gms | German Medical Science

Objectives: Corrective osteotomies of the lower limb are standard procedures in orthopaedic surgery. Still, there is only very limited research on which factors affect bone healing after osteotomies. We hypothesize that especially the location of the osteotomy, the smoking status and the BMI do affect bone healing.

Methods: The outcome of 547 osteotomies of the lower limb in 259 female and 288 male patients with an average age of 40.6 years (range 14-77 years) were evaluated. To assess bone healing, participants were divided into three groups by bone healing duration (< 5 months, 5-8 months, > 8 months). Differences in healing duration were related to the anatomic level of the osteotomy, patient age, gender, smoking status and BMI as well as the modus of the osteotomy (open vs. closed wedge) and were tested for significance using an ordinal regression analysis.

Results and conclusion: This study shows a significant correlation between bone healing and the anatomical level of the osteotomy on femur and tibia and the patients' smoking status. The odds of the diaphysis considering bone healing was 0.187 (95% CI, 0.08 to 0.44) times that of the metaphysis (Wald x2(1) = 14.597, p < .000) while there was no difference between femur and tibia. The odds of smokers considering bone healing was 0.192 (95% CI, 0.11 to 0.33) times that of non-smokers (Wald x2(1) = 35.420, p < .000). All other analyzed factors did not show a significant correlation with bone healing in the regression analysis.

The findings of this study show a significant correlation between bone healing and the localization of the osteotomy as well as the smoking status. Thus, surgeons should be encouraged to perform osteotomies in the metaphyseal areas of the femur and tibia, if applicable for the respective deformity. Moreover, the apparent negative effect of smoking on bone healing does highlight the importance of smoking cessation prior to surgery.