used to achieve optimal stabilisation of biplanar osteotomy. HWR was performed after a second-look arthroscopy through the previous skin incision. For clinical evaluation, the JOA score, VAS score, and ROM were assessed before and 1 year after HWR using the Wilcoxon rank test. Logistic regression analysis was performed to identify the predictors of post-HWR improvement.

Results

Of 98 knees examined (91 patients), 80 (73 patients; 39 men and 34 women) were included. At the time of OWHTO, mean age was 64.0 ± 9.7 years and body mass index, 25.5 ± 3.1 kg/m2; Kellgren–Lawrence (KL) grade 1 was seen in 20 cases, KL-2 in 46, and KL-3 in 14. Mean periods between OWHTO and HWR were 13.4 ± 2.0 months, and 11.9 ± 1.2 months between HWR and evaluation. The JOA score and flexion angle significantly improved after HWR (The JOA score: p = 0.026 flexion angle: p < 0.001); however, the VAS score and extension angle did not (VAS score: p = 0.162, extension angle: p = 0.934). Hardware irritation was observed in four cases (5%), which improved after HWR. Logistic regression analysis revealed that lower preoperative KL grade and flexion angle were predictors of improvement after HWR [KL grade: p = 0.008; odds ratio 3.244, 95% confidence interval (CI) 1.350–7.794; flexion angle: p < 0.001; odds ratio 1.150, 95% CI 1.062–1.245].

Conclusion

HWR improves flexion angle, clinical outcomes and hardware-related complications after OWHTO. Preoperative KL grade and flexion angle are predictors of improvement after HWR in patients who have undergone OWHTO.

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Data availability

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

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Acknowledgements

The authors would like to thank Mika Shimatani for help with data collection. The authors would like to thank Editage for editing and reviewing this manuscript for English language.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Nippon Kokan Fukuyama Hospital, 1844 Tsunoshita Daimon-cho, Fukuyama, Hiroshima, 721-0927, Japan

    Haruyoshi Katayama, Hirotaka Nakashima, Yasuhiro Takahara, Satoru Itani, Yuichi Iwasaki, Hisayoshi Kato & Yoichiro Uchida

  2. Department of Orthopedic Surgery, Wakamatsu Hospital of University of Occupational and Environmental Health, Kitakyushu, Fukuoka, 808-0024, Japan

    Hirotaka Nakashima

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Contributions

HK, HN and YT take the major parts in the plan and formulating the study design. HK and HN contributed equally to this study. HK and HN interpreted the data and writing manuscript. HN performed statistical analysis in this study. SI and YI contributed to collect data. HK and YU play important roles in formulating the plans. All authors have given final approval of the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Yasuhiro Takahara.

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There are no potential conflicts of interest relevant to this article.

Ethical approval

This study was approved by institutional review board (Nippon Kokan Fukuyama Hospital, approval number: 2019-14).

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The informed consent had been obtained from the patients.

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Katayama, H., Nakashima, H., Takahara, Y. et al. Effect of hardware removal and second-look arthroscopy after open-wedge high tibial osteotomy. Arch Orthop Trauma Surg 144, 73–79 (2024). https://doi.org/10.1007/s00402-023-05035-1

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