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de Paula RE, Pires E Albuquerque RS, de Paula Mozella A, Sobral RD, Valente Maia PA, Prinz RAD, Couto AC, da Palma IM, de Araujo Barros Cobra HA, de Sousa EB, Cordeiro A. Equal rates of bone healing and reduced surgical time with iliac crest allograft compared to autograft in medial opening wedge high tibial osteotomy: a randomized controlled clinical trial. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05410-6. [PMID: 38960933 DOI: 10.1007/s00402-024-05410-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 06/20/2024] [Indexed: 07/05/2024]
Abstract
INTRODUCTION Iliac crest autograft is frequently used to fill in bone defects after osteotomies. Nonetheless, surgery for bone autograft procurement is associated with morbidity and pain at the donor site. Alternatives to it have been explored, but there is no consensus to guide their application as a routine practice in several orthopedic procedures. Thus, this study was designed to compare the efficacy and safety between iliac crest autograft and allograft in medial opening wedge high tibial osteotomy. MATERIALS AND METHODS Forty-seven patients with a symptomatic unilateral genu varum and an indication for high tibial osteotomy were randomly assigned to receive either autograft or allograft to fill the osteotomy site. Operative time, bone healing, and complication rates (delayed union, nonunion, superficial and deep infection, loss of correction, and hardware failure) were recorded after a one-year follow-up. Data were expressed as Mean ± Standard Deviation and considered statistically significant when p < 0.05. RESULTS The time to radiologic union was similar between both groups (Allograft: 2.38 ± 0.97 months vs. Autograft: 2.45 ± 0.91 months; p = 0.79). Complication rates were also similar in both groups, with one infection in the allograft group and two in the autograft group, two delayed unions in the allograft group, and three in the autograft group. The operative time differed by 11 min between the groups, being lower in the allograft group (Allograft: 65.4 ± 15.1 min vs. Autograft: 76.3 ± 15.2 min; p = 0.02). CONCLUSION Iliac crest allografts can be safely and effectively used in medial opening wedge high tibial osteotomy as it promotes the same rates of bone union as those achieved by autologous grafts, with the benefits of a shorter operative time. TRIAL REGISTRATION NUMBER U1111-1280-0637 1 December 2022, retrospectively registered.
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Affiliation(s)
- Rafael Erthal de Paula
- Knee Specialized Attendance Center, National Institute of Traumatology and Orthopedics (INTO), Avenida Brasil 500 - Caju, Rio de Janeiro, 20940-070, Brazil.
| | - Rodrigo Sattamini Pires E Albuquerque
- Knee Specialized Attendance Center, National Institute of Traumatology and Orthopedics (INTO), Avenida Brasil 500 - Caju, Rio de Janeiro, 20940-070, Brazil
| | - Alan de Paula Mozella
- Knee Specialized Attendance Center, National Institute of Traumatology and Orthopedics (INTO), Avenida Brasil 500 - Caju, Rio de Janeiro, 20940-070, Brazil
| | - Ricardo Duran Sobral
- Knee Specialized Attendance Center, National Institute of Traumatology and Orthopedics (INTO), Avenida Brasil 500 - Caju, Rio de Janeiro, 20940-070, Brazil
| | - Phelippe Augusto Valente Maia
- Knee Specialized Attendance Center, National Institute of Traumatology and Orthopedics (INTO), Avenida Brasil 500 - Caju, Rio de Janeiro, 20940-070, Brazil
| | - Rafael Augusto Dantas Prinz
- Tissue Bank, National Institute of Traumatology and Orthopedics (INTO), Avenida Brasil 500 - Caju, Rio de Janeiro, RJ, Brazil
| | - Arnaldo Cézar Couto
- Research Division, National Institute of Traumatology and Orthopedics (INTO), Avenida Brasil 500 - Caju, Rio de Janeiro - RJ, Brazil
| | | | - Hugo Alexandre de Araujo Barros Cobra
