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Finger FC, Schröter S, Ihle C, Herbst M, Histing T, Ahrend MD. Postoperative management following osteotomies around the knee: a narrative review. EFORT Open Rev 2024; 9:658-667. [PMID: 38949151 PMCID: PMC11297401 DOI: 10.1530/eor-23-0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
The present narrative review provides a summary of postoperative therapy modalities and their effectiveness following osteotomies around the knee. The topics that are discussed in the scientific discourse include support of cartilage cell regeneration, pain management, drainage insertion, tourniquet use, pharmacological and mechanical thromboembolism prophylaxis, weight-bearing protocols and bone consolidation. There is evidence for the use of pharmacological thromboembolism prophylaxis and weight-bearing protocols. A standardized postoperative treatment concept following osteotomies around the knee cannot be derived due to lack of evidence for the other topics in current literature.
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Affiliation(s)
- Felix Christoph Finger
- BG Klinik Tübingen, Department of Traumatology and Reconstructive Surgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Steffen Schröter
- Diakonie Klinikum Jung-Stilling GmbH, Department of Trauma and Reconstructive Surgery, Siegen, Germany
- Osteotomie Komitee der Deutschen Knie Gesellschaft (DKG), Munich, Germany
| | - Christoph Ihle
- BG Klinik Tübingen, Department of Traumatology and Reconstructive Surgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Moritz Herbst
- BG Klinik Tübingen, Department of Traumatology and Reconstructive Surgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Tina Histing
- BG Klinik Tübingen, Department of Traumatology and Reconstructive Surgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Marc-Daniel Ahrend
- BG Klinik Tübingen, Department of Traumatology and Reconstructive Surgery, Eberhard Karls University of Tübingen, Tübingen, Germany
- Osteotomie Komitee der Deutschen Knie Gesellschaft (DKG), Munich, Germany
- AO Research Institute Davos, Davos, Switzerland
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Miltenberg B, Puzzitiello RN, Ruelos VCB, Masood R, Pagani NR, Moverman MA, Menendez ME, Ryan SP, Salzler MJ, Drager J. Incidence of Complications and Revision Surgery After High Tibial Osteotomy: A Systematic Review. Am J Sports Med 2024; 52:258-268. [PMID: 36779579 DOI: 10.1177/03635465221142868] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND High tibial osteotomy (HTO) is a well-recognized procedure for its effectiveness in treating symptomatic early knee arthritis and malalignment. Although there are numerous systematic reviews evaluating the management and outcomes after HTO, there are few investigations on complications of this procedure. PURPOSE To systematically review the literature to determine the incidence of intraoperative and postoperative complications associated with medial opening wedge and lateral closing wedge HTOs. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS The Cochrane Database of Systematic Reviews, PubMed, Embase, and MEDLINE databases were queried for studies reporting complications associated with HTO with or without concomitant procedures. Data including patient characteristics, procedure type, concomitant procedures, follow-up time, and postoperative imaging were extracted. Rates of intra- and postoperative complications, reoperations, and conversion to arthroplasty were recorded. RESULTS A total of 71 studies were included for analysis, comprising 7836 patients. The overall intraoperative complication rate during HTO was 5.5% (range, 0%-29.3%), and the overall postoperative complication rate was 6.9% (range, 0%-26.6%). The most common intraoperative complication was lateral hinge fracture (incidence, 9.1%; range, 0%-30.4%) in medially based HTOs and peroneal nerve injury in laterally based HTOs (incidence, 3.2%; range, 0%-8.7%). The overall incidence of neurovascular injury after medially or laterally based HTOs was 1.1% (range, 0%-18.9%). The most common postoperative complication was superficial infection (incidence, 2.2%; range, 0%-13%). Of the included studies, 62 included postoperative radiographic analysis, and among those, the incidence of nonunion was 1.9% (range, 0%-15.5%), loss of correction was 1.2% (range, 0%-34.3%), and implant failure was 1.0% (range, 0%-10.2%). Among studies reporting revision surgeries, the overall reoperation rate was 15.5% (range, 0%-70.7%), with the most common type of reoperation being hardware removal (incidence, 10.0%; range, 0%-60%). CONCLUSION Intraoperatively, medially based HTOs are associated with a 1 in 11 risk of lateral hinge fracture and laterally based HTOs with a 1 in 30 risk of peroneal nerve injury. Postoperative complication rates in the range of 10% to 15% can be expected, including infection (2.9%), loss of correction (1.2%), and nonunion (1.9%). Patients should also be counseled that the reoperation rate is approximately 15%, with hardware removal being the most common procedure.
