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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; 144:3053-3061. [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] [MESH Headings] [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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Kesemenli CC, Demiroz S, Memisoglu K, Erdemir C, Yonga Ö, Temez F, Karadeniz E. Use of Tibial Cortical Autograft for the Osteotomy Site in Medial Opening-Wedge High Tibial Osteotomy. Orthop J Sports Med 2024; 12:23259671241233321. [PMID: 38476161 PMCID: PMC10929045 DOI: 10.1177/23259671241233321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/30/2023] [Indexed: 03/14/2024] Open
Abstract
Background Medial opening-wedge high tibial osteotomy (OWHTO) is a useful treatment option in patients with medial compartment osteoarthritis. Typically, the osteotomy site is filled with material such as autologous bone graft, allograft, or synthetic bone substitute. However, all these options have disadvantages. Purpose/Hypothesis The purpose of this study was to describe tibial cortical autograft as an alternative to conventional graft options. It was hypothesized that the tibial rectangular cortical bone that is removed from the proximal medial cortical surface of the distal tibial fragment longitudinally could be a reliable option for recovery of the gap in the osteotomy area. Study Design Cohort study; Level of evidence, 3. Methods A total of 520 patients with medial compartment osteoarthritis who underwent OWHTO between June 2009 and March 2019 were retrospectively analyzed. Patients were divided into 3 groups according to the graft material used to fill the osteotomy site: allograft in group A, iliac crest autograft in group B, and tibial autograft in group C. Bone union, evaluated by radiographs performed at 2 weeks, 4 weeks, 2 months, 3 months, 6 months, and 1 year postoperatively, was defined as occurring when at least 50% of the gap site was bridged with callus. Clinical assessment was performed using the International Knee Documentation Committee (IKDC) and Lysholm scores. Results Included were 122 patients: 40 patients in group A, 42 patients in group B, and 40 patients in group C. The mean correction was 13.87°± 3.58° in group A, 12.33°± 3.92° in group B, and 14.10°± 2.99° in group C. The mean time for radiological bone union was 6.95 ± 1.40 months in group A, 4.48 ± 1.02 months in group B, and 5.07 ± 1.70 months in group C. Patients in all groups had similar IKDC and Lysholm scores at the final follow-up. Conclusion This is the first report of this specific procedure in the literature. All clinical and radiological findings showed that use of tibial cortical autograft was an efficient method in patients undergoing OWHTO.
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Affiliation(s)
- Cumhur Cevdet Kesemenli
- Department of Orthopaedics and Traumatology, School of Medicine, Kocaeli University, İzmit, Kocaeli, Turkey
| | - Serdar Demiroz
- Department of Orthopaedics and Traumatology, School of Medicine, Kocaeli University, İzmit, Kocaeli, Turkey
| | - Kaya Memisoglu
- Department of Orthopaedics and Traumatology, School of Medicine, Kocaeli University, İzmit, Kocaeli, Turkey
| | - Cengiz Erdemir
- Department of Orthopaedics and Traumatology, Darıca Farabi Training and Research Hospital, Darıca, Kocaeli, Turkey
| | - Ömer Yonga
- Department of Orthopaedics and Traumatology, Yeditepe University Hospital, İstanbul, Turkey
| | - Faruk Temez
- Department of Orthopaedics and Traumatology, School of Medicine, Kocaeli University, İzmit, Kocaeli, Turkey
| | - Emre Karadeniz
- Department of Orthopaedics and Traumatology, School of Medicine, Kocaeli University, İzmit, Kocaeli, Turkey
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刘 军, 杨 莉, 吴 家, 苏 伟, 赵 劲. [Management principle and clinical suggestions of osteotomy gap of opening wedge high tibial osteotomy]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:919-926. [PMID: 32666739 PMCID: PMC8180423 DOI: 10.7507/1002-1892.201909110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/20/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To summarize the management principle and clinical suggestions of the osteotomy gap of opening wedge high tibial osteotomy (OWHTO). METHODS The related literature of the osteotomy gap of OWHTO in recent years was reviewed, summarized, and analyzed. RESULTS Delayed union and non-union of the osteotomy gap are main complications of OWHTO. Tomofix plate, as locking steel plate, has the characteristics of angular stability and can better maintain the stability of the osteotomy gap, promote bone healing, and avoid loss of correction. There are some treatment options for the osteotomy gap site, such as, without bone, autologous bone graft, allogeneic bone graft, bone substitute materials graft, and augment factor graft to enhance bone healing. When the osteotomy gap is less than 10 mm, it achieves a good outcome without bone graft. For the obesity, lateral hinge fracture, large osteotomy gap, or correction angle more than 10°, the bone graft should be considered. In cases whose osteotomy gap is nonunion or delayed union, the autologous bone graft is still the gold standard. When the osteotomy gap repaired with the allogeneic bone graft, it is better to choose fragmented cancellous or wedge-shaped cancellous bone, combining with the locking plate technology, also can achieve better bone union. The bone substitute material of calcium-phosphorus is used in the osteotomy gap, which has the characteristics of excellent bone conduction, good biocompatibility, and resorption, combining with the locking plate technology, which can also achieve better bone union in the osteotomy gap. The augment factors enhance the bone healing of the osteotomy gap of OWHTO is still questionable. The bone union of the osteotomy gap is also related to the size of the osteotomy gap and whether the lateral hinge is broken or not. CONCLUSION No matter what type of materials for the osteotomy gap, OWHTO can improve the function and relieve pain for knee osteoarthritis. More randomized controlled trials are needed to provide evidence for clinical decision to determine which treatment option is better for the osteotomy gap of OWHTO.