- Knee Specialized Attendance Center, National Institute of Traumatology and Orthopedics (INTO), Avenida Brasil 500 - Caju, Rio de Janeiro, 20940-070, Brazil
| | - Eduardo Branco de Sousa
- Knee Specialized Attendance Center, National Institute of Traumatology and Orthopedics (INTO), Avenida Brasil 500 - Caju, Rio de Janeiro, 20940-070, Brazil
| | - Aline Cordeiro
- Research Division, National Institute of Traumatology and Orthopedics (INTO), Avenida Brasil 500 - Caju, Rio de Janeiro - RJ, Brazil
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Yamaguchi J, Kondo E, Yasuda K, Onodera J, Yabuuchi K, Kaibara T, Takami K, Iwasaki N, Yagi T. Improvement of absorbability, osteoconductivity, and strength of a β-tricalcium phosphate spacer for opening wedge high tibial osteotomy: clinical evaluations with 106 patients. BMC Musculoskelet Disord 2024; 25:441. [PMID: 38840163 PMCID: PMC11151500 DOI: 10.1186/s12891-024-07533-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 05/22/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND An ideal synthetic spacer for medial opening wedge high tibial osteotomy (MOWHTO) has not yet been developed. The authors have developed a new β-tricalcium phosphate (β-TCP) spacer with 60% porosity (N-CP60) by modifying the micro- and macro-pore structures of a conventional β-TCP spacer (CP60) that is widely used in clinical practice. The purpose of this study was to compare the absorbability, osteoconductivity, and in vivo strength of the N-CP60 spacer with those of the CP60 spacer, when used in MOWHTO. METHODS First, the porosity, diameter distribution of macro- and micropores, and compressive strength of each β-TCP block were examined using methodology of biomaterial science. Secondly, a clinical study was performed using a total of 106 patients (106 knees) with MOWHTO, who were followed up for 18 months after surgery. In these knees, the N-CP60 and CP-60 spacers were implanted into 49 tibias and 57 tibias, respectively. The absorbability and osteoconductivity were radiologically evaluated by measuring the area of the implanted spacer remaining unabsorbed and assessing with the Hemert's score, respectively. The incidence of cracking in the implanted spacers was determined using computed radiography. Statistical comparisons were made with non-parametric tests. The significance level was set at p = 0.05. RESULTS The N-CP60 and CP60 blocks had almost the same porosity (mean, 61.0% and 58.7%, respectively). The diameter of macropores was significantly larger (p < 0.0001) in the N-CP60 block than in the CP60 block, while the diameter of micropores was significantly smaller (p = 0.019) in the N-CP60 block. The ultimate strength of the N-CP60 block (median, 36.8 MPa) was significantly greater (p < 0.01) than that of the CP60 block (31.6 MPa). As for the clinical evaluations, the absorption rate of the N-CP60 spacer at 18 months after implantation (mean, 48.0%) was significantly greater (p < 0.001) than that of the CP60 spacer (29.0%). The osteoconductivity of the N-CP60 spacer was slightly but significantly higher (p = 0.0408) than that of the CP60 spacer only in zone 1. The incidence of in vivo cracking of the posteriorly located N-CP60 spacer at one month (mean, 75.5%) was significantly lower (p = 0.0035) than that of the CP60 spacer (91.2%). CONCLUSIONS The absorbability, osteoconductivity, and compressive strength of the new N-CP60 spacer were significantly improved by modifying the macro- and micro-pore structures, compared with the conventional CP60 spacer. The N-CP60 spacer is more clinically useful than the CP60 spacer. TRIAL REGISTRATION NUMBER H29-0002.
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Affiliation(s)
- Jun Yamaguchi
- Knee Research Center, Yagi Orthopaedic Hospital, 1-35, Nishino-3-5, Nishi-ku, Sapporo, Hokkaido, 063-0033, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan.