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Affiliation(s)
| | | | | | - Raisa Masood
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Nicholas R Pagani
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Michael A Moverman
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Mariano E Menendez
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Scott P Ryan
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Matthew J Salzler
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Justin Drager
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts, USA
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Guo H, Song B, Zhou R, Yu J, Chen P, Yang B, Pan N, Li C, Zhu Y, Wang J. Risk Factors and Dynamic Nomogram Development for Surgical Site Infection Following Open Wedge High Tibial Osteotomy for Varus Knee Osteoarthritis: A Retrospective Cohort Study. Clin Interv Aging 2023; 18:2141-2153. [PMID: 38143487 PMCID: PMC10748744 DOI: 10.2147/cia.s436816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/13/2023] [Indexed: 12/26/2023] Open
Abstract
Background As the worldwide population ages, the population receiving open wedge high tibial osteotomy (OWHTO) is growing, and surgical site infection (SSI) is a rare but fatal surgical complication. This study aimed to identify risk factors independently associated with SSI following OWHTO and develop a predictive nomogram. Methods Clinical data of patients who received OWHTO and followed up for more than 12 months in our hospital were retrospectively reviewed. Multivariable logistic regression was performed to determine independent risk factors for SSI and to construct predictive nomograms. The study further illustrated the predictive performance of the model by using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). Results A total of 1294 eligible patients were included in the study. Multivariate analysis revealed tobacco consumption (OR=3.44, p=0.010), osteotomy size ≥12 mm (OR=3.3, p=0.015), the use of allogeneic bone or artificial bone graft substitutes (allogeneic bone vs none, OR=4.08, p=0.037; artificial bone vs none, OR=5.16, p=0.047), Kellgren-Lawrence (K-L) grade IV (OR=2.5, p=0.046), systemic immune-inflammation index (SII) >423.62 (OR=6.2, p<0.001), high-sensitivity C-reactive protein (HCRP) >2.6 mg/L (OR=2.42, p=0.044), and a higher level of fasting blood glucose (FBG) (OR=1.32, p=0.022) were the independent predictors of SSI. The cutoff score of the model was 148, with a sensitivity of 76.0% and specificity of 81.0%. The concordance index (C-index) and Brier score of the nomogram were 0.856 and 0.017, and the corrected values after 1000 bootstrapping validations were 0.820 and 0.018, respectively. Furthermore, the ROC curve, calibration curve, and DCA exhibited excellent predictive accuracy and clinical applicability of the model. Conclusion This study developed a dynamic nomogram based on seven predictors, which allowed surgeons to individualize risk stratification of patients and intervene promptly to reduce SSI rates.