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Affiliation(s)
- 军廷 刘
- 广西医科大学第一附属医院创伤骨科手外科(南宁 530021)Department of Orthopaedic Trauma and Hand Surgery, the 1st Affiliated Hospital of Guangxi Medical University, Nanning Guangxi, 530021, P.R.China
| | - 莉平 杨
- 广西医科大学第一附属医院创伤骨科手外科(南宁 530021)Department of Orthopaedic Trauma and Hand Surgery, the 1st Affiliated Hospital of Guangxi Medical University, Nanning Guangxi, 530021, P.R.China
| | - 家恒 吴
- 广西医科大学第一附属医院创伤骨科手外科(南宁 530021)Department of Orthopaedic Trauma and Hand Surgery, the 1st Affiliated Hospital of Guangxi Medical University, Nanning Guangxi, 530021, P.R.China
| | - 伟 苏
- 广西医科大学第一附属医院创伤骨科手外科(南宁 530021)Department of Orthopaedic Trauma and Hand Surgery, the 1st Affiliated Hospital of Guangxi Medical University, Nanning Guangxi, 530021, P.R.China
| | - 劲民 赵
- 广西医科大学第一附属医院创伤骨科手外科(南宁 530021)Department of Orthopaedic Trauma and Hand Surgery, the 1st Affiliated Hospital of Guangxi Medical University, Nanning Guangxi, 530021, P.R.China
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Comparable bone union progression after opening wedge high tibial osteotomy using allogenous bone chip or tri-calcium phosphate granule: a prospective randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2019; 27:2945-2950. [PMID: 30377715 DOI: 10.1007/s00167-018-5254-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/22/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of this study is to compare the progression rate of bone union and clinical outcomes of opening wedge high tibial osteotomy (OWHTO) using allogenous bone chip or tri-calcium phosphate (TCP) granule as bone graft materials. The hypothesis was that the bone union progression in OWHTOs using TCP granule grafts would be comparable to that of OWHTOs using allogenous bone chip grafts. METHODS Between 2011 and 2013, 54 patients who had undergone OWHTO for genu varum and osteoarthritis were randomized to one of the two groups at five centres. TCP granule was used to fill the defect in 27 patients and lyophilized allogenous bone chip was used in the other 27 patients. The degree of bone union was classified on a five-point scale and evaluated using plain radiographs of the knee at 6 weeks, 3 months, 6 months, and 12 months postoperatively. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, pain Visual Analogue Scale (VAS) score and complications were also evaluated. RESULTS The highest degree of bone union observed at 6 and 12 months postoperatively was grade 4, and the number of cases of union progression at each time-point was not significantly different between the two groups (p > 0.05). WOMAC and pain VAS scores also showed no differences between the two groups. No complications were observed during the 12-month period following OWHTO in either group. CONCLUSION OWHTO using TCP granule bone substitute showed similar bone union rates and clinical outcomes compared to allogenous bone chip grafts. TCP granule can be used as bone substitutes instead of allogenous bone chip grafts in OWHTO. LEVEL OF EVIDENCE Level 1.
