Open wedge high tibial osteotomies: Calcium-phosphate ceramic spacer versus autologous bonegraft (original) (raw)
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The outcome of bone substitute wedges in medial opening high tibial osteotomy
The open orthopaedics journal, 2013
Opening wedge high tibial osteotomy often requires bone grafting to improve the union rate and avoid instability at the osteotomy site. Autograft and allograft have both been associated with complications and the use of bone substitute wedges has been advocated to improve the outcome. This study investigated the clinical, radiological and histological outcomes of using biphasic calcium phosphate ceramic (Triosite) wedges in opening wedge high tibial osteotomy and determined whether the presence of the graft would compromise the satisfactory conversion to a total knee replacement. A consecutive cohort underwent radiological review to determine whether the osteotomy healed and the correction was maintained. Biopsies were performed on those undergoing second procedures. All patients converted to total knee arthroplasty were assessed separately as to any surgical complications attributed to the Triosite wedge. There were 36 osteotomies in 33 patients with a minimum of 4 years follow up....
Gap healing after medial open-wedge high tibial osteotomy using injectable beta-tricalcium phosphate
Journal of orthopaedic surgery (Hong Kong)
The study aim was to evaluate gap healing after medial open-wedge high tibial osteotomy (MOWHTO) using novel injectable beta-tricalcium phosphate (β-TCP) as gap filler. We also aimed to evaluate radiographic and clinical outcome of MOWHTO using injectable β-TCP. Consecutive 28 patients underwent MOWHTO using anatomical locking plate fixation, and β-TCP was injected as gap filler. Serial radiographs and computed tomography were taken at postoperative 3 and 12 months, and gap healing was assessed. Lower extremity alignment was measured on radiographs, and clinical outcome was evaluated by determining International Knee Documentation Committee, Western Ontario and McMaster Universities Arthritis Index, and visual analogue scales for pain scores. Progress of bone union was found on plain radiographs, and the mean ratio (β-TCP/host bone) of computed tomography attenuation values significantly changed from postoperative 3 months to 12 months, which indicates maturation of β-TCP. The avera...
Comparative Study of Medial Opening-Wedge High Tibial Osteotomy Using 2 Different Implants
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2013
The purpose of this study was to perform a retrospective clinical and radiographic evaluation after openingwedge high tibial osteotomy (HTO) using a short spacer plate (Aescula; B. Braun Korea, Seoul, South Korea) and rigid long plate (TomoFix plate; Mathys, Bettlach, Switzerland) at follow-up 2 years postoperatively. Methods: We performed 94 opening-wedge HTOs with the Aescula plate (group I) and 92 HTOs with the TomoFix plate (group II). Patients underwent clinical and radiographic evaluations preoperatively and at 2 years postoperatively. Clinical evaluations were performed with Knee Society scores. Radiographic analysis included the mechanical tibiofemoral angle (mTFA) and the slope of the tibia angle with preoperative and postoperative full weightebearing anteroposterior whole-leg views, as well as anteroposterior, lateral, and Merchant views of the knee. We measured the mTFA. In addition, we evaluated the complications in each group. The follow-up period was 2 years. Results: At follow-up 2 years postoperatively, we observed an overall complication rate of 38% in group I and 26% in group II (P ¼ .083). We found plate-related complication rates of 20% in group I and 9% in group II (P ¼ .039). Plate-related complications included loss of correction, fracture of the tibial plateau, screw failure, malunion, and fracture of the lateral cortical bone. The mean mTFA was À6.0 AE 3.2 in group I and À4.6 AE 2.8 in group II preoperatively (P ¼ .262). The mean mTFA was 1.0 AE 3.1 in group I and 1.5 AE 2.3 in group II at the latest follow-up (P ¼ .034). In group I, the mean Knee Society knee score and function score were 60.0 AE 12.9 and 57.9 AE 26.8, respectively, preoperatively. They improved to 92.1 AE 8.1 and 89.0 AE 15.1, respectively, at follow-up (P ¼ .001 and P ¼ .001, respectively). In group II, the mean Knee Society knee score and function score were 57.5 AE 14.8 and 57.4 AE 22.1, respectively, preoperatively. They improved to 95.5 AE 5.4 and 95.0 AE 7.6, respectively, at follow-up (P ¼ .001 and P ¼ .001, respectively). In addition, the mean postoperative knee score and function score in group II were higher than those in group I (P ¼ .001 and P ¼ .001, respectively). Conclusions: We have shown a high plate-related complication rate and a significant loss of correction during a short-term follow-up period (2 years) after opening-wedge HTO using the new short spacer HTO plate compared with the rigid long plate. Level of Evidence: Level IV, therapeutic case series.
Bone Grafts and Bone Substitutes for Opening-Wedge Osteotomies of the Knee: A Systematic Review
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 2015
To establish the rate of use of various void fillers in the setting of opening-wedge osteotomy around the knee, the types of fixation used, and the rates of delayed union or nonunion related to these variables. In addition, this review addressed short-term to midterm outcomes and complication rates associated with such procedures. The electronic databases Medline, Embase, and PubMed were searched using the methodology for systematic review as recommended by the Cochrane Collaboration. The search terms used were as follows: knee, osteotomy, knee joint, bone grafting, opening osteotomy, opening wedge, tibial osteotomy, femoral osteotomy, and bone substitute. We screened 1,383 articles and applied exclusion criteria. Fifty-six articles were included. We included 3,033 cases of osteotomy in 2,910 patients. The mean age of patients was 50 years, with a mean follow-up period of 42 months. Male patients comprised 52% of patients. The mean alignment change was 10.8°, shifting the mechanical...