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Affiliation(s)
- Haichuan Guo
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People’s Republic of China
| | - Bixuan Song
- Division of Medical Sciences, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China
| | - Ruijuan Zhou
- College of Education, Hebei Normal University, Shijiazhuang, Hebei, 050010, People’s Republic of China
| | - Jiahao Yu
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People’s Republic of China
| | - Pengzhao Chen
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People’s Republic of China
| | - Bin Yang
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People’s Republic of China
| | - Naihao Pan
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People’s Republic of China
| | - Chengsi Li
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People’s Republic of China
| | - Yanbin Zhu
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People’s Republic of China
- Orthopedic Research Institute of Hebei Province, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People’s Republic of China
| | - Juan Wang
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People’s Republic of China
- Orthopedic Research Institute of Hebei Province, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People’s Republic of China
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Jia G, Sun C, Xie J, Li J, Liu S, Dong W, Yu X. Incidence and risk factors for surgical site infection after medial opening-wedge high tibial osteotomy using a locking T-shape plate. Int Wound J 2023; 20:2563-2570. [PMID: 36849231 PMCID: PMC10410320 DOI: 10.1111/iwj.14124] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 03/01/2023] Open
Abstract
Medial opening-wedge high tibial osteotomy (MOWHTO) is a well-established surgical method for treatment of isolated medial compartment osteoarthritis with varus deformity, but the surgical outcomes may be compromised by surgical site infection (SSI). This study aimed to investigate the incidence and the risk factors for SSI after MOWHTO. This retrospective study included consecutive patients who underwent MOWHTO for isolated medial compartment osteoarthritis with varus deformity in two tertiary referral hospitals from January 2019 and June 2021. Patients who developed SSI within 12 months of surgery were identified by inquiring the medical records for index hospitalisation, notes of after-discharge outpatient visits, or records of readmission for treatment of SSI. Univariate comparisons were performed to detect the differences between SSI and non-SSI groups, and multivariate logistic regression analysis was used to identify the independent risk factors. Six hundred sixteen patients with 708 procedures were included and 30 (4.2%) cases of SSI occurred, with 0.6% rate for deep SSI and 3.6% for superficial. Univariate analyses showed significant difference between groups in terms of morbidity obesity (≥32 kg/m2 ) (20.0% vs 8.9%), comorbid diabetes (26.7% vs 11.1%), active smoking (20.0% vs 6.3%), time from admission to operation (5.2 ± 4.0 vs 4.1 ± 3.0), size of osteotomy ≥12 mm (40.0% vs 20.0%), type of bone grafting and lymphocyte count (2.1 ± 0.5 vs 1.9 ± 0.6). However, in the multivariate analysis, only active smoking (OR, 3.4; 95% CI, 1.4-10.2), size of osteotomy ≥12 mm (OR, 2.8; 95% CI, 1.3-5.9) and allogeneic/artificial vs no bone grafting (OR, 2.4; 95% CI, 1.0-10.8) remained significant. SSI was not uncommon after MOWHTO, but the majority was superficial. The identified three independent factors, including smoking, size of osteotomy ≥12 mm and allogeneic/artificial bone grafting would help risk assessment and stratification, target risk factor modification and clinical surveillance, and inform patient counselling.
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Affiliation(s)
- Guoxing Jia
- Department of Orthopaedic Surgerythe First Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Congcong Sun
- Department of orthopaedic surgerythe Third Hospital of Hebei Medical UniversityShijiazhuangP. R. China
| | - Jin Xie
- Department of Orthopaedic Surgerythe First Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Jia Li
- Department of Orthopaedic Surgerythe First Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Sen Liu
- Department of Orthopaedic Surgerythe First Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Wei Dong
- Department of Orthopaedic Surgerythe First Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Xiaoguang Yu
- Department of Orthopaedic Surgerythe First Hospital of Hebei Medical UniversityShijiazhuangChina
