Vancomycin-soaked femoral head allograft in opening wedge high tibia osteotomy enables earlier postoperative recovery and reduces infection rates compared to allogenic bone chips

Abstract

PurposeTo investigate the benefits of vancomycin‐soaked femoral head allograft versus allogenic bone chips as an osteotomy gap filler in reducing infection rates and perioperative pain control after medial opening wedge high tibial osteotomy (MOW‐HTO). MethodsRetrospective analysis of 114 knees that underwent MOW‐HTO between 2013 and 2020. Osteotomy gaps were filled with vancomycin‐soaked femoral head allograft (Study Group) or allogenic bone chips (Control Group). Both groups received systemic antibiotics. Perioperative parameters studied included pain, blood loss, length of stay, postoperative day (POD1) pain scores at rest, with activity as well as ambulatory distance. Patients in the Study Group were also followed up prospectively and clinical outcome scores, namely Knee Society Score, Oxford knee score (OKS) and Physical and Mental Component of the Short‐Form 36 Questionnaire (PCS and MCS, respectively). Statistical analyses using Student’s T‐test were performed between the groups. ResultsPatients of the study group had significantly better POD1 visual analogue scale (VAS) at rest (0.9 ± 1.6 vs 2.9 ± 1.2, p < 0.001) as well as when active (3.0 ± 1.9 vs 5.8 ± 1.5, p < 0.001). A greater proportion of patients in the study group ambulated on POD 1, (90.6% vs 26.0%, p < 0.001). Of those who ambulated on POD1, study group patients managed to cover a greater ambulatory distance (13.9 ± 7.4 m vs 8.4 ± 9.3 m, p < 0.05). The proportion of study group patients requiring patient‐controlled analgesia (PCA) was also significantly less compared to the control group (32.8% vs 58.0%, p < 0.05). Of those requiring PCA, the amount of morphine requirement was also significantly reduced in the group with vancomycin‐soaked allograft (8.7 ± 8.1 mg vs 23.9 ± 33.0 mg, p < 0.05). The study group also had a reduced length of stay (3.5 ± 2.0 days vs 5.5 ± 2.6 days, p < 0.001). Patients in the study group demonstrated significant improvement in Knee Society Knee Score (KSKS), OKS, PCS and MCS at 12 months postoperatively. The study group had a significantly reduced incidence of superficial wound infections compared to the control group (3.1% vs 18.0%, p < 0.05). ConclusionVancomycin‐soaked femoral head allograft reduced superficial and deep wound infections in MOW‐HTO. It was also effective in reducing postoperative pain, thereby enabling early ambulation and shorter hospital stays. Level of evidenceRetrospective comparative study, III.

Large Versus Small Opening Wedge High Tibial Osteotomies Performed With a Protective Wire Over the Lateral Hinge: Incidence of Lateral Hinge Fracture and Early Clinical Outcomes

“…However, the protective benefit of a hinge wire has been established. 11,21 The clinical significance of this study was to demonstrate this protective effect peri-operatively even with larger corrections. Advanced imaging was not used for all patients to detect the presence of LHF, therefore potentially underreporting its incidence.…”

“…A protective K-wire over the lateral hinge was introduced in a proximal-to-distal manner, starting from the extra-articular aspect of the lateral tibial plateau and across the desired hinge point, with care taken to avoid violating the proximal tibiofibular joint. 21 This proximal-to-distal introduction of the protective K-wire differs from the technique described by Gulagaci et al 11 ; however, the principle of reinforcing the hinge point remains (Figure 2; Supplemental Video). MOW-HTO was then performed according to preoperatively planned parameters.…”

“…Patients then underwent a standard postoperative MOW-HTO protocol at the institution. 21 Patients were allowed to bear weight as tolerated from postoperative day 1. Patients were followed up in the specialist outpatient setting at 2 weeks to assess their wounds.…”