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Osteotomy gap filling delayed among smokers
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After open wedge high tibial osteotomy, osteotomy gap filling was delayed in patients who smoked and in patients who had unstable lateral hinge fractures due to opening of the gap, according to study results.
Researchers performed a series of open wedge high tibial osteotomy (HTO) with the TomoFix plate (DePuy Synthes) with radiologic follow-up examinations postoperatively after 6 and 12 weeks and after 6, 12 and 18 months to measure osteotomy gap filling. The researchers compared bone healing in patients who smoked vs. nonsmokers who underwent open wedge HTOs with intact lateral hinges, and classified fractured lateral hinges according to the Takeuchi classification, analyzing them separately regarding bone healing. The researchers randomly assigned patients to undergo early or standard full-weight-bearing rehabilitation.
Results showed a delay in the osteotomy gap filling rate between smokers and nonsmokers at all follow-up periods; however, the differences were not significant, according to the researchers. The researchers found 39% of patients had a fracture of the lateral hinge, with 14% of patients experiencing a type I fracture, 13% a type II fracture and 6% a type III fracture.
According to study results, patients with intact lateral hinges had the highest increase in the osteotomy gap filling rate between 12 weeks and 6 months after surgery, whereas the highest increase in the gap-filling rate was delayed until 6 to 12 months among patients with unstable type II fractures.
The researchers also found early full weight-bearing had no effect on the gap-filling rate in any of the patient groups evaluated. – by Casey Tingle
Disclosure: Schröter reports having received support from Deutsche Gesetzliche Unfallversicherung FR 150.
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