Complications Associated With Medial Opening-Wedge High Tibial Osteotomy Using a Locking Plate: A Multicenter Study.

BACKGROUND: The aim of this study is to investigate complications following medial opening-wedge high tibial osteotomy using a locking plate. In addition, we aimed to compare postoperative outcomes between the complicated and the uncomplicated group. METHODS: This study enrolled 209 patients who underwent medial opening-wedge high tibial osteotomy between 2010 and 2015. Patients with a follow-up period of at least 2 years were enrolled. Medical records and radiologic data were retrospectively reviewed. The complications were assessed up to postoperative 2 years and categorized into major and minor complications. The preoperative and postoperative clinical statuses were assessed using the Western Ontario McMaster University Osteoarthritis Index. RESULTS: The mean patient age was 56.4 ± 5.9 years. Overall complication rate was 29.7%. Minor complications included undisplaced lateral hinge fracture (12.0%), hardware irritation (1.4%), displaced lateral hinge fracture (2.4%), delayed wound healing (1.9%), undisplaced lateral tibial plateau fracture (1%), and superficial wound infection (1%). Major complications were symptomatic hardware which needed hardware removal (4.8%), deep wound infection (1.9%), hardware failure with correction loss (1%), nonunion (0.5%), and early conversion to arthroplasty (0.5%). Most complications occurred intraoperatively (30.6%) and within 3 months postoperatively (40.3%). The major complication group showed a statistically higher Western Ontario McMaster University Osteoarthritis Index score than did other groups at postoperative 1 year (P = .013) and 2 years (P = .001). CONCLUSION: The overall complication rate was 29.7%. Most complications were minor. The most common complication was undisplaced lateral hinge fracture. Major complications occurred in 8.6%. The major complication group showed significantly worse clinical outcomes than did the uncomplicated and minor complication groups.

Difference in the degree of improvement in patient-reported outcomes after total knee arthroplasty between octogenarians and sexagenarians: a propensity score matching analysis.

BACKGROUND: As the population ages, the use of primary total knee arthroplasty (TKA) is on the rise in the octogenarian population. AIMS: The objective of this study was to compare patient-reported outcomes after TKA in octogenarians versus sexagenarians. METHODS: This retrospective case-controlled comparative study with a propensity score matching analysis was conducted by 251 patients who underwent TKA for degenerative osteoarthritis of the knee. After the propensity score matching analysis, 38 octogenarians and 41 sexagenarians were identified. Range of motion (ROM), degree of flexion contracture, Charlson Comorbidity Index score, Knee Society score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, the 36-Item Short-Form Health Survey (SF-36), postoperative complications, length of stay, and 90-day mortality after TKA were compared. The degree of improvement of each functional parameter was also assessed. RESULTS: There was no significant difference in the degree of improvement in postoperative ROM, flexion contracture, or KSS. There were only significant differences in length of hospital stay and volume of blood transfusion (p < 0.001 and p = 0.004, respectively). The octogenarian patient group showed significantly inferior outcomes for WOMAC and SF-36 score compared to the sexagenarian patient group (p = 0.009 and p = 0.022, respectively). CONCLUSION: Although the functional improvements after TKA were excellent regardless of age, TKA seemed to contribute little to quality of life in octogenarian patients. Therefore, a careful approach to improving satisfaction with subjective outcomes is needed for octogenarian patients who undergo TKA.

The Learning Curve for Biplane Medial Open Wedge High Tibial Osteotomy in 100 Consecutive Cases Assessed Using the Cumulative Summation Method.

PURPOSE: The purpose of this study was to investigate whether surgical experience could improve surgical competency in medial open wedge high tibial osteotomy (MOWHTO). MATERIALS AND METHODS: One hundred consecutive cases of MOWHTO were performed with preoperative planning using the Miniaci method. Surgical errors were defined as under- or overcorrection, excessive posterior slope change, or the presence of a lateral hinge fracture. Each of these treatment failures was separately evaluated using the cumulative summation test for learning curve (LC-CUSUM). RESULTS: The LC-CUSUM showed competency in prevention of undercorrection, excessive posterior slope change, and lateral hinge fracture after 27, 47, and 42 procedures, respectively. However, the LC-CUSUM did not signal achievement of competency in prevention of overcorrection after 100 procedures. Furthermore, the failure rate for overcorrection showed an increasing tendency as surgical experience increased. CONCLUSIONS: Surgical experience may improve the surgeon's competency in prevention of undercorrection, excessive posterior slope change, and lateral hinge fracture. However, it may not help reduce the incidence of overcorrection even after performance of 100 cases of MOWHTO over a period of 6 years.