Postoperative results after open-wedge high tibial osteotomy with lateral hinge fracture

초록

Background: Lateral hinge fracture (LHF) is a known complication of open-wedge high tibial osteotomy (OWHTO), potentially resulting in postoperative instability, displacement, loss of correction, malunion, and non-union. This study tested the hypothesis that patients who develop LHF after OWHTO can achieve clinical outcomes comparable to those without LHF, without requiring additional surgical intervention. Methods: This retrospective study included 96 patients who underwent OWHTO with a locking plate between 2019 and 2021. Postoperative radiographs and computed tomography (CT) scans identified LHF in 24 patients (25%). Lower limb alignment was assessed using whole-leg standing radiographs at 6 weeks, 3 months, 6 months, and 12 months postoperatively. Clinical outcomes were evaluated using the Hospital for Special Surgery (HSS) score, Knee Society Knee Score (KS), and Function Score (FS). Results: In patients with LHF, the mechanical axis was 59.0 +/- 7.4% at 6 weeks, 57.7 +/- 7.8% at 3 months, 55.9 +/- 9.5% at 6 months, and 53.9 +/- 12.2% at 12 months. In patients without LHF, the corresponding values were 58.5 +/- 6.1%, 57.8 +/- 6.7%, 56.7 +/- 7.0%, and 55.6 +/- 7.4%, respectively. Although the mechanical axis decreased by 5.2% in the LHF group and 2.9% in the non-LHF group by 12 months, the difference was not statistically significant (p = .219). Similarly, the longitudinal change in alignment did not differ significantly between groups (p = .743). Postoperative clinical scores improved in all patients, with no significant differences between groups regardless of LHF status. Conclusion: Patients who experienced LHF following OWHTO demonstrated comparable clinical outcomes and alignment correction to those without LHF, suggesting that LHF does not adversely affect postoperative results.

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