Corrective osteotomies of femur and tibia: which factors influence bone healing?

• Published in: Archives of orthopaedic and trauma surgery Vol. 140; no. 3; pp. 303 - 311
• Main Authors: Simon, Michael H., Grünwald, L., Schenke, M., Dickschas, J., Strecker, W.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-03-2020; Springer Nature B.V
• Subjects: Adolescent; Adult; Age; Aged; Arthritis; Bone surgery; Bones; Congenital diseases; Female; Femur - physiology; Femur - surgery; Humans; Joint surgery; Localization; Male; Medicine; Medicine & Public Health; Metabolic disorders; Middle Aged; Orthopaedic Surgery; Orthopedics; Osteotomy - methods; Osteotomy - statistics & numerical data; Patients; Prospective Studies; Smoking; Surgeons; Surgical techniques; Tibia - physiology; Tibia - surgery; Trauma; Wound Healing - physiology; X-rays; Young Adult; Lower limb; Smoking status; Bone healing; Osteotomy; Anatomic level of the osteotomy
• ISSN: 0936-8051; 1434-3916
• DOI: 10.1007/s00402-019-03217-4

Introduction
Corrective osteotomies of the lower limb are standard procedures in orthopedic surgery. Still, there is only limited research on factors affecting bone healing after osteotomies. We hypothesize that especially the location of the osteotomy, smoking status and BMI affect bone healing.
Material and methods
The healing process of 547 patients who underwent osteotomies of the lower limb (259 female, 288 male; average 40.6 years, range 14–77) was evaluated. To assess bone healing, participants were divided into three groups by bone healing duration ( < 5/5–8/ > 8 months). Differences in healing duration related to the anatomic level of the osteotomy (diaphysis vs. metaphysis), age, gender, smoking status, BMI, and modus of the osteotomy (open vs. closed wedge) were tested for significance using an ordinal regression analysis.
Results
A significant correlation between bone healing and the anatomical level of the osteotomy on femur and tibia and the patients’ smoking status was found. The odds of the diaphysis considering bone healing was 0.187 (95% CI, 0.08–0.44) times that of the metaphysis (Wald
χ
2
(1) = 14.597,
p
 < 0.000). The odds ratio of smokers considering bone healing was 0.192 (95% CI, 0.11–0.33) times that of non-smokers (Wald
χ
2
(1) = 35.420,
p
 < 0.000). All other analyzed factors did not show a significant correlation with bone healing.
Conclusions
Smoking status and the localization of the osteotomy on femur and tibia (diaphysis vs. metaphysis) are significantly correlated with bone healing duration. In line with current literature emphasizing the detrimental effect of smoking on bone healing, our findings should encourage surgeons to think twice about the indication to perform osteotomies on smokers. Furthermore, if applicable, osteotomies should be performed in the metaphyseal areas of femur and tibia.