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Kahan ME, Chen Z, Angerett NR, Sax OC, Bains SS, Assayag MJ, Delanois RE, Nace J. Unicompartmental Knee Arthroplasty Has Lower Infection, Conversion, and Complication Rates Compared to High Tibial Osteotomy. J Knee Surg 2022; 35:1518-1523. [PMID: 36538939 DOI: 10.1055/s-0042-1757597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Isolated medial knee osteoarthritis can be surgically treated with either unicompartmental knee arthroplasty (UKA) or high tibial osteotomy (HTO). Proponents of UKA suggest superior survivorship, while HTO offers theoretically improved alignment and joint preservation delaying total knee arthroplasty (TKA). Therefore, we compared complications in a large population of patients undergoing UKAs or HTOs. We specifically assessed 90 days, 1 year, and 2 years: (1) periprosthetic joint infection (PJI) rates, (2) conversion to TKA rates, as well as (3) complication rates. METHODS A review of an administrative claims database was used to identify patients undergoing primary UKA (n = 13,674) or HTO (n = 1,096) from January 1, 2010 to December 31, 2019. Complication rates at 90 days, 1 year, and 2 years were compared between groups using unadjusted odds ratios (ORs) with 95% confidence intervals. Subsequently, multivariate logistic regressions were performed for PJI and conversion to TKA rates. RESULTS At all time points, patients who underwent UKA were associated with lower rates of infection compared with those who underwent HTOs (all OR ≤ 0.51, all p ≤ 0.010). After 1 year, patients who received UKAs were found to have lower risk of requiring a conversion to a TKA versus those who received HTOs (all OR ≤ 0.55, all p < 0.001). Complications such as dislocations, periprosthetic fractures, and surgical site infections were found at lower odds in UKA compared with HTO patients. CONCLUSION This study provides large-scale analyses demonstrating that UKA is associated with lower infection rates and fewer conversions to TKA compared with patients who have undergone HTO. Dislocations, periprosthetic fractures, and surgical site infections were also found to be lower among UKA patients. However, with careful patient selection, good results and preservation of the native knee are achieved with HTOs. Therefore, UKA versus HTO may be an important discussion to have with patients in an effort to lower the incidence of postoperative infections and complications.
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Affiliation(s)
- Michael E Kahan
- LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Zhongming Chen
- LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Nathan R Angerett
- LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Oliver C Sax
- LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Sandeep S Bains
- LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Michael J Assayag
- LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland.,LifeBridge Health, Rubin Institute for Advanced Orthopedics, International Center for Limb Lengthening, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Ronald E Delanois
- LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - James Nace
- LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
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Ma X, Hu Y, Wang K. Chinese Clinical Practice Guidelines in Treating Knee Osteoarthritis by Periarticular Knee Osteotomy. Orthop Surg 2022; 14:789-806. [PMID: 35509153 PMCID: PMC9087466 DOI: 10.1111/os.13281] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/09/2022] [Accepted: 03/21/2022] [Indexed: 12/25/2022] Open
Abstract
Unicompartmental knee osteoarthritis (UKOA) is the early stage of knee joint degeneration, which is characterized by unicompartmental degeneration and mostly occurs in medial compartment. Pain and limited motion are main symptoms, which affect patients' life quality. Periarticular knee osteotomy (PKO) for lower extremity alignment correction is an effective treatment for UKOA with abnormal alignment, which could relieve pain and improve joint function by adjusting lower extremity alignment. At present, no clinical guidelines are available for the treatment of UKOA by PKO for lower extremity alignment correction. Experts from the Clinical New Technology Application Committee of the Chinese Hospital Association, Joint Surgery Study Group of the Chinese Orthopaedic Association of the Chinese Medical Association, and Osteoarthritis Study Group of the Chinese Association of Orthopaedic Surgeons of the Chinese Medical Doctor Association formulated these guidelines. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) grading system and the Reporting Items for Practice Guidelines in Healthcare (RIGHT) were adopted to select 25 most concerning questions. Finally, 25 recommendations were formulated through evidence retrieval, evidence quality evaluation, and the determination of directions and strength of recommendations. Recommendation items 1-5 are indications and contraindications for PKO for lower extremity alignment correction, items 6-21 are surgical methods and principles, item 22 describes 3D printing corrective osteotomy technique, and items 23-25 address the perioperative period, follow-up management, and other content. These guidelines are designed to improve the normalization and standardization of KOA treatment by PKO for lower extremity alignment correction.
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Affiliation(s)
- Xin‐long Ma
- Department of OrthopaedicsTianjin HospitalTianjinChina
| | - Yong‐cheng Hu
- Department of OrthopaedicsTianjin HospitalTianjinChina
| | - Kun‐zheng Wang
- Department of Orthopaedic SurgeryThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'an ShaanxiChina
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