Skip to main content
SpringerLink
Log in

Type of bone graft and primary diagnosis were associated with nosocomial surgical site infection after high tibial osteotomy: analysis of a national database

  • KNEE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Although several small-scale studies have reported risk factors for surgical site infection (SSI) after high tibial osteotomy (HTO), no study has collectively analysed risk factors in a large cohort. The present study aimed to clarify the risk factors for SSI after HTO using a national database.

Methods

Data of inpatients who underwent HTO from 2010 to 2017 were obtained from the Diagnosis Procedure Combination database in Japan. Outcome measures were the incidence of SSI and deep SSI after HTO. Associations between SSI and patient data were examined with multivariable logistic regression analysis.

Results

Among 12,853 patients who underwent HTO, 195 developed SSI (1.52%) and 50 developed deep SSI (0.39%). Univariate analysis showed that male sex, smoking, and longer anaesthesia duration were associated with higher incidences of SSI, whereas a primary diagnosis of osteonecrosis and use of natural bone grafts were associated with lower incidences. In multivariable analysis, SSI was positively associated with male sex, anaesthesia duration longer than 210 min (vs. 150–210 min), and use of artificial bone graft (vs. natural bone graft). SSI was negatively associated with age ≤ 49 years (vs. 50–59 years) and a primary diagnosis of osteonecrosis (vs. osteoarthritis).

Conclusion

The present study revealed novel risk factors for SSI after HTO that previous studies have failed to find, including use of artificial bone graft and longer anaesthesia duration; primary diagnosis of osteonecrosis and younger age were novel protective factors. These findings will help surgeons assess risks of SSI after HTO in individual patients.

Level of evidence

III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

HTO:

High tibial osteotomy

OA:

Osteoarthritis

SSI:

Surgical site infection

DPC:

Diagnosis Procedure Combination

ICD-10:

International Classification of Diseases, 10th Revision

ON:

Osteonecrosis

OR:

Odds ratio

CI:

Confidence interval

References

  1. Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H (2008) The long-term outcome of high tibial osteotomy: a ten- to 20-year follow-up. J Bone Jt Surg Br 90:592–596

    CAS  Google Scholar 

  2. Anagnostakos K, Mosser P, Kohn D (2013) Infections after high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 21:161–169

    PubMed  Google Scholar 

  3. Blood AG, Sandoval MF, Burger E, Halverson-Carpenter K (2017) Risk and protective factors associated with surgical infections among spine patients. Surg Infect (Larchmt) 18:234–249

    Google Scholar 

  4. Brophy RH, Wright RW, Huston LJ, Nwosu SK, Spindler KP, Group MK (2015) Factors associated with infection following anterior cruciate ligament reconstruction. J Bone Jt Surg Am 97:450–454

    Google Scholar 

  5. Chen J, Cui Y, Li X, Miao X, Wen Z, Xue Y et al (2013) Risk factors for deep infection after total knee arthroplasty: a meta-analysis. Arch Orthop Trauma Surg 133:675–687

    PubMed  Google Scholar 

  6. Chen H, Chen S, Shi Y, Lu Y, Yu B (2019) Children with open tibial fractures show significantly lower infection rates than adults: clinical comparative study. Int Orthop 43:713–718

    PubMed  Google Scholar 

  7. Duchman KR, Pugely AJ, Martin CT, Gao Y, Bedard NA, Callaghan JJ (2017) Operative time affects short-term complications in total joint arthroplasty. J Arthroplasty 32:1285–1291

    PubMed  Google Scholar 

  8. Gowd AK, Liu JN, Bohl DD, Agarwalla A, Cabarcas BC, Manderle BJ et al (2019) Operative time as an independent and modifiable risk factor for short-term complications after knee arthroscopy. Arthroscopy 35:2089–2098

    PubMed  Google Scholar 

  9. Guo S, Dipietro LA (2010) Factors affecting wound healing. J Dent Res 89:219–229

    CAS  PubMed  PubMed Central  Google Scholar 

  10. Hake ME, Etscheidt J, Chadayammuri VP, Kirsch JM, Mauffrey C (2017) Age and dressing type as independent predictors of post-operative infection in patients with acute compartment syndrome of the lower leg. Int Orthop 41:2591–2596