| | - Kazunori Yasuda
- Knee Research Center, Yagi Orthopaedic Hospital, 1-35, Nishino-3-5, Nishi-ku, Sapporo, Hokkaido, 063-0033, Japan
| | - Jun Onodera
- Knee Research Center, Yagi Orthopaedic Hospital, 1-35, Nishino-3-5, Nishi-ku, Sapporo, Hokkaido, 063-0033, Japan
| | - Koji Yabuuchi
- Knee Research Center, Yagi Orthopaedic Hospital, 1-35, Nishino-3-5, Nishi-ku, Sapporo, Hokkaido, 063-0033, Japan
| | - Takuma Kaibara
- Department of Orthopaedic Surgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Kimiaki Takami
- Laboratory of Product Development, Olympus Termo Biomaterials Corporation, 1002-1, Shimonagakubo, Nagaizumi-cho, Shizuoka, 413-0934, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Tomonori Yagi
- Knee Research Center, Yagi Orthopaedic Hospital, 1-35, Nishino-3-5, Nishi-ku, Sapporo, Hokkaido, 063-0033, Japan
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Getgood AMJ. Editorial Commentary: Locking Plate Removal Is Safe and May Improve Function 1 Year After Medial Opening Wedge High Tibial Osteotomy. Arthroscopy 2024; 40:1845-1847. [PMID: 38253293 DOI: 10.1016/j.arthro.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024]
Abstract
The development of angular stable locking late fixation in realignment osteotomy has resulted in the ability to be more aggressive with weight bearing and rehabilitation after high tibial osteotomy. One of the downsides of some of these plate fixators is the degree of soft-tissue irritation and discomfort that can be experienced by many patients, resulting in the need for hardware removal. Studies have shown greater than 50% of patients requiring hardware removal with no resulting loss of correction, although there may be cultural reasons for the higher number, not solely attributable to the symptom profile. It is encouraging to see that after 1 year postoperatively, hardware removal after high tibial osteotomy not only is safe but also results in a clinically important improvement in pain and function, with progressive bone healing out to 2 years.
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Mao Y, Yao L, Li J, Li J, Xiong Y. No Superior Bone Union Outcomes with Allografts Compared to No Grafts and Autografts Following Medial Opening Wedge High Tibial Osteotomy: A Retrospective Cohort Study. Orthop Surg 2024; 16:363-373. [PMID: 38111034 PMCID: PMC10834220 DOI: 10.1111/os.13961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/01/2023] [Accepted: 11/03/2023] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVE There has been long-standing debate about whether a medial opening wedge high tibial osteotomy (MOWHTO) gap should be filled with autologous bone graft or any other filler to expedite the healing process. The main purpose of this study was to compare the clinical and radiological outcomes of MOWHTO with an opening gap ≥10 mm, utilizing autograft, allograft, or no graft at 1 year postoperatively. METHODS A total of 68 patients were included in this retrospective study and divided into three treatment groups: Group A (no bone graft), Group B (autologous iliac crest graft), and Group C (allogenous tibia plateau graft). At postoperative 1-year follow-up, the area of callus filling in the most medial side of the knee was measured using anteroposterior radiographs, and a modified van Hemert scoring system was used to evaluate bone union outcomes in five mediolaterally divided zones. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and relevant complications were assessed. The correlations between the gap width and bone union scores were evaluated. RESULTS Patients in the autograft group demonstrated better bone union progression (p = 0.031) and higher bone union scores (p < 0.01) compared to patients in the allograft or no graft groups. There were no significant differences in terms of postoperative WOMAC scores and incidence of complications among the three groups. No discernible linear relationships between the width of the opening gap and the bone union score were found. CONCLUSION For MOWHTOs with an average gap opening width of 12.1 mm, autografts resulted in superior bone union outcomes compared to allografts and no graft at 1 year postoperatively. However, no bone graft achieved similar outcomes to allografts, suggesting that routine use of allografts should not be recommended.
