The outcome of bone substitute wedges in medial opening high tibial osteotomy (original) (raw)
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Open wedge high tibial osteotomies: Calcium-phosphate ceramic spacer versus autologous bonegraft
Orthopaedics & traumatology, surgery & research : OTSR, 2010
Valgus tibial osteotomy (VTO) is a well-known procedure for the treatment of medial compartment femoro-tibial osteoarthritis. Good and very good results have been reported with calcium phosphate wedges, which avoid the inconveniences of autologous grafts use. The hypothesis of this study is that with equivalent results in the treatment of osteoarthritis of the knee, the use of calcium phosphate wedges (BMCaPh) to fill the bone defect created by osteotomy would result in fewer specific complications and less pain associated with autologous grafts (AUTO) harvesting. This prospective, controlled, randomised study included one arm that received a macroporous, biphasic calcium phosphate wedge (BMCaPh group) and one arm that received an autologous tricortical graft (AUTO group) for filling. The same plate with locked screws was used for fixation in all cases. All patients underwent at least two years of clinical and radiographic post-operative follow-up. Forty patients were included. Loss...
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...
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.
International Orthopaedics, 2013
Purpose High tibial osteotomy (HTO) is frequently used to treat varus osteoarthritis in younger patients with the goal of delaying the need for total knee arthroplasty (TKA). While it has been reported that the results of TKA following HTO are worse than those in patients without prior knee surgery, the influence of osteotomy technique (medial openingwedge versus lateral closing-wedge) has not been explored. The purpose of this study was to evaluate the influence of HTO technique on the performance and results of TKA. Methods A total of 141 TKA's performed in 118 patients with prior HTO (24 opening wedge and 117 closing wedge) were reviewed at a mean follow-up of two years. Reviewed data included intra-operative factors (tourniquet time, the need for additional exposure, and intra-operative complications), clinical results (International Knee Score (IKS)) and radiographic assessment of limb alignment. Results The average IKS knee and function scores improved from 54.0 and 60.3 to 87.0 and 79.5 (p< 0.0001). There was no significant difference in IKS scores based on osteotomy technique. There was a trend toward an increased need for tibial tubercle osteotomy in the closing wedge group. There was an increased need for extensive medial release in the opening wedge group and extensive lateral release in the closing wedge group. No differences in tourniquet time, complication rates, or hip-knee-ankle angle were noted between the two groups. Conclusions Radiographic limb alignment, patient-reported outcomes, and complication rates are equal in patients undergoing TKA after opening and closing wedge HTO.
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...
In vitro stability of open wedge high tibial osteotomy with synthetic bone graft
The Knee, 2010
It has been predicted that significant stress will be applied to the plate and lateral cortical hinge of an osteotomy site when early full weight bearing is commenced after an open wedge high tibial osteotomy. We hypothesized that the stress concentration on the plate or at the lateral cortical hinge would be reduced by inserting bone substitutes into the osteotomy gap. Two different types of tibia model were investigated: Group A, fixation with TomoFix with the osteotomy site left as an open space; and Group B, two β-TCP wedges are inserted into osteotomy site and fixed with TomoFix. Stress at five points was measured using strain gauges. Specimens were mounted onto a testing machine with an FTA (femoro-tibial angle) of 170°. Cyclic load tests and an ultimate load test were then performed. The mean stress on the plate was measured at 15.5 ± 1.8 Mpa in Group A. On the other hand, this value in Group B was only 9.52 ± 2.1 Mpa and this was a significant difference (P b 0.01). The mean stress on the lateral hinge in Groups A and B was 3.31 ± 0.5 and 2.49 ± 0.2, respectively which was also a significant difference (P b 0.05). The mean maximum breaking load in Group A was 2500 ± 280 N and in Group B 4270 ± 420 N which was a significant difference (P b 0.01). Hence, for OWHTO procedures, the use of β-TCP wedges and TomoFix is thus likely to improve the initial axial and possibly rotational stability at the osteotomy site in comparison with methods that leave the osteotomy gap open.
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...
Biomaterials, 2005
A histological study was performed of bone biopsies from 16 patients (17 biopsies) treated with open wedge high tibial osteotomies for medial knee osteoarthritis. The open wedge osteotomies were filled with a wedge of osteoconductive beta tricalcium phosphate (beta-TCP) ceramic bone replacement. At the time of removal of the fixation material, core biopsies of the area where the beta-TCP was located were taken at different follow-up periods (6-25 months). beta-TCP resorption, bone ingrowth and bone remodelling were studied. We hypothesized that the incorporation and remodelling process occurs similarly as in animals. Histology showed a good resorption of the beta-TCP with complete incorporation and remodelling into new bone. The different phases as described in animal studies were found. A correlation was found between histological findings and radiological assessment. In conclusion, beta-TCP appeared to be a bone replacement material with optimal biocompatibility, resorption charac...