Early experience of lateral hinge fracture during medial opening-wedge high tibial osteotomy: incidence and clinical outcomes.

PURPOSE: Lateral hinge fracture (LHF) during a medial opening-wedge high tibial osteotomy (MOWHTO) is considered to be the main cause of instability, further displacement, loss of correction, malunion, and nonunion. The purposes of this study were to evaluate whether the incidence of LHFs during MOWHTOs has decreased as the number of cases performed over time has increased, and whether the radiographic and clinical outcomes of patients with LHFs were worse than those of patients without LHFs. MATERIALS AND METHODS: During the period of July 2013 to January 2017, 132 MOWHTOs were performed by a single surgeon using a locking plate (TomoFix®, DePuySynthes, Solothurn, Switzerland) for the treatment of medial compartment osteoarthritis, with LHFs postoperatively detected in 32 knees (24.2%). To evaluate trends in the incidence of LHFs occurring during MOWHTOs over time, all 132 cases were divided chronologically into four groups of 33 cases and compared. The time for bony union and loss of correction were compared between the LHF group and the non-LHF group using an osteotomy filling index, hip-knee-ankle (HKA) angles, medial proximal tibial angles (MPTA), weight-bearing line (WBL) ratios, and posterior tibial slope (PTS) angles on radiographs. Clinical outcomes were also compared using the Knee Society Scores (KSS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores 1 year post-surgery. RESULTS: The incidence of LHFs in each group of 33 cases did not decrease over time (21.2%, 27.3%, 24.2%, and 24.2%, respectively, p = 0.954). The time to union was significantly different between the non-LHF group (5.0 months) and the LHF group (7.3 months) (p < 0.001). However, there were no immediate or 1-year postoperative differences in the HKA angles, MPTAs, WBL ratios, or PTS angles between the non-LHF and LHF groups (all p > 0.05). The KSS and WOMAC scores were significantly improved in both groups (all p < 0.001) 1 year post-surgery, without any differences between the groups (p = 0.997 and p = 0.122, respectively). CONCLUSIONS: LHFs during MOWHTO procedures occurred consistently, with a similar incidence over time. Although patients with LHFs required more time to bony union, they showed similarly favorable radiographic and clinical results as the patients without LHFs 1 year after surgery.

Unicompartmental knee arthroplasty is superior to high tibial osteotomy in post-operative recovery and participation in recreational and sports activities.

PURPOSE: To compare (1) the recovery pattern of post-operative physical activity and function in the early post-operative period and (2) the difference of participation in recreational and sports activities pre- and post-operatively following unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO). METHODS: In this prospective comparative study, 49 HTOs (49 patients) and 42 UKAs (42 patients) performed to treat medial compartmental knee osteoarthritis (OA) were included. The pain visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index score (WOMAC), Tegner activity score, Lysholm knee score, and the University of California at Los Angeles (UCLA) activity score were evaluated pre-operatively and post-operatively at three, six, 12, and 24 months. Participation in recreational and sports activities was also assessed pre-operatively and 24 months post-operatively. RESULTS: Pre-operatively, although there were no differences in VAS, WOMAC, and Lysholm scores between the two groups, the UKA group had inferior Tegner and UCLA scores (p < 0.05). At post-operative three and six months, the UKA group showed superior VAS, WOMAC, and Lysholm scores (p < 0.05 for all). However, at 12 and 24 months post-operatively, both groups had similar outcome scores (p > 0.05 for all). When all the baseline scores were adjusted for the mean changes, the UKA group showed a significantly better UCLA score than the HTO group until 12 months after the operation (p = 0.008). The rate of return to sports activity was 94.1% in the UKA group and 75.0% in the HTO group at 24 months post-operatively (p = 0.031). CONCLUSION: These findings indicate that UKA had better short-term functional outcomes and return to recreational and sports activities than did HTO in patients with medial OA.