Implant removal improved pain, function after medial open-wedge high tibial osteotomy
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Key takeaways:
- Implant removal provided pain relief and functional improvements after medial open-wedge high tibial osteotomy.
- Patients had progressive bone healing and no loss of correction after implant removal.
According to published results, implant removal provided pain relief and functional improvements with progressive bone healing and no loss of correction after medial open-wedge high tibial osteotomy.
Researchers analyzed data from 55 patients (mean age of 53.3 years) who underwent medial open-wedge high tibial osteotomy with a locking plate between March 2014 and September 2017 with minimum 2-year follow-up. According to the study, 92.7% of patients (n= 51) reported implant-related pain prior to removal, with 43 patients reporting mild pain and eight patients reporting moderate pain.
Clinical and functional outcome measures included implant-related pain on the VAS pain scale, Lysholm scores and Tegner score. Radiographic outcomes included the gap-filling rate, weight-bearing line ratio, hip-knee-ankle angle, medial proximal tibial angle and posterior tibial slope angle.
Overall, 10.9% of patients (n= 6) reported mild pain at 1 year and 9.1% of patients (n = 5) reported mild pain at 2 years after implant removal. No other patients reported implant-related pain after removal. At 1-year follow-up, mean Lysholm score improved from 77 to 86.8, while mean Tegner score improved from 3.3 to 3.9. Mean gap-filling rate improved from 84.4% at implant removal to 93.7% and 97.4% at 1 and 2 years, respectively. Researchers noted no statistically significant differences in weight-bearing line ratio, hip-knee-ankle angle, medial proximal tibial angle and posterior tibial slope angle after implant removal.
“Even after implant removal, bone healing progressed gradually without a loss of correction in all patients,” the researchers wrote in the study.
Perspective
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This was an interesting study in which the authors recommended routine hardware removal after medial open-wedge high tibial osteotomy. Their findings were well-documented and showed good healing of the open-wedge osteotomy without bone graft and even progression of healing after hardware removal along the medial cortex. Some pain relief was present after hardware removal, which is not surprising considering the prominence of such hardware along the medial aspect of the tibia. Considering these data, it would be prudent to explain to patients before this type of surgery and hardware removal that it may be beneficial 1-year to 2-years postoperatively.
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