Faster union rate and better clinical outcomes using autologous bone graft after medial opening wedge high tibial osteotomy
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To compare the radiological bone union rate after medial opening wedge high tibial osteotomy (MOW-HTO) and stabilization using a TomoFix™ plate (Synthes, Oberdorf, Switzerland) in three patient groups.
Retrospective analysis of 137 knees that underwent MOW-HTO between January 2014 and January 2017 was using a TomoFix™ plate. Osteotomy gaps were filled with β-tricalcium phosphate (β-TCP) (group A), left unfilled (group B), and subject to autologous bone graft and β-TCP (group C). Radiological bone union using simple radiography was determined by a modified version of the Brosset et al. osteotomy filling index. Clinical outcomes were evaluated using the International Knee Documentation Committee (IKDC) and Lysholm score. Statistical analyses using the Chi-square and ANOVA tests were performed between the groups.
The mean time for radiological bone union was 8.3 ± 3.1 months in group A, 7.2 ± 3.2 in group B and 3.4 ± 1.5 in group C (p = 0.001). There was statistically significant faster bone union in Group C. If the opening distance was more than 10 mm, group A united in 8.6 ± 3.6 months, group B in 8.8 ± 3.4, and group C in 3.5 ± 1.7 (p = 0.001). IKDC and Lysholm knee scores improved significantly (p = 0.004 for IKDC and 0.001 for Lysholm knee scores) in group C when compared to groups A and B at sixth month follow-up. At final follow-up, there was no difference in IKDC and Lysholm knee scores. Less delayed union occurred in group C.
MOW-HTO with autologous bone graft and β-TCP had the fastest radiological bone union and best clinical scores at 6 month follow-up.
Level of evidence
Retrospective comparative study, Level III.
KeywordsOpen wedge high tibial osteotomy Bone union Osteotomy gap Autologous bone grafting Osteoarthritis Knee
The authors would like to thank Prof. Yong Chan Ha and Jian Kang for their advice and expert technical assistance with the statistical analysis.
Design of study: WHJ and RT. Analysis of data: DHK and RN. Writing of manuscript: RN and DHK. Supervision of study: WHJ and RT. All authors read and approved the final manuscript.
This study did not receive any funding.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
Supplementary electronic data: Video of bone graft harvesting from medial femoral condyle (MP4 31760 KB)
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