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Affiliation(s)
- Yunhe Mao
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Yao
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Junqiao Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics, Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Xiong
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics, Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
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Chen J, Li J, Zhang H, Feng W, Ye P, Qi X, Li J, Deng P, Li Y, Huang Y, Zeng J, Zeng Y. Bone Healing and Clinical Outcome Following Medial Opening-wedge High Tibial Osteotomy Using Wedge-Shaped Cancellous Allograft. Orthop Surg 2024; 16:86-93. [PMID: 38014470 PMCID: PMC10782265 DOI: 10.1111/os.13939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE Medial opening-wedge high tibial osteotomy (MOWHTO) is considered to be an effective treatment for symptomatic knee osteoarthritis (KOA) of isolated the medial compartment with varus alignment of the lower extremity. However, the choice of material to fill the void remains controversial. This study aims to evaluate the bone union of the osteotomy gap using a novel wedge-shaped cancellous allograft after MOWHTO and its effect on clinical outcomes. METHODS All patients who underwent MOWHTO using a novel wedge-shaped cancellous allograft combined with TomoFix locking compression plate (LCP) fixation between January 2016 and July 2020 were enrolled. The radiographic parameters including hip-knee-ankle angle (HKAA), medial proximal tibial angle (MPTA), femorotibial angle (FTA) and posterior tibial slope angle (PTSA) were measured between pre-operative and post-operative radiographs. Knee Society score (KSS) and range of motion (ROM) were assessed preoperatively and at last follow-up. Patients included in this study were divided into two groups according to the correction angle: small correction group (< 10°; SC group) and large correction group (≥ 10°; LC group). The modified Radiographic Union score for tibial fractures (mRUST) was used to assess the difference in bone healing between the two groups at 1, 3, 6, and 12 months postoperatively and at the final follow-up. A paired student's t test was conducted for comparison of differences of the relevant data pre-operatively and post-operatively. RESULTS A total of 82 patients (88 knees) were included in this study. The HKAA, MPTA, FTA and PTSA increased from -6.4° ± 3.0°, 85.1° ± 2.6°, 180.1° ± 3.2° and 7.7° ± 4.4° preoperatively to 1.2° ± 4.3° (p < 0.001), 94.4° ± 3.3° (p < 0.001), 171.0° ± 2.8° and 11.8° ± 5.8° (p < 0.001) immediately postoperatively, respectively. However, no significant statistic difference was found in above-mentioned parameters at last follow-up compared to immediate postoperative data (p > 0.05). All patients in this study achieved good bone healing at the final follow-up and no significant differences in mRUST scores were seen between the SC group and LC group. The KSS-Knee score and KSS-Function score improved significantly from 55.4 ± 3.7 and 63.3 ± 4.6 preoperatively to 86.4 ± 2.8 (p < 0.001) and 89.6 ± 2.9 (p < 0.001) at last follow-up, respectively. Nevertheless, there was no significant difference in ROM between pre-operation and last follow-up (p > 0.05). CONCLUSION For MOWHTO, the wedge-shaped cancellous allograft was a reliable choice for providing good bone healing and clinical outcomes.
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Affiliation(s)
- Jinlun Chen
- The First Clinical Medical CollegeGuangzhou University of Chinese MedicineGuangzhouChina
- Department of OrthopaedicsThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Jiahao Li
- Department of OrthopaedicsPanyu Hospital of Chinese MedicineGuangzhouChina
| | - Haitao Zhang
- Longhua HospitalShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Wenjun Feng
- Department of OrthopaedicsThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Pengcheng Ye
- Department of OrthopaedicsThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Xinyu Qi
- Department of OrthopaedicsThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Jie Li
- Department of OrthopaedicsThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Peng Deng
- Department of OrthopaedicsGuangdong Second Traditional Chinese Medicine HospitalGuangzhouChina
| | - Yijin Li
- The First Clinical Medical CollegeGuangzhou University of Chinese MedicineGuangzhouChina
| | - Yiwei Huang
- The First Clinical Medical CollegeGuangzhou University of Chinese MedicineGuangzhouChina
| | - Jianchun Zeng
- Department of OrthopaedicsThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Yirong Zeng
- Department of OrthopaedicsThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
