Skip to main content

Advertisement

SpringerLink
Log in

Bovine xenograft locking Puddu plate versus tricalcium phosphate spacer non-locking Puddu plate in opening-wedge high tibial osteotomy: a prospective double-cohort study

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

The aim of the study was to compare clinical and radiographic outcomes of opening-wedge high tibial osteotomy (HTO) augmented with either xenograft or tricalcium phosphate spacer for the management of medial compartment osteoarthritis (OA) with genu varum.

Methods

Between 2004 and 2007, we prospectively enrolled 52 patients with medial compartment knee OA who underwent opening-wedge HTO fixed with locking Puddu plate and xenograft (n = 26) or non-locking Puddu plate and tricalcium phosphate spacer (n = 26). The alignment of the lower limb was assessed by measuring the hip-knee-ankle (HKA) angle. Clinical outcomes were assessed with the Knee Society Score, Western Ontario and McMaster Universities Osteoarthritis Index, SF-36 and European Quality of Life-5 Dimensions scale. All patients were followed up at six weeks and at three, six, 12 and 24 months post-operatively. Clinical outcomes were assessed preoperatively and at 24 months post-operatively.

Results

All clinical scores improved significantly in both groups after surgery, without any significant difference between the two groups. Immediately after surgery, the HKA angle went from 9.1 ± 5.2° in varus to 3.1 ± 4.8° in valgus (P = 0.01) in the xenograft group, and from 8.5 ± 5.9° in varus to 3.4 ± 4.2° in valgus (P = 0.01) in the tricalcium phosphate group. At the last follow-up, the tricalcium phosphate group showed a significant loss of correction (P = 0.03).

Conclusions

HTO performed with xenograft locking plate and tricalcium phosphate non-locking plate constructs showed good clinical outcomes. However, the xenograft locking plate construct is superior to the tricalcium phosphate spacer non-locking plate to prevent the loss of correction in the middle term.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Amendola A, Bonasia DE (2010) Results of high tibial osteotomy: review of the literature. Int Orthop 34:155–160

    Article  PubMed  Google Scholar 

  2. Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H (2008) The long-term outcome of high tibial osteotomy: a ten- to 20-year follow-up. J Bone Joint Surg Br 90:592–596

    Article  PubMed  CAS  Google Scholar 

  3. DeMeo PJ, Johnson EM, Chiang PP, Flamm AM, Miller MC (2010) Midterm follow-up of opening-wedge high tibial osteotomy. Am J Sports Med 38:2077–2084

    Article  PubMed  Google Scholar 

  4. Santic V, Tudor A, Sestan B, Legovic D, Sirola L, Rakovac I (2010) Bone allograft provides bone healing in the medial opening high tibial osteotomy. Int Orthop 34:225–229

    Article  PubMed  Google Scholar 

  5. Yacobucci GN, Cocking MR (2008) Union of medial opening-wedge high tibial osteotomy using a corticocancellous proximal tibial wedge allograft. Am J Sports Med 36:713–719

    Article  PubMed  Google Scholar 

  6. Levai JP, Bringer O, Descamps S, Boisgard S (2003) Xenograft-related complications after filling valgus open wedge tibial osteotomy defects. Rev Chir Orthop Reparatrice Appar Mot 89:707–711

    PubMed  Google Scholar 

  7. Koshino T, Murase T, Saito T (2003) Medial opening-wedge high tibial osteotomy with use of porous hydroxyapatite to treat medial compartment osteoarthritis of the knee. J Bone Joint Surg Am 85:78–85

    Article  PubMed  Google Scholar 

  8. Koshino T, Murase T, Takagi T, Saito T (2001) New bone formation around porous hydroxyapatite wedge implanted in opening wedge high tibial osteotomy in patients with osteoarthritis. Biomaterials 22:1579–1582

    Article  PubMed  CAS  Google Scholar 

  9. Dallari D, Savarino L, Albisinni U, Fornasari P, Ferruzzi A, Baldini N et al (2012) A prospective, randomised, controlled trial using a Mg-hydroxyapatite - demineralized bone matrix nanocomposite in tibial osteotomy. Biomaterials 33:72–79

    Article  PubMed  CAS  Google Scholar 

  10. Hernigou P, Ma W (2001) Open wedge tibial osteotomy with acrylic bone cement as bone substitute. Knee 8:103–110

    Article  PubMed  CAS  Google Scholar 

  11. Goutallier D, Julieron A, Hernigou P (1992) Cement wedge replacing iliac graft in tibial wedge osteotomy. Rev Chir Orthop Reparatrice Appar Mot 78:138–144

