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Background: This study investigated the epidemiology and demographics of slipped capital femoral epiphysis (SCFE) in South Korea using a nationwide population-based database., Methods: Information on sex, age at onset, endocrine comorbidities, history of growth hormone therapy, history of radiation therapy, surgical methods, and complications in patients with SCFE aged younger than 18 years between 2007 and 2019 was retrieved from the Korean Health Insurance Review and Assessment Service database., Results: Data were available for 586 children (429 boys, 157 girls). The average age at onset was 11.1 ± 1.8 years (boys, 11.3 ± 1.9; girls, 10.6 ± 1.5). Five hundred and twenty-nine (90.3%) patients were aged 9-14 years; the incidence rate in this age group was 6.0/100,000 (95% confidence interval, 5.5-6.6) and significantly higher in boys (8.4 vs 3.5, p<0.001). There was a significant increase in the annual incidence rate from 0.96/100,000 in 2009 to 2.05/100,000 in 2019 (p = 0.006). Ninety-five patients (16.2%) had endocrine comorbidities or a history of hormone/radiation therapy. Osteotomy and internal fixation were performed in 59 patients and in situ pinning in 527. Seventy-six patients developed postoperative complications., Conclusion: The annual incidence rate of SCFE in South Korea has increased since 2009., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Kim et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Among various patient risk factors affecting survival after high tibial osteotomy (HTO), the ideal age limit for HTO is unclear. This study was performed to evaluate the effect of age on survival rate and complications after HTO for medial unicompartmental osteoarthritis. Among of 61,145 HTO patients from Korean National Health Insurance database, 41,112 patients underwent the procedure before the age of 60 years (Group A), 13,895 patients between the age of 60 and 65 years (Group B), and 6138 patients after the age of 65 years (Group C). We compared the survival rate in person-years among the three groups from the date of primary surgery until subsequent total knee arthroplasty. Perioperative complications were also recorded. The adjusted hazard ratio (HR) were calculated using the multivariable Cox proportional hazard regression model, adjusting for the potential confounders: age, sex, type of medical insurance, region of residence, hospital type, comorbidities, and Charlson comorbidity index score. The total number of HTO increased 6.5-fold, especially in patients aged > 65 years (by 8.2-fold) from 2008 to 2018. The overall revision rate was 4.2% in Group A, 6.4% in Group B, and 7.3% in Group C. The 5- and 10-year revision rate was significantly lower in Group A (p < 0.001), but no difference between Groups B and C. After adjusting for potential confounders, multivariable regression analysis revealed that revision rate was significantly lower in Group A than Group B (HR: 0.57; p < 0.0001), but no difference between Groups B and C. The incidence of complications was also significantly lower in Group A than in other groups. The inferior survival rate and more perioperative complications after HTO was found in old patients (aged ≥ 60 years) than in young patients. Therefore, the patient age is one of the predicting factors for a high risk of failure after HTO., (© 2021. The Author(s).)

