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Staple versus locking compression plate fixation after lateral closing wedge high tibial osteotomy

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To compare the results of staple versus locking compression plate fixation after closing wedge high tibial osteotomy. A group of 23 patients (24 knees) who underwent box high tibial osteotomy and staple fixation was compared with another group of 19 patients (22 knees) who underwent a similar procedure but with locking compression plate fixation. Both groups were followed up for 3 years. The range of movement, Hospital for Special Surgery (HSS) Knee Score, time to full weight bearing, incidence of delayed union, femorotibial angle, and stage of osteoarthritis were compared. At 6 months after the operation, the median HSS score and the proportion of patients with excellent or good scores were significantly higher in the locking compression plate than the staple fixation group (76 vs 62, p=0.003; 75% vs 42%, p=0.0354), but not at one and 3 years. The range of movement was significantly greater in the locking compression plate fixation group in the short term (6 weeks, 3 and 6 months), but not after one year. The median time to full weight bearing was significantly shorter in the locking compression plate fixation group (86 vs 116 days, p0.001). There were fewer delayed unions in the locking compression plate fixation group but not significantly (1 vs 5, p=0.198), possibly because of the small numbers involved. There was no difference, within the limits of measurement error, in the femorotibial angle or correction loss between the 2 groups. Locking compression plate fixation obviates the use of plaster casts, enables early mobilisation and bone union, and reduces the numbers with delayed union and the time to full weight bearing. Longer-term studies are needed to evaluate its effect on revarisation and arthropathy.

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									Journal of Orthopaedic Surgery 2008;16(3):303-7




Staple versus locking compression plate
fixation after lateral closing wedge high tibial
osteotomy
S Agarwala, SB Shah
PD Hinduja National Hospital and Medical Research Centre, Mumbai, India




                                                            and 3 years. The range of movement was significantly
                                                            greater in the locking compression plate fixation group
ABSTRACT                                                    in the short term (6 weeks, 3 and 6 months), but not
                                                            after one year. The median time to full weight bearing
Purpose. To compare the results of staple versus            was significantly shorter in the locking compression
locking compression plate fixation after closing            plate fixation group (86 vs 116 days, p<0.001). There
wedge high tibial osteotomy.                                were fewer delayed unions in the locking compression
Methods. A group of 23 patients (24 knees) who              plate fixation group but not significantly (1 vs 5,
underwent box high tibial osteotomy and staple              p=0.198), possibly because of the small numbers
fixation was compared with another group of                 involved. There was no difference, within the limits
19 patients (22 knees) who underwent a similar              of measurement error, in the femorotibial angle or
procedure but with locking compression plate                correction loss between the 2 groups.
fixation. Both groups were followed up for 3 years.         Conclusion. Locking compression plate fixation
The range of movement, Hospital for Special Surgery         obviates the use of plaster casts, enables early
(HSS) Knee Score, time to full weight bearing,              mobilisation and bone union, and reduces the
incidence of delayed union, femorotibial angle, and         numbers with delayed union and the time to full
stage of osteoarthritis were compared.                      weight bearing. Longer-term studies are needed to
Results. At 6 months after the operation, the median        evaluate its effect on revarisation and arthropathy.
HSS score and the proportion of patients with excellent
or good scores were significantly higher in the locking     Key words: bone plates; fracture fixation, internal;
compression plate than the staple fixation group (76        osteoarthritis, knee; osteotomy
vs 62, p=0.003; 75% vs 42%, p=0.0354), but not at one




Address correspondence and reprint requests to: Dr Sanjay Agarwala, PD Hinduja National Hospital and Medical Research
Centre, Mumbai, 400016, Maharashtra, India. E-mail: drsa@rediffmail.com
304 S Agarwala and SB Shah                                                             Journal of Orthopaedic Surgery


INTRODUCTION                                                                         Table 1
                                                                Hospital for Special Surgery (HSS) Knee Score15
Lateral closing wedge high tibial osteotomy has been
a standard procedure for genu varum secondary to           HSS Knee Score
osteoarthritis of the knee.1–7 The correction angle is     Pain (30 points)
the most important factor attributing to the long-term        No pain at any time                                 30
revarisation and arthropathy,1,8 in addition to age, the      No pain on walking or at rest                       15
extent of deformity of the knee and degeneration of           Mild pain on walking or at rest                     10
                                                              Moderate pain on walking or at rest                  5
articular cartilage.1,4–6,8–11 To avoid recurrent varus       Severe pain on walking or at rest                    0
deformity, it has been advised that the femorotibial       Function (22 points)
angle be overcorrected,9,10 and be maintained as              Walking and standing unlimited                      22
such throughout the postoperative period.2,5,6,12,13          Walking 5 to 10 blocks and standing for >0.5 hou
								
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