Abstract
One-week staged bilateral open-wedge high tibial osteotomies (OWHTOs) can be a safe
procedure, with the added advantage of fast functional recovery, cost saving, and
reduced hospital stay. However, there can be concerns about correction loss after
1-week staged OWHTOs because high loading is inevitably applied to osteotomy sites
during postoperative weight bearing. Although leaving the osteotomy site with no grafts
is possible in OWHTOs, the use of grafts can provide additional stability to the osteotomy
site and prevent correction loss. We compared the amount and incidence of correction
loss between 1-week staged bilateral OWHTOs with and without allogenic bone grafts.
Seventy-five patients who underwent 1-week staged bilateral OWHTOs with a locking
spacer plate (Nowmedipia, Seoul, Korea) by a single surgeon were retrospectively reviewed.
Allogenic cancellous bone grafts were applied in 53 patients (group G; 106 knees,
operated consecutively between 2012 and 2017) but not in 22 patients (group N; 44
knees, operated consecutively between 2017 and 2019). Demographics were similar between
the groups. Radiographically, the mechanical axis (MA), medial proximal tibial angle
(MPTA), and posterior tibial slope (PTS) were evaluated preoperatively and within
1 year postoperatively. Unstable hinge fracture was investigated using computed tomography
in all cases. The incidence of correction loss (MPTA loss ≥ 3 degrees) was determined.
There were no significant differences in the MA, MPTA, and PTS between the groups
preoperatively and 2 weeks postoperatively. The incidence of unstable hinge fractures
did not differ. The losses in MA, MPTA, and PTS during the first postoperative year
were significantly greater in group N than in group G (MA, −5.5 vs. −2.3 degrees;
MPTA, −3.0 vs. 0 degrees; PTS, −2.0 vs. −0.7 degrees; p < 0.05 on all parameters). The correction loss incidence was 6.6% (7/106) and 31.8%
(14/44) in groups G and N, respectively (p < 0.001). Appropriate treatment is necessary to prevent correction loss in 1-week
staged bilateral OWHTOs. Grafting, which provides additional stability to the osteotomy
site, is a recommended method. Level of evidence is IV.
Keywords
knee - high tibial osteotomy - open-wedge - staged - correction loss