Background: High tibial osteotomy (HTO) is often performed to postpone or avoid the need for subsequent total knee arthroplasty (TKA). We designed the present study to investigate the incidence rate and risk factors for subsequent revision in patients treated with HTO compared with those managed with TKA., Methods: In this retrospective nationwide cohort study, we reviewed the South Korean National Health Insurance claims database from January 1, 2009, to August 31, 2017. We evaluated patients ≥41 years old who had undergone TKA or HTO as the primary surgical procedure without a history of having undergone either procedure during the preceding 2 years. By including only new interventions without such prior surgery, we could eliminate the influence of previous TKA and HTO treatments. Multivariable logistic regression models were used to compare the risk of revision between the groups after propensity score matching with inverse probability of treatment weighting (IPTW). Revision was defined as conversion to revision TKA after primary TKA and conversion to TKA after HTO., Results: After applying the IPTW, a total of 436,538 patients with TKA and 452,724 patients with HTO were identified. The risk of revision during the entire study period was higher for patients with HTO than for patients with TKA (adjusted hazard ratio [HR], 2.47). The Kaplan-Meier 8-year survival was 97.8% in the TKA group and 91.5% in the HTO group. Compared with patients with TKA, patients with HTO had an increased risk of revision in cases of advanced age (HR of 1.85 for patients who were ≥61 to 69 years old and HR of 4.17 for those who were ≥70 years old), female sex (HR, 2.90), recipients of Medical Aid program benefits (HR, 4.77), the presence of hyperlipidemia (HR, 3.70), the presence of diabetes (HR, 4.86), and the presence of osteoporosis (HR, 3.53). However, younger patients with HTO (≤60 years old) had a lower risk of subsequent revision (HR, 0.64)., Conclusions: The risk of revision was higher for patients with HTO than for patients with TKA. The risk factors for subsequent revision in patients with HTO in our cohort of patients were advanced age (>60 years), female sex, receipt of Medical Aid, and the presence of comorbidities, such as diabetes, osteoporosis, and hyperlipidemia., Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Background: This study compared the rates of plain radiographs and computed tomography (CT) for detecting lateral hinge fractures and to evaluate factors affecting lateral hinge fractures in patients following medial opening-wedge high tibial osteotomy (MOWHTO)., Methods: This prospective study included 59 patients (65 knees) undergoing MOWHTO for primary medial compartment osteoarthritis with a 2-year follow-up between 2013 and 2016. Clinical and radiographic evaluations were performed using Knee Society Score and Western Ontario and McMaster Universities Arthritis Index, and we calculated the hip-knee-ankle angle, weight-bearing line ratio, lateral distal femoral angle, medial proximal tibial angle, posterior tibial slope, osteotomy gap height, and osteotomy gap filling rate. Immediate plain radiographs and CT were used to detect lateral hinge fractures according to Takeuchi's method., Results: Among 65 knees, the incidence of lateral hinge fractures was 13.8% (Type I: 7, Type II: 2). Only 6 knee fractures (9.2%) were detected on postoperative plain radiographs, including 5 Type I fractures and 1 Type II fracture. An additional 3 knees (4.6%) were detected on postoperative CT scans, including 2 Type I fractures and 1 Type II fracture. Furthermore, osteotomy gap height (adjusted odds ratio = 1.831, P = .016) was the only predictor of lateral hinge fractures., Conclusion: The incidence of lateral hinge fractures after MOWHTO was 13.8%. CT (13.8%) afforded higher detection rates for lateral hinge fractures than did plain radiographs (9.2%) despite a marginal difference with uncertain significance. Osteotomy gap height was the only predictor of lateral hinge fractures., Level of Evidence: Prospective cohort study (Level II)., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: The aim of this study is to investigate complications following medial opening-wedge high tibial osteotomy using a locking plate. In addition, we aimed to compare postoperative outcomes between the complicated and the uncomplicated group., Methods: This study enrolled 209 patients who underwent medial opening-wedge high tibial osteotomy between 2010 and 2015. Patients with a follow-up period of at least 2 years were enrolled. Medical records and radiologic data were retrospectively reviewed. The complications were assessed up to postoperative 2 years and categorized into major and minor complications. The preoperative and postoperative clinical statuses were assessed using the Western Ontario McMaster University Osteoarthritis Index., Results: The mean patient age was 56.4 ± 5.9 years. Overall complication rate was 29.7%. Minor complications included undisplaced lateral hinge fracture (12.0%), hardware irritation (1.4%), displaced lateral hinge fracture (2.4%), delayed wound healing (1.9%), undisplaced lateral tibial plateau fracture (1%), and superficial wound infection (1%). Major complications were symptomatic hardware which needed hardware removal (4.8%), deep wound infection (1.9%), hardware failure with correction loss (1%), nonunion (0.5%), and early conversion to arthroplasty (0.5%). Most complications