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Belsey J, Diffo Kaze A, Jobson S, Faulkner J, Maas S, Khakha R, Wilson AJ, Pape D. Graft materials provide greater static strength to medial opening wedge high tibial osteotomy than when no graft is included. J Exp Orthop 2019; 6:13. [PMID: 30923931 PMCID: PMC6439028 DOI: 10.1186/s40634-019-0184-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 03/08/2019] [Indexed: 12/02/2022] Open
Abstract
Background The purpose of this study was to compare the stability of medial opening-wedge high tibial osteotomy (MOWHTO) with and without different graft materials. Good clinical and radiological outcomes have been demonstrated when either using or not using graft materials during MOWHTO. Variations in the biomechanical properties of different graft types, regarding the stability they provide a MOWHTO, have not been previously investigated. Methods A 10 mm biplanar MOWHTO was performed on 15 artificial sawbone tibiae, which were fixed using the Activmotion 2 plate. Five bones had OSferion60 wedges (synthetic group), five had allograft bone wedges (allograft group), and five had no wedges (control group) inserted into the osteotomy gap. Static compression was applied axially to each specimen until failure of the osteotomy. Ultimate load, horizontal and vertical displacements were measured and used to calculate construct stiffness and valgus malrotation of the tibial head. Results The synthetic group failed at 6.3 kN, followed by the allograft group (6 kN), and the control group (4.5 kN). The most valgus malrotation of the tibial head was observed in the allograft group (2.6°). The synthetic group showed the highest stiffness at the medial side of the tibial head (9.54 kN·mm− 1), but the lowest stiffness at the lateral side (1.59 kN·mm-1). The allograft group showed high stiffness on the medial side of the tibial head (7.54 kN·mm− 1) as well as the highest stiffness on the lateral side (2.18 kN·mm− 1). Conclusions The use of graft materials in MOWHTO results in superior material properties compared to the use of no graft. The static strength of MOWHTO is highest when synthetic grafts are inserted into the osteotomy gap. Allograft wedges provide higher mechanical strength to a MOWHTO than when no graft used. In comparison to the synthetic grafts, allograft wedges result in the stiffness of the osteotomy being more similar at the medial and lateral cortices.
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Affiliation(s)
- James Belsey
- Department of Sport, Exercise & Health, University of Winchester, Sparkford Road, Winchester, Hampshire, SO22 4NR, England. .,Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, Hampshire, RG24 9NA, England.
| | - Arnaud Diffo Kaze
- Faculty of Science, Technology and Communication, University of Luxembourg, 6, rue R. Coudenhove-Kalergi, L-1359, Luxembourg, Luxembourg.,Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg, L-1460, Luxembourg, Luxembourg
| | - Simon Jobson
- Department of Sport, Exercise & Health, University of Winchester, Sparkford Road, Winchester, Hampshire, SO22 4NR, England
| | - James Faulkner
- Department of Sport, Exercise & Health, University of Winchester, Sparkford Road, Winchester, Hampshire, SO22 4NR, England
| | - Stefan Maas
- Faculty of Science, Technology and Communication, University of Luxembourg, 6, rue R. Coudenhove-Kalergi, L-1359, Luxembourg, Luxembourg
| | - Raghbir Khakha
- Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, Hampshire, RG24 9NA, England
| | - Adrian J Wilson
- The Hampshire Clinic, Basing Road, Old Basing, Basingstoke, Hampshire, RG24 7AL, England
| | - Dietrich Pape
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg, L-1460, Luxembourg, Luxembourg
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Ozel O, Yucel B, Mutlu S, Orman O, Mutlu H. Changes in posterior tibial slope angle in patients undergoing open-wedge high tibial osteotomy for varus gonarthrosis. Knee Surg Sports Traumatol Arthrosc 2017; 25:314-318. [PMID: 25763850 DOI: 10.1007/s00167-015-3571-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 03/04/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE In this study, postoperative changes in the posterior tibial slope angle and clinical outcomes following open-wedge high tibial osteotomy were evaluated. METHODS This study included 39 knees (18 left, 21 right) of 35 patients (three male, 32 female; median age, 53 years; age range 37-64 years) with symptomatic isolated medial joint osteoarthritis who underwent open-wedge high tibial osteotomy and fixation with a Puddu plate. The patients were clinically assessed according to the Lysholm knee score, a visual analogue pain scale, and a patient satisfaction questionnaire. Radiological assessment was made according to the changes in the posterior tibial slope angle and the correlation between these changes and clinical signs. The median follow-up period was 11 years (range 7-14 years). RESULTS Significant improvements were observed in the preoperative and postoperative clinical scores of the Lysholm knee scale, visual analogue pain scale, and patient satisfaction questionnaire (p < 0.05). Radiological assessment showed that the posterior tibial slope angle was significantly higher during the postoperative and follow-up periods (p 0.05). There was no correlation between the postoperative Lysholm scores and the increase in the posterior tibial slope angle (p = n.s.). CONCLUSIONS We conclude that both the conventional Puddu plate design and its anteromedial plate placement are what increase the tibial slope after an opening-wedge proximal tibial osteotomy. Therefore, current new plate design may help preserve the posterior tibial slope angle. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Omer Ozel
- Department of Orthopaedics, Istanbul Baskent University Hospital, Istanbul, Turkey
| | - Bulent Yucel
- Department of Orthopaedics, Kanuni Sultan Süleyman Training and Research Hospital, Atakent Mahallesi, Turgut Ozal Caddesi, No: 1, Kucukcekmece, 34303, Istanbul, Turkey
| | - Serhat Mutlu
- Department of Orthopaedics, Kanuni Sultan Süleyman Training and Research Hospital, Atakent Mahallesi, Turgut Ozal Caddesi, No: 1, Kucukcekmece, 34303, Istanbul, Turkey.