    PubMed  CAS  Google Scholar 

  12. Gouin F, Yaouanc F, Waast D, Melchior B, Delecrin J, Passuti N (2010) Open wedge high tibial osteotomies: calcium-phosphate ceramic spacer versus autologous bone graft. Orthop Traumatol Surg Res 96:637–645

    Article  PubMed  CAS  Google Scholar 

  13. Hernigou P, Roussignol X, Flouzat-Lachaniette CH, Filippini P, Guissou I, Poignard A (2010) Opening wedge tibial osteotomy for large varus deformity with Ceraver resorbable beta tricalcium phosphate wedges. Int Orthop 34:191–199

    Article  PubMed  Google Scholar 

  14. Dugdale TW, Noyes FR, Styer D (1992) Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length. Clin Orthop Relat Res 274:248–264

    PubMed  Google Scholar 

  15. Asik M, Sen C, Kilic B, Goksan SB, Ciftci F, Taser OF (2006) High tibial osteotomy with Puddu plate for the treatment of varus gonarthrosis. Knee Surg Sports Traumatol Arthrosc 14:948–954

    Article  PubMed  Google Scholar 

  16. Kuremsky MA, Schaller TM, Hall CC, Roehr BA, Masonis JL (2010) Comparison of autograft vs allograft in opening-wedge high tibial osteotomy. J Arthroplasty 25:951–957

    Article  PubMed  Google Scholar 

  17. Aryee S, Imhoff AB, Rose T, Tischer T (2008) Do we need synthetic osteotomy augmentation materials for opening-wedge high tibial osteotomy. Biomaterials 29:3497–3502

    Article  PubMed  CAS  Google Scholar 

  18. Dong J, Uemura T, Shirasaki Y, Tateishi T (2002) Promotion of bone formation using highly pure porous beta-TCP combined with bone marrow-derived osteoprogenitor cells. Biomaterials 23:4493–4502

    Article  PubMed  CAS  Google Scholar 

  19. Zorzi AR, da Silva HG, Muszkat C, Marques LC, Cliquet A Jr, de Miranda JB (2011) Opening-wedge high tibial osteotomy with and without bone graft. Artif Organs 35:301–307

    Article  PubMed  Google Scholar 

  20. Agneskirchner JD, Freiling D, Hurschler C, Lobenhoffer P (2006) Primary stability of four different implants for opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 14:291–300

    Article  PubMed  CAS  Google Scholar 

  21. Stoffel K, Stachowiak G, Kuster M (2004) Open wedge high tibial osteotomy: biomechanical investigation of the modified Arthrex Osteotomy Plate (Puddu Plate) and the TomoFix Plate. Clin Biomech (Bristol, Avon) 19:944–950

    Article  Google Scholar 

  22. Niemeyer P, Schmal H, Hauschild O, von Heyden J, Sudkamp NP, Kostler W (2010) Open-wedge osteotomy using an internal plate fixator in patients with medial-compartment gonarthritis and varus malalignment: 3-year results with regard to preoperative arthroscopic and radiographic findings. Arthroscopy 26:1607–1616

    Article  PubMed  Google Scholar 

  23. Haviv B, Bronak S, Thein R, Kidron A (2012) Mid-term outcome of opening-wedge high tibial osteotomy for varus arthritic knees. Orthopedics 35:e192–e196

    PubMed  Google Scholar 

  24. Spahn G, Muckley T, Kahl E, Hofmann GO (2006) Biomechanical investigation of different internal fixations in medial opening-wedge high tibial osteotomy. Clin Biomech (Bristol, Avon) 21:272–278

    Article  Google Scholar 

  25. van Raaij TM, Brouwer RW, de Vlieger R, Reijman M, Verhaar JA (2008) Opposite cortical fracture in high tibial osteotomy: lateral closing compared to the medial opening-wedge technique. Acta Orthop 79:508–514

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Centre for Sports and Exercise Medicine, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, UK

    Nicola Maffulli

  2. Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Rome, Italy

    Mattia Loppini, Umile Giuseppe Longo & Vincenzo Denaro

  3. Department of Orthopaedic and Trauma Surgery, Tor Vergata University, Rome, Italy

    Francesco Oliva

  4. Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England, UK

    Nicola Maffulli

Authors
  1. Nicola Maffulli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mattia Loppini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Umile Giuseppe Longo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vincenzo Denaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Francesco Oliva
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nicola Maffulli.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Maffulli, N., Loppini, M., Longo, U.G. et al. Bovine xenograft locking Puddu plate versus tricalcium phosphate spacer non-locking Puddu plate in opening-wedge high tibial osteotomy: a prospective double-cohort study. International Orthopaedics (SICOT) 37, 819–826 (2013). https://doi.org/10.1007/s00264-013-1817-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-013-1817-5

Keywords

Search

Navigation