European Journal of Orthopaedic Surgery & Traumatology, 2017
Medial knee osteoarthritis on angular varus deformity of a lower limb is very common. Open-wedge high tibial osteotomy is a treatment of choice if cartilage is not excessively worn (Allback 1 or 2). The technique based on a plate fixation and the bone defect filled with calcium phosphate cement is thoroughly described. Data at 1, 3, 6 months and 1 year of a 19 cases continuous and prospective series are collected and analysed. Mean age at the time of operation was 55 years. The average preoperative varus deformity was 5° and corrected to an average postoperative valgus of 4° (range 3°–6°). Each control includes the collection of eventual complications, the measurement of health status (quality of life and functional scores) and antero-posterior and lateral X-rays. All osteotomies were considered healed at 6 weeks without any correction loss except one, probably result of a technical error. There was no difference in clinical and functional results between the group and the literatur...
Minimally invasive open wedge high tibial osteotomy with press-fit tricortical bone graft
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2009
Numerous operative procedures has been described for high tibial osteotomy (HTO), however the HTO without implant fixation has never been reported. The objective of this study was to propose a new technique and evaluate the preliminary results. Prospective review study on a series of case, at the Hospital. Seventeen patients (10 females, 7 males), and a total of 18 knees with a mean age at the operative time of 53 years (range, 35 to 64 years) were available for follow-up evaluation at a minimum of 24 months. The open-wedge HTO with press-fit tricortical bone graft was performed by one surgeon. The average time to union was 8.5 weeks (range, 6 to 12). There was one case of delayed union (5.5%). No nonunion, grafts collapse or dislodge were found. The average preoperative varus deformity was 8 degrees (range 6 to 11) and postoperative valgus was 8 degrees (range, 6 to 13). The pre and postoperative average pain level were 8.7 (range, 7 to 10) and 3.6 (range, 0 to 7), respectively. Th...
The high tibial osteotomy, open versus closed wedge, a comparison of methods in 108 patients
Archives of Orthopaedic and Trauma Surgery, 2005
Introduction: One hundred and eight patients with varus gonarthrosis were treated with high tibial osteotomy (HTO) in 2001. Fifty one patients received an open wedge osteotomy by using the 'Puddu' plate and 57 patients received a Coventry-type closing wedge osteotomy. For both groups the follow-up examination period was 22.5 months (253-1009 days). Material and Methods: To evaluate the study, radiological and subjective criteria as well as the Lysholm and the Tegner Activity Score were used. Altogether 84 % of the patients were included in the follow-up examination study. Results: In both groups a significant improvement of both scores were achieved. Both methods obtained safe and reproducible results for the correction considering the different operation techniques. There were no differences in outcome between the two methods. Satisfactory results were also achieved for early arthrosis of the femoropatellar and the lateral compartment. Conclusion: Open and closed wedge HTOs obtain significant improvement in patients with medial osteoarthritis of the knee. Using the right technique is very important for good results. For stabilization of the medial ligament we recommend the open wedge osteotomy. The patient should be informed about the routine removal of the metal plate.
Knee Surgery, Sports Traumatology, Arthroscopy, 2018
Purpose Medial open wedge high tibial osteotomy (owHTO) is a valuable surgical technique used to manage medial degeneration in varus knees. Iliac crest autograft is considered the gold standard gap-filler. It was hypothesised that iliac crest autograft promotes gap healing and improves functional outcome in owHTO. Methods Between 2005 and 2009, patients scheduled to undergo owHTO stabilised by a medial locking compression plate were randomised to undergo owHTO either with iliac crest autograft (group A) or without bone void filler (group B). Pre-and postoperative leg axes were recorded. At 3 and 12 months postoperatively, the healing of the osteotomy gap was measured as a percentage on CT images, and functional scores were recorded. Results There were 15 patients in group A, and 25 in group B. The groups were similar in age, sex ratio, knee varus deformity, body mass index, and smoking status. Group A and B had similar preoperative varus (6.9° vs. 7.6°) and postoperative valgus (2.2° vs. 3.0°). Compared with the control group, group A had a significantly greater degree of osseous gap healing after 3 months (40.1% vs. 10.8%, p = 0.045) and 12 months (91.5% vs. 59.1%, p ≤ 0.001). Multiple linear regression analysis found that bone grafting was an independent promoting factor for gap healing, while increased preoperative varus was an independent retardant factor at 3 months (p = 0.004 and p = 0.002, respectively) and 12 months (p ≤ 0.001 and p = 0.003, respectively). Younger age was a promoting factor for gap healing on CT at 3 months (p ≤ 0.001), but not at 12 months. No correlations were found between bone healing and functional outcome, body mass index, or smoking status. Conclusions Iliac crest autograft significantly increases healing of the osteotomy gap after owHTO. Increased preoperative varus and older patient age are independent factors that delay early healing of the osteotomy. However, no functional advantage was found at 3 or 12 months postoperatively. Therefore, routine use of iliac crest autograft cannot be recommended. Level of evidence II.