Comparison of osteoconductivity and absorbability of beta-tricalcium phosphate and hydroxyapatite in clinical scenario of opening wedge high tibial osteotomy

Abstract

The purpose of this study was to compare the osteoconductivity, and absorbability of hydroxyapatite or beta-tricalcium phosphate in clinical scenario of opening wedge high tibial osteotomy Total 41 knees of 40 patients with follow up period of more than 1 year were enrolled. These patients were divided into two groups, Group I (22 knees, 21 patients) used hydroxyapatite and Group II (19 knees, 19 patients) used beta-tricalcium phosphate as a substitute in the opening gap. According to proven method, the osteoconductivity was assessed radiographically by the extent of new bone formation at osteotomy space and absorbability was evaluated by measuring the area occupied by substitute at immediate postoperative, postoperative 6 months and 1 year. Regarding preoperative demographic data, no significant differences were found between two groups. No statistically significant differences were found between two groups regarding lower limb alignment (mechanical femorotibial angle, weight-bearing line%) and posterior tibial slope at postoperative and final follow up radiographs. Concerning the osteoconductivity, there were no significant differences between two groups in any zone. However, the absorption rate was significantly greater in the Group II than in Group I at 6 months (Group I: 13.7 ± 6.8, group II: 35.3 ± 15.8, P = 0.001) and 1 year (Group I: 24.2 ± 6.3, Group II: 49.6 ± 14.3, P < 0.0001). The complications related to bone substitutes were not observed. Both hydroxyapatite and beta-tricalcium phosphate showed satisfactory gap healing without complications and can be successfully used as alternative healing materials in opening wedge high tibial osteotomy. Our study showed that beta-tricalcium phosphate has superior absorbability than hydroxyapatite. But osteoconductivity showed no significant difference.

Analysis and quantification of bone healing after open wedge high tibial osteotomy

“…Oh et al. described an adaption of the van Hemert score for bone and allograft healing in the gap, dividing the gap into four zones and starting the staging from the medial site [11]; since we did not use allografts in our study, this score was not applicable. There has been a study in which Akiyama et al.…”

Bone substitutes: a review of their characteristics, clinical use, and perspectives for large bone defects management

“… 8 , 9 , 23 , 94 , 113 , 114 Synthetic HA can be made by the precipitation of calcium nitrate and ammonium dihydrogen phosphate. 23 This association presents all the advantages of its two components (osteoconductivity, 94 , 115 – 118 biocompatibility, 94 , 113 safe and nonallergen use, 113 and promotion of bone formation 106 ). The major gain of using biphasic ceramics (HA and β-TCP mixture) concerns their resorption.…”

Biological properties of calcium phosphate biomaterials for bone repair: a review

“…This phenomenon is called "osteoinduction," and the capacity for osteoinduction is called "osteoinductivity" or "osteoinductive potential". Normally, whether a material is bone induced depends on whether it can still function well, even in the situation of ectopic implantation such as subcutaneous injection 53 and intramuscular implantation. 54 Among numerous biomaterials, calcium phosphate materials, such as HA, TCP and BCP have been regarded as prominent candidates for bone reconstruction due to their great osteoinductivity, which is of importance for the adsorption and differentiation of mesenchymal cells into osteoblasts and osteocytes, further enhancing the vascular formation as well as bone tissue regeneration.…”