Department of Orthopaedic Surgery, the First Hospital of Hebei Medical University, Shijiazhuang, China.
Department of orthopaedic surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, P. R. China.
Int Wound J. 2023 Sep;20(7):2563-2570. doi: 10.1111/iwj.14124. Epub 2023 Feb 27.
Medial opening-wedge high tibial osteotomy (MOWHTO) is a well-established surgical method for treatment of isolated medial compartment osteoarthritis with varus deformity, but the surgical outcomes may be compromised by surgical site infection (SSI). This study aimed to investigate the incidence and the risk factors for SSI after MOWHTO. This retrospective study included consecutive patients who underwent MOWHTO for isolated medial compartment osteoarthritis with varus deformity in two tertiary referral hospitals from January 2019 and June 2021. Patients who developed SSI within 12 months of surgery were identified by inquiring the medical records for index hospitalisation, notes of after-discharge outpatient visits, or records of readmission for treatment of SSI. Univariate comparisons were performed to detect the differences between SSI and non-SSI groups, and multivariate logistic regression analysis was used to identify the independent risk factors. Six hundred sixteen patients with 708 procedures were included and 30 (4.2%) cases of SSI occurred, with 0.6% rate for deep SSI and 3.6% for superficial. Univariate analyses showed significant difference between groups in terms of morbidity obesity (≥32 kg/m ) (20.0% vs 8.9%), comorbid diabetes (26.7% vs 11.1%), active smoking (20.0% vs 6.3%), time from admission to operation (5.2 ± 4.0 vs 4.1 ± 3.0), size of osteotomy ≥12 mm (40.0% vs 20.0%), type of bone grafting and lymphocyte count (2.1 ± 0.5 vs 1.9 ± 0.6). However, in the multivariate analysis, only active smoking (OR, 3.4; 95% CI, 1.4-10.2), size of osteotomy ≥12 mm (OR, 2.8; 95% CI, 1.3-5.9) and allogeneic/artificial vs no bone grafting (OR, 2.4; 95% CI, 1.0-10.8) remained significant. SSI was not uncommon after MOWHTO, but the majority was superficial. The identified three independent factors, including smoking, size of osteotomy ≥12 mm and allogeneic/artificial bone grafting would help risk assessment and stratification, target risk factor modification and clinical surveillance, and inform patient counselling.
内侧切开楔形胫骨高位截骨术（MOWHTO）是治疗内侧间室骨关节炎合并内翻畸形的一种成熟的手术方法，但手术部位感染（SSI）可能会影响手术效果。本研究旨在探讨 MOWHTO 后 SSI 的发生率和危险因素。本回顾性研究纳入了 2019 年 1 月至 2021 年 6 月在两家三级转诊医院因孤立性内侧间室骨关节炎合并内翻畸形行 MOWHTO 的连续患者。通过查询索引住院、出院后门诊就诊记录或 SSI 治疗的再次入院记录，确定术后 12 个月内发生 SSI 的患者。对 SSI 组和非 SSI 组进行单因素比较，采用多因素 logistic 回归分析确定独立危险因素。共纳入 616 例患者，708 例手术，发生 SSI30 例（4.2%），其中深部 SSI 发生率 0.6%，浅部 SSI 发生率 3.6%。单因素分析显示，两组在肥胖发病率（≥32kg/m2）（20.0% vs. 8.9%）、合并糖尿病（26.7% vs. 11.1%）、吸烟（20.0% vs. 6.3%）、入院至手术时间（5.2±4.0 vs. 4.1±3.0）、截骨≥12mm （40.0% vs. 20.0%）、植骨类型和淋巴细胞计数（2.1±0.5 vs. 1.9±0.6）方面存在显著差异。然而，多因素分析显示，只有吸烟（OR，3.4；95%CI，1.4-10.2）、截骨≥12mm（OR，2.8；95%CI，1.3-5.9）和同种异体/人工骨与非植骨（OR，2.4；95%CI，1.0-10.8）是独立的危险因素。MOWHTO 后 SSI 并不少见，但大多数为浅表性。确定的三个独立危险因素，包括吸烟、截骨≥12mm 和同种异体/人工植骨，有助于评估和分层风险、目标危险因素的修正和临床监测，并为患者咨询提供信息。