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An JS, Bouguennec N, Batailler C, Tardy N, Rochcongar G, Frayard JM, Ollivier M. Better clinical outcomes and faster weight bearing after medial opening-wedge high tibial osteotomy using allogeneic than synthetic graft: A secondary analysis of a Francophone Arthroscopy Society Symposium. Orthop Traumatol Surg Res 2023; 109:103700. [PMID: 37813331 DOI: 10.1016/j.otsr.2023.103700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/16/2023] [Accepted: 09/26/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION Although an autogenous graft has the highest rate of bone union to fill the void created in medial opening wedge high tibial osteotomy (MOWHTO), it also has some disadvantages, such as prolonged surgical time, donor site pain and morbidity. Two possible candidates for ideal grafts to replace autogenous grafts are allogeneic and synthetic graft, which are free from donor site pain and morbidity. However, previous reports comparing the clinical results of allogeneic to synthetic graft have been limited and controversial. The purpose of this study is to compare radiological findings and clinical outcomes of using synthetic versus allogenic graft to fill the void created in MOWHTO. HYPOTHESIS The present clinical study hypothesized that allogenic graft to fill the void would allow the higher rate of bone union and better clinical outcomes. MATERIAL AND METHODS This study compared the clinical and radiological outcomes of 95 patients who received MOWHTO to fill the void with either synthetic or allogenic graft (44 in Syn group, 51 in Allo group). Preoperatively and postoperatively, all patients were clinically evaluated; Return to work, Tegner activity score, and the Western Ontario and Macmaster University scores were reported. Radiographically, osteoarthritis grade and pre- and postoperative parameters were reported, including Hip-knee-ankle angle, mechanical lateral distal femoral angle, medial proximal tibial angle, joint line convergence angle, proximal posterior tibial angle, and limb length discrepancy. Perioperative details and complications were also reported. RESULTS Mean follow-up (months) were 24.0±1.3 in Syn group and 26.8±1.2 in Allo group (p=0.13). The postoperative improvement of pain and global WOMAC scores in Allo group were significantly better than in Syn group (ΔPain of WOMAC: Syn group 27.8±4.4, Allo group 49.3±3.8, p value <0.001*) (ΔGlobal score of WOMAC: Syn group 16.7±3.2, Allo group 37.4±4.9, p value=0.002*). The risk of hinge fracture in Syn group was significantly higher than in Allo group (Hinge fracture by Takeuchi grade (0/1/2/3): Syn group 37/3/3/1, Allo group 43/8/0/0, p value=0.04*). The timing of full weight bearing in Allo group was significantly earlier than in Syn group (Weight Bearing (1=FWB, 2=PWB 3wk, 3=PWB 6wk): Syn group 2.7±0.1, Allo group 2.3±0.1, p value=0.01*). DISCUSSION The use of allogenic graft to fill the void in MOWHTO does not show superiority in bone union compared to synthetic graft, however it improves pain, function, decreases the risk of hinge fracture and allows faster weight bearing than synthetic graft. LEVEL OF PROOF III; Case-control study.
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Affiliation(s)
- Jae-Sung An
- Tokyo Medical and Dental University, Tokyo, Japan; Institut du mouvement et de l'appareil locomoteur, Marseille, France
| | | | - Cécile Batailler
- Service de chirurgie orthopédique, hôpital de la Croix-Rousse, Lyon, France
| | - Nicolas Tardy
- Centre Ostéo-Articulaire des Cèdres, Clinique des Cèdres, Echirolles, France
| | - Goulven Rochcongar
- Département de chirurgie orthopédique et traumatologique, université de Caen, Basse-Normandie, CHU de Caen, Caen cedex, France
| | | | - Matthieu Ollivier
- Institut du mouvement et de l'appareil locomoteur, Marseille, France.
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Medina-Echeverria J, Feroe AG, Hidden KA. Iliac Crest Allograft with Plate Osteosynthesis for a Bone-Patellar Tendon-Bone Anterior Cruciate Ligament Donor-Site Fracture: A Case Report. JBJS Case Connect 2023; 13:01709767-202303000-00069. [PMID: 36947633 DOI: 10.2106/jbjs.cc.22.00728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
CASE A 20-year-old man sustained a comminuted bone-patellar tendon-bone donor-site fracture 17 days after a contralateral anterior cruciate ligament revision reconstruction. Successful fixation was achieved by using a tricortical iliac crest allograft bone plug with mesh plate osteosynthesis. At 6 months of follow-up, the patient had full range of motion without pain. CONCLUSION Patellar fractures after bone-patellar tendon-bone harvest may be treated successfully with mesh plate osteosynthesis and a tricortical iliac crest allograft bone plug. This unique fixation option addresses bone loss and restores the extensor mechanism while avoiding autograft donor site morbidity.