| | - Osman Orman
- Department of Orthopaedics, Silivri Government Hospital, Istanbul, Turkey
| | - Harun Mutlu
- Department of Orthopaedics, Taksim Training and Research Hospital, Istanbul, Turkey
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Woodacre T, Ricketts M, Evans JT, Pavlou G, Schranz P, Hockings M, Toms A. Complications associated with opening wedge high tibial osteotomy--A review of the literature and of 15 years of experience. Knee 2016; 23:276-82. [PMID: 26596554 DOI: 10.1016/j.knee.2015.09.018] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 08/27/2015] [Accepted: 09/30/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Complication rates following opening wedge high tibial osteotomy (OWHTO) is an issue that has not been comprehensively addressed in current literature. METHODS We performed a retrospective study of local patients who underwent OWHTO for isolated medial compartment knee osteoarthritis from 1997 to 2013. We analysed survivorship and complication rates and compared this to a literature review of previously reported data. RESULTS One hundred and fifteen patients met the inclusion criteria. Mean follow-up=8.4 years. Mean age=47 (range 32 to 62). Mean Body Mass Index (BMI)=29.1 (range 20.3 to 40.2). Devices used consisted of Tomofix (72%), Puddu plate (21%) and Orthofix (seven percent) (no significant differences in age/sex/BMI). Wedge defects were filled with autologous graft (30%), Chronos (35%) or left empty (35%). Five years survival rate (without requiring conversion to arthroplasty)=80%. Overall complication rate=31%. Twenty five percent of patients suffered 36 complications including minor wound infections (9.6%), major wound infections (3.5%), metalwork irritation necessitating plate removal (seven percent), non-union requiring revision (4.3%), vascular injury (1.7%), compartment syndrome (0.9%), and other minor complications (four percent). No thromboembolic complications were observed. CONCLUSION No significant differences existed in complication rates following OWHTO relative to BMI, implant type, type of bone graft used or patient age at surgery. When the complications from OWHTO were analysed closely they appear higher than previously reported in the literature; however serious complications appear rare. LEVEL OF EVIDENCE 3: Retrospective cohort study.
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Affiliation(s)
- T Woodacre
- Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon EX25DW, UK; Torbay Hospital, Newton Road, Torquay, Devon TQ27AA, UK.
| | - M Ricketts
- Torbay Hospital, Newton Road, Torquay, Devon TQ27AA, UK.
| | - J T Evans
- Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon EX25DW, UK.
| | - G Pavlou
- Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon EX25DW, UK.
| | - P Schranz
- Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon EX25DW, UK.
| | - M Hockings
- Torbay Hospital, Newton Road, Torquay, Devon TQ27AA, UK.
| | - A Toms
- Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon EX25DW, UK.
