Firat Gulagaci1,2,3, Christophe Jacquet1,2,3, Matthieu Ehlinger4, Akash Sharma1,2,3, Kristian Kley1,2,3, Adrian Wilson5, Sebastien Parratte1,2,3, Matthieu Ollivier6,7,8. 1. Institute of Movement and Locomotion Department of Orthopedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France. 2. APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Aix Marseille University, Marseille, France. 3. The Institute for Locomotion, Aix-Marseille University, Marseille, France. 4. Service de Chirurgie Orthopédique et de Traumatologie, CHU Hautepierre, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67098, Strasbourg Cedex, France. 5. The Wellington Hospital, Wellington Place, St. John's Wood, London, UK. 6. Institute of Movement and Locomotion Department of Orthopedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France. matthieu.ollivier@ap-hm.fr. 7. APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Aix Marseille University, Marseille, France. matthieu.ollivier@ap-hm.fr. 8. The Institute for Locomotion, Aix-Marseille University, Marseille, France. matthieu.ollivier@ap-hm.fr.
Abstract
PURPOSE: A recent study reported that positioning a K-wire to intersect the cutting plane at the theoretical lateral hinge location increases the lateral hinge's resistance to fracture during the opening of opening wedge high tibial osteotomy (OWHTO). The purpose of this study was to evaluate the clinical relevance of the use of this K-wire and its benefits in terms of lateral hinge protection during OWHTO in daily practice. METHODS: A retrospective comparative study identified 206 patients who underwent OWHTO from January 2014 to December 2017. Among these patients, 71 had an additional K-wire (HK + group), whereas 135 did not (HK- group). The subjects meeting the inclusion criteria were included in a matched pairing process, which identified 60 patients in the HK + group and 60 patients in the HK- group. Mean follow-up time was 2.3 ± 1.0 years (range 2-4.2). Radiographic outcomes were evaluated with intraoperative and postoperative fluoroscopic imaging and with CT imaging at 6 weeks post OWHTO surgery. The knee osteoarthritis outcomes score (KOOS) was used and time needed to return to work and any kind of sports was collected. RESULTS: Thirty six patients (30%) were found to have a LHF. Among these patients, 26 (72%) did not have an additional K-wire positioned at their theoretical lateral hinge location (HK- group) during the procedure. LHF rate for patients without additional K-wire group (HK-) was 43.3%, whereas it was 16.7% for the patients with an additional K-wire (HK +) [Odd ratio 3.8 95% CI 1.6-8.3; p = 0.005]. The mean time to return to work, return to any kind of sports, and bone union was significantly shorter for HK + group (p < 0.05). CONCLUSION: This study demonstrated that during OWHTO, positioning a K-wire intersecting the cutting plane at the theoretical lateral hinge location reduced the number of intraoperative lateral hinge fractures. LEVEL OF EVIDENCE: III retrospective case-control study.
PURPOSE: A recent study reported that positioning a K-wire to intersect the cutting plane at the theoretical lateral hinge location increases the lateral hinge's resistance to fracture during the opening of opening wedge high tibial osteotomy (OWHTO). The purpose of this study was to evaluate the clinical relevance of the use of this K-wire and its benefits in terms of lateral hinge protection during OWHTO in daily practice. METHODS: A retrospective comparative study identified 206 patients who underwent OWHTO from January 2014 to December 2017. Among these patients, 71 had an additional K-wire (HK + group), whereas 135 did not (HK- group). The subjects meeting the inclusion criteria were included in a matched pairing process, which identified 60 patients in the HK + group and 60 patients in the HK- group. Mean follow-up time was 2.3 ± 1.0 years (range 2-4.2). Radiographic outcomes were evaluated with intraoperative and postoperative fluoroscopic imaging and with CT imaging at 6 weeks post OWHTO surgery. The knee osteoarthritis outcomes score (KOOS) was used and time needed to return to work and any kind of sports was collected. RESULTS: Thirty six patients (30%) were found to have a LHF. Among these patients, 26 (72%) did not have an additional K-wire positioned at their theoretical lateral hinge location (HK- group) during the procedure. LHF rate for patients without additional K-wire group (HK-) was 43.3%, whereas it was 16.7% for the patients with an additional K-wire (HK +) [Odd ratio 3.8 95% CI 1.6-8.3; p = 0.005]. The mean time to return to work, return to any kind of sports, and bone union was significantly shorter for HK + group (p < 0.05). CONCLUSION: This study demonstrated that during OWHTO, positioning a K-wire intersecting the cutting plane at the theoretical lateral hinge location reduced the number of intraoperative lateral hinge fractures. LEVEL OF EVIDENCE: III retrospective case-control study.
Entities:
Keywords:
HTO; Hinge fracture; Patient specific cutting guide; Postoperative outcomes
Authors: Raghbir S Khakha; Hamid Rahmatullah Bin Abd Razak; Kristian Kley; Ronald van Heerwaarden; Adrian J Wilson Journal: J Clin Orthop Trauma Date: 2021-10-01