occurred intraoperatively (30.6%) and within 3 months postoperatively (40.3%). The major complication group showed a statistically higher Western Ontario McMaster University Osteoarthritis Index score than did other groups at postoperative 1 year (P = .013) and 2 years (P = .001)., Conclusion: The overall complication rate was 29.7%. Most complications were minor. The most common complication was undisplaced lateral hinge fracture. Major complications occurred in 8.6%. The major complication group showed significantly worse clinical outcomes than did the uncomplicated and minor complication groups., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: East Asians usually have short and flat noses and broad nasal bones. Therefore, rhinoplasty with dorsal augmentation and nasal osteotomy is often required. However, many surgeons are wary of performing nasal osteotomy in conjunction with augmentation with silicone. The authors sought to evaluate the availability and safety of osteotomy in esthetic rhinoplasty of East Asian patients., Methods: In a clinical study, a retrospective chart review was performed for 227 patients who had undergone nasal osteotomy (paramedian oblique osteotomy plus percutaneous lateral osteotomy) and dorsal augmentation with silicone. Patient satisfaction after surgery was evaluated by the Rhinoplasty Outcome Evaluation test. In addition, a cadaveric study was conducted in which 5 fresh cadavers received different osteotomies on each side of the nose (right side: paramedian oblique and percutaneous lateral osteotomy; left side: medial oblique and intranasal continuous lateral osteotomy)., Results: In the clinical study, patients were satisfied with the outcome after esthetic rhinoplasty with nasal osteotomy (paramedian oblique osteotomy plus percutaneous lateral osteotomy) and augmentation with silicone. The results revealed a low complication rate. The average Rhinoplasty Outcome Evaluation test score significantly increased (P < 0.001), with 91.2% of patients scoring their postoperative result better than "good." In the cadaveric study, stability was greater when paramedian oblique and percutaneous lateral osteotomy was performed., Conclusions: Paramedian oblique and percutaneous lateral osteotomy is effective for reducing broad nasal bones, thus providing a stable framework and a reliable method for achieving a good outcome when augmentation with silicone is performed simultaneously.

Background: Each year, thousands of patients, particularly Eastern Asians, receive reduction malarplasty to achieve a more feminine and slender facial appearance. To date, there lacks a systematic analysis regarding the postoperative complications related to this procedure. Hence, the authors performed a comprehensive literature review with meta-analysis., Methods: Articles were searched and reviewed using the MEDLINE and Embase databases. Among the studies regarding surgical outcomes after reduction malarplasty, articles with explicit reports and clear numbers of postoperative complications were selected for meta-analysis. Additionally, manual searches were made from references of selected articles., Results: A total 14 retrospective review articles that represented 3149 cases were reviewed, and 7 different postoperative complications were analyzed. The complication that showed the highest weighted mean percentage of frequency was transient sensory weakness, with 5.8% (Z = -18.012; 95% confidence interval, 4.3-7.6%), followed by drooping (2.8%), nonunion (2.2%), asymmetry (1.8%), mouth opening restriction (1.8%), uncontrolled bleeding (1.3%), and facial nerve injury (0.9%)., Conclusions: According to our meta-analysis of previous literatures, the aggregated rates of various complications related to reduction malarplasty were not high. Among the various complications, short-term sensory weakness was shown as the most frequent complication, emphasizing the necessity of patient warning and education before and after the operation. Moreover, soft tissue drooping and bone nonunion are also not rare and surgeons should be aware of these complications.

We reviewed 91 patients (103 feet) who underwent a Ludloff osteotomy combined with additional procedures. According to the combined procedures performed, patients were divided into Group I (31 feet; first web space release), Group II (35 feet; Akin osteotomy and trans-articular release), or Group III (37 feet; Akin osteotomy, supplementary axial Kirschner (K-) wire fixation, and trans-articular release). Each group was then further subdivided into severe and moderate deformities. The mean hallux valgus angle correction of Group II was significantly greater than that of Group I (p = 0.001). The mean intermetatarsal angle correction of Group III was significantly greater than that of Group II (p < 0.001). In severe deformities, post-operative incongruity of the first metatarsophalangeal joint was least common in Group I (p = 0.026). Akin osteotomy significantly increased correction of the hallux valgus angle, while a supplementary K-wire significantly reduced the later loss of intermetatarsal angle correction. First web space release can be recommended for severe deformity. Additionally, K-wire fixation (odds ratio (OR) 5.05 (95% confidence interval (CI) 1.21 to 24.39); p = 0.032) and the pre-operative hallux valgus angle (OR 2.20 (95% CI 1.11 to 4.73); p = 0.001) were shown to be factors affecting recurrence of hallux valgus after Ludloff osteotomy.