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Structural allograft impaction enables fast rehabilitation in opening-wedge high tibial osteotomy: a consecutive case series with one year follow-up

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Painful and slow recovery are the presumed disadvantages after opening-wedge high tibial osteotomy (HTO) and play a role in favouring arthroplasty as treatment for moderate isolated medial knee arthritis. The primary study objective was to investigate the effect of press-fit structural impacted bone allograft with locking plate fixation on early ambulation, postoperative pain levels, and resumption of daily-life activities in opening-wedge HTO.

Methods

A prospective consecutive opening-wedge HTO case series was conducted, including 103 patients with final follow-up at 1 year. Weight-bearing was allowed from the day after surgery “as tolerated” by the patient. Clinical assessment included the Numeric Rating Scale (NRS), Knee injury and Osteoarthritis Outcome Score (KOOS), and Lysholm score. Additionally, the Knee Society Score (KSS) was assessed during consultation at 1, 3, and 12 months postoperatively with special attention for clinical anchor questions. Required sample size was calculated and a linear mixed-effect model was used for repeated measures over time of the clinical scores.

Results

The NRS decreased by 1.5 at 1 month (p < 0.01) and 2.1 at 3 months (p < 0.01), while KOOS pain significantly improved with 19.2 (p < 0.01) by this time compared to baseline. Under reduced pain levels, 98% were able to walk > 500 m without support, while all patients were able to climb up and down the stairs 3 months postoperatively.

Conclusion

The study strongly supports the initial hypothesis that applying structural triangular bone allograft in HTO leads to low postoperative pain levels, early ambulation, and excellent short-term clinical outcomes. Study results have the potential to alter the general perception about HTO being a painful procedure with painstakingly slow recovery and consequently encourage the consideration of HTO as a highly valuable joint-preserving option, while treating unicompartmental knee arthritis.

Level of evidence

IV (case series).

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Acknowledgements

The authors would like to thank Nathalie Van Beek (PhD) for statistical analysis and comprehensive data interpretation.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Antwerp University, Antwerp, Belgium

    Wouter Van Genechten, Maxim Van den Bempt & Wouter Van Tilborg

  2. Department of Orthopaedic Surgery, AZ Herentals, Herentals, Belgium

    Stijn Bartholomeeusen, Gert Van Den Bogaert, Toon Claes & Steven Claes

  3. Department of Orthopaedic Surgery, Leuven University Hospital, Leuven University, Leuven, Belgium

    Steven Claes

Authors
  1. Wouter Van Genechten
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  2. Maxim Van den Bempt
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  3. Wouter Van Tilborg
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  4. Stijn Bartholomeeusen
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  5. Gert Van Den Bogaert
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  6. Toon Claes
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Correspondence to Wouter Van Genechten.

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Conflict of interest

Two authors of this paper are consultants for Arthrex.

Ethical approval

The study was approved by the ethical committee of the Antwerp university hospital and by the local ethical committee of the AZ Herentals hospital.

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No external grants or funding was obtained for this study.

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Van Genechten, W., Van den Bempt, M., Van Tilborg, W. et al. Structural allograft impaction enables fast rehabilitation in opening-wedge high tibial osteotomy: a consecutive case series with one year follow-up. Knee Surg Sports Traumatol Arthrosc 28, 3747–3757 (2020). https://doi.org/10.1007/s00167-019-05765-z

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