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Affiliation(s)
- Juan Medina-Echeverria
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
- Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Aliya G Feroe
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Krystin A Hidden
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Zhong R, Yu G, Wang Y, Fang C, Lu S, Liu Z, Gao J, Yan C, Zhao Q. Research on the Influence of the Allogeneic Bone Graft in Postoperative Recovery After MOWHTO: A Retrospective Study. Ther Clin Risk Manag 2023; 19:193-205. [PMID: 36876223 PMCID: PMC9974733 DOI: 10.2147/tcrm.s400354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/15/2023] [Indexed: 02/25/2023] Open
Abstract
Purpose To compare the effects of an allogeneic bone graft and a non-filled bone graft on the rate of osteotomy gap union in medial opening wedge high tibial osteotomy (MOWHTO) with an opening width less than 10 mm. Methods A total of 65 patients undergoing MOWHTO between January 2018 and December 2020 were enrolled in this retrospective study. The patients were divided into two groups: the allograft group (MOWHTO with allogeneic bone grafting, 30 patients) and the non-filling group (MOWHTO without bone void fillers, 35 patients). The clinical outcomes, including the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC), Lysholm score, and post-operative complications, were compared. The radiographic evaluation included changes in hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), femorotibial angle (FTA), and weight-bearing line ratio (WBLR) at pre-operation, at two-day post-operation, and the last follow-up. Radiographs were obtained at three, six and twelve months post-surgery, and at the time of the last follow-up to assess the fill area of the osteotomy gap. The union rate of the osteotomy gap was calculated and compared, and risk factors that may affect the rate of osteotomy gap union were also discussed. Results The rate of osteotomy gap union at 3 and 6 months after the operation in the allograft group was significantly higher compared with the non-filling group (all P<0.05), while no significant difference was found after the 1-year post-operative and at the last follow-up. Also, the WOMAC and Lysholm scores of the allograft group were significantly higher than those of the non-filling group (all P<0.05), and there was no significant difference between the two groups at the last follow-up. Conclusion Filling the gaps with the allograft bones may accelerate the union of osteotomy gap, improve clinical outcomes, and have important implications for patient rehabilitation in the early post-operative course. Bone grafting did not affect the final rate of osteotomy gap union and the clinical score of patients.
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Affiliation(s)
- Rui Zhong
- Department of Sports Medicine, The Affiliated Provincial Hospital of Anhui Medical University, Hefei, 230001, People's Republic of China
| | - Gang Yu
- Department of Sports Medicine, The Affiliated Provincial Hospital of Anhui Medical University, Hefei, 230001, People's Republic of China
| | - Yingming Wang
- Department of Sports Medicine, The Affiliated Provincial Hospital of Anhui Medical University, Hefei, 230001, People's Republic of China
| | - Chao Fang
- Department of Sports Medicine, The Affiliated Provincial Hospital of Anhui Medical University, Hefei, 230001, People's Republic of China
| | - Shuai Lu
- Department of Sports Medicine, The Affiliated Provincial Hospital of Anhui Medical University, Hefei, 230001, People's Republic of China
| | - Zhilin Liu
- Department of Sports Medicine, The Affiliated Provincial Hospital of Anhui Medical University, Hefei, 230001, People's Republic of China
| | - Jingyu Gao
- Department of Sports Medicine, The Affiliated Provincial Hospital of Anhui Medical University, Hefei, 230001, People's Republic of China
| | - Chengyuan Yan
- Department of Sports Medicine, The Affiliated Provincial Hospital of Anhui Medical University, Hefei, 230001, People's Republic of China
| | - Qichun Zhao
- Department of Sports Medicine, The Affiliated Provincial Hospital of Anhui Medical University, Hefei, 230001, People's Republic of China
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Lack of Efficacy of Bone Void Filling Materials in Medial Opening-Wedge High Tibial Osteotomy: A Systematic Review and Network Meta-Analysis. Arthroscopy 2022:S0749-8063(22)00835-0. [PMID: 36581002 DOI: 10.1016/j.arthro.2022.11.