    PubMed  Google Scholar 

  11. Han JH, Kim HJ, Song JG, Yang JH, Bhandare NN, Fernandez AR et al (2015) Is bone grafting necessary in opening wedge high tibial osteotomy? A meta-analysis of radiological outcomes. Knee Surg Relat Res 27:207–220

    PubMed  PubMed Central  Google Scholar 

  12. Han SB, In Y, Oh KJ, Song KY, Yun ST, Jang KM (2019) Complications associated with medial opening-wedge high tibial osteotomy using a locking plate: a multicenter study. J Arthroplasty 34:439–445

    PubMed  Google Scholar 

  13. Ives CL, Harrison DK, Stansby GS (2007) Tissue oxygen saturation, measured by near-infrared spectroscopy, and its relationship to surgical-site infections. Br J Surg 94:87–91

    CAS  PubMed  Google Scholar 

  14. Jackson JP, Waugh W (1960) Tibial osteotomy for osteoarthritis of the knee. Proc R Soc Med 53:888

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Jackson JP, Waugh W (1961) Tibial osteotomy for osteoarthritis of the knee. J Bone Joint Surg Br 43-B:746–751

    CAS  PubMed  Google Scholar 

  16. Jensen JA, Goodson WH, Hopf HW, Hunt TK (1991) Cigarette smoking decreases tissue oxygen. Arch Surg 126:1131–1134

    CAS  PubMed  Google Scholar 

  17. Kagawa M, Kerr D, Uchida H, Binns CW (2006) Differences in the relationship between BMI and percentage body fat between Japanese and Australian-Caucasian young men. Br J Nutr 95:1002–1007

    CAS  PubMed  Google Scholar 

  18. Kawata M, Sasabuchi Y, Inui H, Taketomi S, Matsui H, Fushimi K et al (2017) Annual trends in knee arthroplasty and tibial osteotomy: analysis of a national database in Japan. Knee 24:1198–1205

    PubMed  Google Scholar 

  19. Kawata M, Sasabuchi Y, Taketomi S, Inui H, Matsui H, Fushimi K et al (2018) Atopic dermatitis is a novel demographic risk factor for surgical site infection after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 26:3699–3705

    PubMed  Google Scholar 

  20. Kawata M, Sasabuchi Y, Taketomi S, Inui H, Matsui H, Fushimi K et al (2018) Annual trends in arthroscopic meniscus surgery: analysis of a national database in Japan. PLoS ONE 13:e0194854

    PubMed  PubMed Central  Google Scholar 

  21. Kong L, Cao J, Zhang Y, Ding W, Shen Y (2017) Risk factors for periprosthetic joint infection following primary total hip or knee arthroplasty: a meta-analysis. Int Wound J 14:529–536

    PubMed  Google Scholar 

  22. Koshino T (1982) The treatment of spontaneous osteonecrosis of the knee by high tibial osteotomy with and without bone-grafting or drilling of the lesion. J Bone Jt Surg Am 64:47–58

    CAS  Google Scholar 

  23. Liu X, Chen Z, Gao Y, Zhang J, Jin Z (2019) High tibial osteotomy: review of techniques and biomechanics. J Healthc Eng 2019:8363128

    PubMed  PubMed Central  Google Scholar 

  24. Meng J, Sun T, Zhang F, Qin S, Li Y, Zhao H (2018) Deep surgical site infection after ankle fractures treated by open reduction and internal fixation in adults: a retrospective case-control study. Int Wound J 15:971–977

    PubMed  Google Scholar 

  25. Murphy MV, Du DT, Hua W, Cortez KJ, Butler MG, Davis RL et al (2016) Risk factors for surgical site infections following anterior cruciate ligament reconstruction. Infect Control Hosp Epidemiol 37:827–833

    PubMed  Google Scholar 

  26. Namba RS, Inacio MC, Paxton EW (2013) Risk factors associated with deep surgical site infections after primary total knee arthroplasty: an analysis of 56,216 knees. J Bone Jt Surg Am 95:775–782

