Various implant materials have been used in medial, opening-wedge high tibial osteotomy (HTO) including traditional metal and modern polyetheretherketone (PEEK) implants. The purpose of this study was to compare metal and PEEK implants and determine safety, varus deformity correction, as well as short- to mid-term hardware removal and arthroplasty rates.
HTO performed with metal and PEEK implants were reviewed between 2000 and 2015 at two institutions with a minimum of 2 years follow-up. Postoperative complications, radiographic measures, and osteotomy union were compared between groups using Kruskal–Wallis and Fisher’s exact testing. Survival free of hardware removal and arthroplasty was compared between groups using Kaplan–Meier testing. Risk factors for HTO conversion to arthroplasty were examined using Cox proportional hazards regression.
Ninety-five HTOs were performed in 90 patients (59 M, 31 F) using 50 metal and 45 PEEK implants. Mean follow-up was 4.2 years (range 2.0–16.5). Two metal and two PEEK HTO patients experienced nonunions, resulting in revision HTO at a mean of 1.0 years postoperatively (range 0.4–1.4 years). Both implant groups demonstrated similar, significant improvements in coronal deformity, with mean angulation improving from 6.0° and 5.4° varus preoperatively to 1.1° and 1.0° valgus postoperatively for the metal (p < 0.01) and PEEK groups (p < 0.01), respectively. 2- and 5-year hardware removal-free survival was 94% and 94% for PEEK, which was significantly superior to 80% and 73% observed for metal (p = 0.02). 2- and 5-year arthroplasty-free survival was similar for the metal (98% and 94%) and PEEK groups (100% and 78%) (n.s.). HTO performed for focal cartilage defects was observed to demonstrate decreased arthroplasty risk (HR 0.36, p = 0.03) when compared to HTO performed for osteoarthritis.
Both metal and PEEK implants were found to be effective in obtaining and maintaining coronal varus deformity correction, with 88% overall arthroplasty-free survival at 5 years. Metal fixation demonstrated a higher rate of hardware removal while HTO performed for medial compartment osteoarthritis predicted conversation to arthroplasty.
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Proximal tibial osteotomy
High tibial osteotomy
Insall Salvatti Ratio
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No external funding was used.
Conflict of interest
Mario Hevesi has received consulting fees from Moximed. Jeffrey A. Macalena serves as a board or committee member of AAOS, AOSSM, and the Mid-America Orthopaedic Society. He receives research or other financial support from Arthrex, Vericel, and the Musculoskeletal Transplant Foundation. Isabella T. Wu and Christopher L. Camp declare no conflicts of interest. Bruce A. Levy received consulting fees from Arthrex, CONMED Linvatec, and Smith & Nephew; he receives research support from Biomet, Smith & Nephew, and Stryker and serves on the Editorial or Governing board for Clinical Orthopaedics and Related Research, Journal of Knee Surgery, Knee Surgery, Sports Traumatology, Arthroscopy, and Orthopedics Today. Elizabeth A. Arendt received consulting fees from Smith & Nephew and serves on the Editorial or Governing board for AJSM, British Journal of Sports Medicine, International Society of Arthroscopy, Knee Surgery, Orthopaedic Sports Medicine, and Knee Surgery, Sports Traumatology, Arthroscopy. Michael J. Stuart received consulting fees from Arthrex and research support from Stryker. He serves on the Editorial or Governing board for AJSM. Aaron J. Krych received consulting fees from Arthrex, JRF Ortho, and Vericel and research support from Aesculap/B. Braun, Arthrex, Arthritis Foundation, Ceterix, and Histogenics. He serves on the Editorial or Governing board for AJSM, the International Cartilage Repair Society, International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine, Minnesota Orthopedic Society, and Musculoskeletal Transplantation Foundation.
The study was performed following and in accordance with Institutional Review Board (IRB) approval.
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Hevesi, M., Macalena, J.A., Wu, I.T. et al. High tibial osteotomy with modern PEEK implants is safe and leads to lower hardware removal rates when compared to conventional metal fixation: a multi-center comparison study. Knee Surg Sports Traumatol Arthrosc 27, 1280–1290 (2019). https://doi.org/10.1007/s00167-018-5329-0
- High tibial osteotomy
- High tibial osteotomy