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 11/22/2022] [Accepted: 11/30/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE To systematically review the clinical and radiologic outcomes of isolated medial opening-wedge high tibial osteotomies with different bone void filling materials and to compare the outcomes by network meta-analysis. METHODS This systematic review and network meta-analysis included searches of Medline, Embase, Cochrane Library, Web of Science, and Scopus from inception to July 30, 2022, for clinical comparative studies comparing 2 or more bone void filling materials in patients undergoing medial opening-wedge high tibial osteotomies. We performed Bayesian random-effect network meta-analyses to summarize the evidence and applied the Grading of Recommendations Assessment, Development, and Evaluation frameworks to rate the certainty of evidence, calculate the absolute effects, and present the findings. Cochrane Risk of Bias Tool 2.0 and modified Newcastle-Ottawa Scale were used to assess the risk of bias. RESULTS In total, 2,755 citations were identified by our search, of which 25 eligible trials, including 10 randomized controlled trials and 15 nonrandomized comparative trials (NCTs) enrolled 1,420 participants and 6 different interventions (autografts, allografts, synthetic grafts, mixed grafts, xenografts, and without grafts). There were some concerns on the risk of bias assessment among randomized controlled trials, and the median Newcastle-Ottawa Scale score was 6 for NCTs. All fillers showed no significantly superior treatment effects when compared with unfilled group in final Knee Society Scoring, Western Ontario and McMasters Universities score, time to bone union (TBU), and loss of correction (LOC). Exceptionally, moderate-certainty evidence suggested that autograft would produce superior incidence of complete bone union (CBU) than the unfilled at postoperative 1 year (odds ratio [OR] 13.0, 95% confidence interval [CI] 1.60-95.6), whereas low- to very low-certainty evidence suggested allografts (OR 0.2, 95% CI 0.06-0.52) and synthetic grafts (OR 0.29, 95% CI 0.10-0.68) would result in inferior CBU. Low-certainty evidence suggested allografts would result in larger LOC angle than unfilled group (mean difference 1.1, 95% CI 0.1-2.3). As for TBU, low-certainty evidence suggested mixed grafts would take longer time to reach clinical bone union (mean difference -14.04, 95% CI -21.0 to -6.9). CONCLUSIONS There is a lack of efficacy for different bone void filling materials to result better outcomes in Knee Society Scoring, Western Ontario and McMasters Universities score, TBU, and LOC than without graft. Although applying the autografts would produce a superior possibility of radiologic CBU than other fillers, because of the inclusion of NCTs, the overall certainty of the evidence synthesis is low. LEVEL OF EVIDENCE Level Ⅲ, meta-analysis of Level I randomized controlled trials and Level Ⅱ∼Ⅲ non-randomized comparative trails.
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Preoperative planning by osteotomy master software helps to improve the accuracy of target limb alignment in high tibial osteotomy. J Orthop Surg Res 2020; 15:504. [PMID: 33138838 PMCID: PMC7607877 DOI: 10.1186/s13018-020-02033-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 10/20/2020] [Indexed: 12/18/2022] Open
Abstract
Background The accuracy of targeted lower limb alignment correction following HTO is closely related to patients’ pain relief and knee joint survival time. How to accurately perform osteotomy and how to obtain the ideal target limb alignment to maximize the curative effect are the difficulty in HTO practice. The purpose of this study is to evaluate the predictive and application value of osteotomy master software (OsteoMaster) in coronal plane preoperative planning of high tibial osteotomy. Method Sixty-seven patients with medial compartment osteoarthritis and varus deformity treated by medial open-weight high tibial osteotomy were enrolled and divided into observation group (31 cases) and control group (36 cases). The observation group was planned by OsteoMaster, while the control group was planned by Miniaci. The preoperative predicted values of osteotomy depth, open height, correction angle, WBL ratio, and FTA of the observation group were compared with the actual intraoperative values to study their accuracy. The operative time, blood loss, number of fluoroscopy, and WBL ratio were compared between the observation group and the control group to study its application value. Result There was no significant difference between two groups in preoperative prediction and intraoperative reality of osteotomy depth, open height, correction angle, FTA, and WBL ratio (P > 0.05). The operation time and number of fluoroscopy in the observation group were significantly less than those in the control group (P < 0.05), while the difference in blood loss was not statistically significant (P > 0.05). The good rate of WBL ratio was 87.1% in the observation group and 75% in the control group. Conclusion OsteoMaster has predictive value in osteotomy depth, open height, correction angle, FTA, and WBL ratio of HTO, which is also helpful to reduce the number of fluoroscopy, shorten the operation time, and improve the accuracy of target limb alignment. The drawback of this approach is 2-dimensional approach in contrast to 3-dimensional preoperative planning that is including the more real study.
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