    Google Scholar 

  27. Nåsell H, Ottosson C, Törnqvist H, Lindé J, Ponzer S (2011) The impact of smoking on complications after operatively treated ankle fractures—a follow-up study of 906 patients. J Orthop Trauma 25:748–755

    PubMed  Google Scholar 

  28. Novikov DA, Swensen SJ, Buza JA, Gidumal RH, Strauss EJ (2016) The effect of smoking on ACL reconstruction: a systematic review. Phys Sportsmed 44:335–341

    PubMed  Google Scholar 

  29. OECD (2017) Length of hospital stay (indicator). https://data.oecd.org/healthcare/length-of-hospital-stay.htm. Accessed 23 Jan 2020

  30. Ogihara S, Yamazaki T, Maruyama T, Oka H, Miyoshi K, Azuma S et al (2015) Prospective multicenter surveillance and risk factor analysis of deep surgical site infection after posterior thoracic and/or lumbar spinal surgery in adults. J Orthop Sci 20:71–77

    PubMed  Google Scholar 

  31. Oh KJ, Ko YB, Jaiswal S, Whang IC (2016) Comparison of osteoconductivity and absorbability of beta-tricalcium phosphate and hydroxyapatite in clinical scenario of opening wedge high tibial osteotomy. J Mater Sci Mater Med 27:179

    PubMed  Google Scholar 

  32. Ohya J, Chikuda H, Oichi T, Kato S, Matsui H, Horiguchi H et al (2017) Seasonal Variations in the Risk of Reoperation for Surgical Site Infection Following Elective Spinal Fusion Surgery: A Retrospective Study Using the Japanese Diagnosis Procedure Combination Database. Spine (Phila Pa 1976) 42:1068–1079

    Google Scholar 

  33. Porter SE, Hanley EN (2001) The musculoskeletal effects of smoking. J Am Acad Orthop Surg 9:9–17

    CAS  PubMed  Google Scholar 

  34. Reischl N, Wahl P, Jacobi M, Clerc S, Gautier E, Jakob RP (2009) Infections after high tibial open wedge osteotomy: a case control study. Arch Orthop Trauma Surg 129:1483–1487

    PubMed  Google Scholar 

  35. Ren YM, Duan YH, Sun YB, Yang T, Hou WY, Zhu RS et al (2019) Opening-wedge high tibial osteotomy using autograft versus allograft: a systematic review and meta-analysis. J Knee Surg. https://doi.org/10.1055/s-0039-1681065

    Article  PubMed  Google Scholar 

  36. Schenke M, Dickschas J, Simon M, Strecker W (2018) Corrective osteotomies of the lower limb show a low intra- and perioperative complication rate-an analysis of 1003 patients. Knee Surg Sports Traumatol Arthrosc 26:1867–1872

    PubMed  Google Scholar 

  37. Schwartz C (2018) Minimally invasive opening wedge tibia outpatient osteotomy, using screw-to-plate locking technique and a calcium phosphate cement. Eur J Orthop Surg Traumatol 28:799–809

    PubMed  Google Scholar 

  38. Sørensen LT, Jørgensen S, Petersen LJ, Hemmingsen U, Bülow J, Loft S et al (2009) Acute effects of nicotine and smoking on blood flow, tissue oxygen, and aerobe metabolism of the skin and subcutis. J Surg Res 152:224–230

    PubMed  Google Scholar 

  39. Spahn G (2004) Complications in high tibial (medial opening wedge) osteotomy. Arch Orthop Trauma Surg 124:649–653

    PubMed  Google Scholar 

  40. Stall A, Paryavi E, Gupta R, Zadnik M, Hui E, O'Toole RV (2013) Perioperative supplemental oxygen to reduce surgical site infection after open fixation of high-risk fractures: a randomized controlled pilot trial. J Trauma Acute Care Surg 75:657–663

    CAS  PubMed  Google Scholar 

  41. Staubli AE, De Simoni C, Babst R, Lobenhoffer P (2003) TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia–early results in 92 cases. Injury 34(Suppl 2):B55–62

    PubMed  Google Scholar 

  42. Sun Y, Wang H, Tang Y, Zhao H, Qin S, Xu L et al (2018) Incidence and risk factors for surgical site infection after open reduction and internal fixation of ankle fracture: A retrospective multicenter study. Medicine (Baltimore) 97:e9901

