Does obesity and nicotine abuse influence the outcome and complication rate after open-wedge high tibial osteotomy? A retrospective evaluation of five hundred and thirty three patients.

PURPOSE: Nicotine abuse and obesity are well-known factors leading to common post-operative complications. However, their influence on the outcome after high tibial osteotomy is controversial. Thus, the aim of this study was to evaluate their effect on the clinical outcome with particular regard to bone non-union and local complications. METHODS: The functional outcome after open-wedge high tibial osteotomy using the TomoFix® plate was assessed by means of the 12-item Oxford knee score in a multicentre study. In addition the intra- and post-operative complications were determined. RESULTS: Of 533 eligible patients, 386 were interviewed after a mean follow-up of 3.6 years. The median Oxford knee score was 43 points (max. 48 points). Six per cent of these patients experienced at least one local post-operative complication. Patients with a body mass index (BMI) of up to 25 and between 25 and 30 had a higher mean score by 3.5 and 1.8 points, respectively, compared with those having a BMI of more than 30 showing a score of 37.5. No correlation was observed between smoking and the functional outcome. Smoking habits, BMI, the absolute patient weight and the interaction term between smoking and BMI were not significant with reference to the complication rate. CONCLUSIONS: This study reveals favourable mid-term results after high tibial osteotomy in varus osteoarthritis even in patients who smoked and obese patients. The indication in patients with a BMI above 30 should be handled with care due to the slightly inferior outcome, although the complication rate was not increased in these patients.

Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients.

PURPOSE: Open-wedge valgus high tibial osteotomy is a well-established procedure in the management of medial osteoarthritis of the knee. In recent years, improved osteotomy and fixation methods have led to an increased use of this technique. The aim of this study was to identify predictive parameters for the clinical outcome after valgus high tibial osteotomy. METHODS: A multicentre case series involving retrospective capture of baseline data and prospective outcome assessment of patients with knee OA who underwent an osteotomy using Tomofix(®) plate was conducted. Functional outcome was assessed using Oxford 12-item Knee Score. RESULTS: Before surgery, the majority of patients had grade III (52%) and grade IV (33%) lesions according to Outerbridge classification. Three hundred and eighty-six of 533 eligible patients were interviewed for follow-up after an average of 3.6 years. The mean Oxford Knee Score was 43 points. Six per cent experienced at least one local postoperative complication. There was a tendency towards lower score results in patients with a higher preoperative degree of the medial cartilage lesion. No correlation between patient age and the Oxford Knee Score was observed. CONCLUSION: Being male, being operated by an experienced surgeon, having no intake of pain medication at follow-up and having no postoperative complication are positive predictors of the Oxford Knee Score up to 5 years after surgery. This study reveals favourable midterm results after valgus high tibial osteotomy in varus osteoarthritis, even in older patients with high degree of cartilage damage. LEVEL OF EVIDENCE: II.

Cementless short stem hip arthroplasty METHA® as an encouraging option in adults with osteonecrosis of the femoral head.

INTRODUCTION: The implantation of a total hip arthroplasty is the standard treatment for patients with progressive osteonecrosis. However, there is uncertainty about the type of arthroplasty that provides the best outcome and whether short stem arthroplasty represents a reasonable alternative for young patients in order to have more options in case of revision. This uncertainty exists due to the lack of studies analysing contemporary short stem arthroplasty in osteonecrosis. AIM: The aim of this study was to determine the outcome of the METHA(®) short stem arthroplasty in patients with progressive osteonecrosis. PATIENTS AND METHODS: This study evaluated the clinical and radiological short- to midterm results after implantation of the cementless short stem arthroplasty METHA(®). 73 hips in 64 patients with progessive osteonecrosis after implantation of the METHA(®) arthroplasty were investigated by measuring the clinical outcome, the Harris Hip Score (HHS) and visual analogue pain scale for the preoperative stage and follow-up. Radiological analyses of X-rays were conducted to assess the bone ingrowth as well as subsidence, osteolysis or fracture. RESULTS: The pain scale improved from preoperatively 7.8 to postoperatively 1.7, while the HHS increased from 41.4 to 90.6 points 34 months post-surgery. Complications associated with revision of the METHA(®) short stem included two traumatic femoral shaft fracture and one deep infection. The radiological assessment showed good bone ingrowth in all patients despite osteonecrosis. CONCLUSION: The study confirms encouraging results as well as good bone ingrowth of the cementless short stem arthroplasty METHA(®) even in patients with osteonecrosis.