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The role of bone void fillers in medial opening wedge high tibial osteotomy: a systematic review

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

An Erratum to this article was published on 19 October 2016

Abstract

Purpose

A variety of bone void filling materials and methods are available in opening medial wedge HTO (OWHTO). The pertinent question revolves around if and when bone void fillers are needed. The primary purpose of this study was to systematically review outcomes and complications after OWHTO with and without the use of bone void fillers.

Methods

The EMBASE, PubMed\MEDLINE, Cochrane Library and Google Scholar databases were searched to identify articles that reported OWHTO results using different bone void fillers until March 2016. Only articles reporting the exact bone void filler type, the opening gap size and the fixation method were included. The extracted data included the study design, demographic data, the radiological and clinical results and complication rates. Outcomes were analysed with regard to bone void filler type, and comparison was made between the groups (allograft, autograft, synthetic bone void filler and OWHTO without bone void filling).

Results

Twenty-two articles reporting the results of 1421 OWHTO met the inclusion criteria. In total, 647 osteotomies were completed with allogeneic graft as bone void filler, 367 with synthetic materials, 199 with autograft and 208 without any bone void filling material. The maximum opening gap size was similar in all groups with mean of 9.8 mm (range 4–17.5 mm). Locking plate fixation was used in 90 % of the osteotomies that were completed without bone void filler, while all allograft cases and more then 90 % of the autograft cases were done with non-locking systems. The highest rates of non-union (1.1 %) were seen in the synthetic group, compared to 0.5 % in the all the other groups.

Conclusions

This systematic review showed no definitive advantages for OWHTO with any bone void filler in terms of union rates and loss of correction. Moreover, the use of autografts or allografts showed more favourable outcomes than synthetic bone substitutes. OWHTO with gaps smaller then 10 mm and rigid fixation might be successfully managed without bone grafting. However, when bone grafting is needed, autograft bone provides higher rates of clinical and radiographic union. The use of synthetic bone substitutes in OWHTO cannot be recommended.

Level of evidence

III.

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Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Meir General Hospital, Kfar Saba, Israel

    Omer Slevin

  2. Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada

    Olufemi R. Ayeni

  3. OrthoPlus, Munich, Germany

    Stefan Hinterwimmer

  4. Department of Orthopaedic Surgery, University Medicine Rostock, Rostock, Germany

    Thomas Tischer

  5. Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Freiburg, Germany

    Matthias J. Feucht

  6. Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), CH-4101, Bruderholz, Switzerland

    Omer Slevin & Michael T. Hirschmann

  7. AGA- Society for Arthroscopy and Joint Surgery, Comittee for OA and Joint Preserving Surgery, Wiesbaden, Germany

    Omer Slevin, Stefan Hinterwimmer, Thomas Tischer, Matthias J. Feucht & Michael T. Hirschmann

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  1. Omer Slevin
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Correspondence to Michael T. Hirschmann.

Additional information

An erratum to this article is available at http://dx.doi.org/10.1007/s00167-016-4344-2.

Appendix: Search strategy

Appendix: Search strategy

Core terms of the PubMed search strategy, adapted as needed for use in other databases.

Strategy

#1 OR #2 AND #3 AND #4

Concept #1

High[All Fields] AND (“tibia”[MeSH Terms] OR “tibia”[All Fields] OR “tibial”[All Fields]) AND (“osteotomy”[MeSH Terms] OR “osteotomy”[All Fields])

Concept #2

(Proximal[All Fields] AND (“tibia”[MeSH Terms] OR “tibia”[All Fields] OR “tibial”[All Fields]) AND (“osteotomy”[MeSH Terms] OR “osteotomy”[All Fields])) OR (medial[All Fields] AND (“tibia”[MeSH Terms] OR “tibia”[All Fields] OR “tibial”[All Fields]) AND (“osteotomy”[MeSH Terms] OR “osteotomy”[All Fields])) OR (opening[All Fields] AND wedge[All Fields] AND high[All Fields] AND (“tibia”[MeSH Terms] OR “tibia”[All Fields] OR “tibial”[All Fields]) AND (“osteotomy”[MeSH Terms] OR “osteotomy”[All Fields]))

Concept #3

(“Bone transplantation”[MeSH Terms] OR (“bone”[All Fields] AND “transplantation”[All Fields]) OR “bone transplantation”[All Fields] OR (“bone”[All Fields] AND “graft”[All Fields]) OR “bone graft”[All Fields]) OR ((“bone and bones”[MeSH Terms] OR (“bone”[All Fields] AND “bones”[All Fields]) OR “bone and bones”[All Fields] OR “bone”[All Fields]) AND filler[All Fields]) OR (synthetic[All Fields] AND (“bone substitutes”[MeSH Terms] OR (“bone”[All Fields] AND “substitutes”[All Fields]) OR “bone substitutes”[All Fields] OR (“bone”[All Fields] AND “substitute”[All Fields]) OR “bone substitute”[All Fields])) OR (“autografts”[MeSH Terms] OR “autografts”[All Fields] OR “autograft”[All Fields]) OR (“allografts”[MeSH Terms] OR “allografts”[All Fields] OR “allograft”[All Fields])

Concept #4

(Non [All Fields] AND union[All Fields]) OR (delayed[All Fields] AND union[All Fields]) OR (correction[All Fields] AND loss[All Fields])

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Slevin, O., Ayeni, O.R., Hinterwimmer, S. et al. The role of bone void fillers in medial opening wedge high tibial osteotomy: a systematic review. Knee Surg Sports Traumatol Arthrosc 24, 3584–3598 (2016). https://doi.org/10.1007/s00167-016-4297-5

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