    Google Scholar 

  43. Takeuchi R, Aratake M, Bito H, Saito I, Kumagai K, Hayashi R et al (2009) Clinical results and radiographical evaluation of opening wedge high tibial osteotomy for spontaneous osteonecrosis of the knee. Knee Surg Sports Traumatol Arthrosc 17:361–368

    PubMed  Google Scholar 

  44. Tayton ER, Frampton C, Hooper GJ, Young SW (2016) The impact of patient and surgical factors on the rate of infection after primary total knee arthroplasty: an analysis of 64,566 joints from the New Zealand Joint Registry. Bone Jt J 98-B:334–340

    CAS  Google Scholar 

  45. Wang Z, Zeng Y, She W, Luo X, Cai L (2018) Is opening-wedge high tibial osteotomy superior to closing-wedge high tibial osteotomy in treatment of unicompartmental osteoarthritis? A meta-analysis of randomized controlled trials. Int J Surg 60:153–163

    PubMed  Google Scholar 

  46. W-Dahl A, Toksvig-Larsen S (2006) Infection prophylaxis: a prospective study in 106 patients operated on by tibial osteotomy using the hemicallotasis technique. Arch Orthop Trauma Surg 126:441–447

    PubMed  Google Scholar 

  47. W-Dahl A, Robertsson O, Lohmander LS (2012) High tibial osteotomy in Sweden, 1998–2007: a population-based study of the use and rate of revision to knee arthroplasty. Acta Orthop 83:244–248

    PubMed  PubMed Central  Google Scholar 

  48. Woodacre T, Ricketts M, Evans JT, Pavlou G, Schranz P, Hockings M et al (2016) Complications associated with opening wedge high tibial osteotomy—A review of the literature and of 15 years of experience. Knee 23:276–282

    CAS  PubMed  Google Scholar 

  49. Xing D, Ma JX, Ma XL, Song DH, Wang J, Chen Y et al (2013) A methodological, systematic review of evidence-based independent risk factors for surgical site infections after spinal surgery. Eur Spine J 22:605–615

    PubMed  Google Scholar 

  50. Zhu Y, Liu S, Zhang X, Chen W, Zhang Y (2017) Incidence and risks for surgical site infection after adult tibial plateau fractures treated by ORIF: a prospective multicentre study. Int Wound J 14:982–988

    PubMed  Google Scholar 

Download references

Acknowledgements

Nothing particular.

Funding

This work was supported by grants from the Ministry of Health, Labour and Welfare, Japan (19AA2007 and H30-Policy-Designated-004) and the Ministry of Education, Culture, Sports, Science and Technology, Japan (17H04141). The funding bodies played no role in the design of the study; collection, analysis, or interpretation of the data; or writing of the manuscript.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Manabu Kawata, Shuji Taketomi, Hiroshi Inui, Ryota Yamagami & Sakae Tanaka

  2. Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Taisuke Jo

  3. Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan

    Hiroki Matsui & Hideo Yasunaga

  4. Department of Health Informatics and Policy, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan

    Kiyohide Fushimi

Authors
  1. Manabu Kawata
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Taisuke Jo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shuji Taketomi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hiroshi Inui
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ryota Yamagami
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hiroki Matsui
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kiyohide Fushimi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hideo Yasunaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Sakae Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

KF and HY collected the data. MK, TJ, ShT, HY, and SaT designed the study. MK, TJ, ShT, HI, RY, HM, and HY analysed and interpreted the data. MK, TJ, ShT, HI, RY, and HY drafted the manuscript. All authors had complete access to all data (including statistical reports and tables) used in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Shuji Taketomi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval and informed consent

The ethics committee of our institution approved the study design and waived the requirement for informed consent, because all data were anonymous (approval number: 3501).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kawata, M., Jo, T., Taketomi, S. et al. Type of bone graft and primary diagnosis were associated with nosocomial surgical site infection after high tibial osteotomy: analysis of a national database. Knee Surg Sports Traumatol Arthrosc 29, 429–436 (2021). https://doi.org/10.1007/s00167-020-05943-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-020-05943-4

Keywords

Search

Navigation