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Villatte G, Erivan R, Fournier PL, Pereira B, Galvin M, Descamps S, Boisgard S. Opening-wedge high tibial osteotomy with a secure bone allograft (Osteopure™) and locked plate fixation: Retrospective clinical and radiological evaluation of 69 knees after 7.5years follow-up. Orthop Traumatol Surg Res 2015; 101:953-7. [PMID: 26596418 DOI: 10.1016/j.otsr.2015.09.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 09/18/2015] [Accepted: 09/28/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Medial opening-wedge high tibial osteotomy (OWHTO) provides reliable and long-lasting benefits, despite the wide range of wedge-filling and internal-fixation techniques used. The purpose of this work was to assess the clinical and radiological outcomes in a case-series of OWHTO performed using a secure bone allograft and locked plate fixation. HYPOTHESIS The clinical and radiological outcomes of OWHTO with a high-safety bone allograft and locked plate fixation are similar to those reported in previous case-series studies. MATERIALS AND METHODS A single-centre retrospective design was used to study 69 knees in 64 patients with a mean age of 51.8years (31-53years) and a preoperative hip-knee-ankle (HKA) angle of 173° (165°-180°). The wedge was filled with secure Osteopure™ bone allograft and fixation was achieved using an Integra Surfix(®) locked plate. Mean follow-up was 7.5years (5-9.3years). Clinical and functional outcomes were assessed by determining the IKS and KOOS-PS scores and recording complications related or unrelated to the allograft. The main criterion for assessing OWHTO survival was the time to revision surgery for symptom recurrence. Radiological assessment criteria were the HKA angle, tibial slope, patellar height, and osteoarthritis grade. GESTO criteria were used to evaluate the behaviour of the allograft. RESULTS Of the 69 knees, 64 (92.8%) were re-evaluated. The survival rate after 9.3years was 95%±2.7% (3 failures managed with arthroplasty). The functional IKS score improved significantly, by 20 points (P<0.001). Mean increases of 7.8° for the HKA angle and 3.5° for tibial slope were recorded. Bone healing without radiological abnormalities was consistently achieved within 6months. There were no complications related to the allograft (infections, allergies; local or systemic toxicity). DISCUSSION The clinical, radiological, and safety outcomes documented in our study were similar to those reported in earlier work. LEVEL OF EVIDENCE IV, retrospective case-series study.
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Affiliation(s)
- G Villatte
- Service d'orthopédie-traumatologie, CHU Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - R Erivan
- Service d'orthopédie-traumatologie, CHU Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - P-L Fournier
- Service d'orthopédie-traumatologie, CHU Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - B Pereira
- Service Biostatistique, CHU de Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - M Galvin
- Service d'orthopédie-traumatologie, CHU Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - S Descamps
- Service d'orthopédie-traumatologie, CHU Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France; Laboratoire C-Biosenss, EA 4676, Université d'Auvergne 1, 63000 Clermont-Ferrand, France
| | - S Boisgard
- Service d'orthopédie-traumatologie, CHU Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
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Clinical and radiographic outcomes of medial open-wedge high tibial osteotomy with Anthony-K plate: prospective minimum five year follow-up data. INTERNATIONAL ORTHOPAEDICS 2015. [DOI: 10.1007/s00264-015-2919-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Medial opening-wedge high tibial osteotomy fixation with short plate without any graft, synthetic material or spacer. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2014; 24:1549-55. [DOI: 10.1007/s00590-014-1417-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 01/10/2014] [Indexed: 10/25/2022]
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Cho SW, Kim DH, Lee GC, Lee SH, Park SH. Comparison between Autogenous Bone Graft and Allogenous Cancellous Bone Graft in Medial Open Wedge High Tibial Osteotomy with 2-Year Follow-up. Knee Surg Relat Res 2013; 25:117-25. [PMID: 24032100 PMCID: PMC3767897 DOI: 10.5792/ksrr.2013.25.3.117] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 07/13/2013] [Accepted: 07/17/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To compare the radiographic and clinical results of medial open wedge high tibial osteotomy (OWHTO) using autogenous bone graft and allogenous cancellous bone graft for medial compartment osteoarthritis of the knee with two-year follow-up. MATERIALS AND METHODS Fifty-one patients (52 knees) who underwent medial OWHTO from October 2007 to April. 2010 were included in the study. The patients were divided into group I (n=29) that received an autogenous tricortical bone graft and group II (n=23) that received an allogenous cancellous bone chip graft. The radiographic parameters (preoperative anatomical and mechanical femorotibial angles, modified tibial bone varus angle, and posterior tibial slope), clinical parameters, bone union period, and complications were evaluated from medical records. RESULTS The radiographic and clinical outcomes did not show significant difference between two groups. The average bone union period was 11.7 weeks in group I and 12.1 weeks in group II. The visual analog scale score on the first postoperative day was significantly higher in group I than group II. CONCLUSIONS Medial OWHTO using allogenous cancellous bone graft for medial compartment osteoarthritis of the knee can be considered as an alternative treatment method that provides equivalent radiographic and clinical results of OWHTO using autogenous bone graft and causes less immediate postoperative pain.
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Affiliation(s)
- Sung Won Cho
- Department of Orthopaedic Surgery, Chosun University Hospital, Gwangju, Korea
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