Is iliac autogenous graft augmentation in medial open wedge high tibial osteotomies superior to no augmentation in terms of bone healing?

Abstract

Osteoarthritis (OA) is a progressive and debilitating condition. [1,2] Varus deformity of knee joint increases the risk of progression of medial compartment OA. High tibial osteotomy (HTO) is a well-established surgical technique for individuals with medial OA and varus deformity. [3] The aim is to change the load distribution across the knee from the diseased medial part to the healthy lateral part in order to reduce pain, slow the degenerative process and delay the requirements for total knee replacement. [4] Osteotomy of the proximal tibia is becoming popular as compartmental OA of the knee is increasing in younger patients with malalignment of the joint. Open wedge high tibial osteotomy (OWHTO) on the medial side has been described as an effective surgical procedure in the treatment of medial compartmental OA. [5,6] Prevention of patella alta, easy correction of the deformity and no need for fibular osteotomy are the described advantages of medial sided osteotomy. Grafting the osteotomy site for quicker healing either with biologic resources or bone substitutes Objectives: This study aims to investigate if iliac autogenous graft augmentation in medial open wedge high tibial osteotomies (OWHTOs) is superior to no augmentation in terms of bone healing. Patients and methods: Twenty-five patients (14 males, 11 females; mean age 40.9±4.0 years; range, 33 to 48 years) with medial compartmental osteoarthritis of knee joint who underwent high tibial osteotomy with medial open wedge between January 2016 and December 2018 were included in this retrospective study. Twelve of the operated knees were the right knee. Graft was used in 13 patients (52%). Data including age, gender, body mass index (BMI), direction, follow-up period, union, Lysholm and International Knee Documentation Committee (IKDC) scores, pre-and postoperative femoral tibial angles (FTAs) and posterior tibial slopes were evaluated. Results: The mean BMI was 26.4±1.9 (range, 22.0 to 30.0). Only 48% of the patients were smoking. The mean follow-up period was 28.6±5.3 months (range, 24 to 38 months). No statistically significant difference was found between the grafted and nongrafted groups in terms of age, BMI, follow-up time, gender, side and smoking status (p>0.05) There was no statistically significant difference between two groups in terms of pre-and postoperative Lysholm scores, pre-and postoperative IKDC scores, or pre-and postoperative FTA values (p>0.050). Conclusion: Iliac autogenous graft augmentation in medial OWHTO has no effect on union but shortens the union time. Preoperative high varus degree adversely affects union. Therefore, routine use of iliac crest autograft is not recommended.

Comparison of Iliac Bone Transplantation with Bone Transport in the Treatment of Femur Fracture and Bone Defect

“…Bone displacement is based on bone extension, and 1 mm of bone movement is evidenced every day so that the soft tissue is in a state of tension. Vascular endothelial cells will gradually move to polymorphic mesenchymal cells and to some extent evolve into osteoblasts [ 9 – 12 ].…”

“…Bone displacement is based on bone extension, and 1 mm of bone movement is evidenced every day so that the soft tissue is in a state of tension. Vascular endothelial cells will gradually move to polymorphic mesenchymal cells and to some extent evolve into osteoblasts [9][10][11][12]. With the elongation of bone, the callus site changes to a certain extent, and the central fibroblasts gradually differentiate into a parallel structure similar to the bone.…”

Iliac Crest Allograft with Plate Osteosynthesis for a Bone-Patellar Tendon-Bone Anterior Cruciate Ligament Donor-Site Fracture

“…26 These procedures have demonstrated favorable outcomes with union rates comparable with those of autografts. 26-31…”

“…26 These procedures have demonstrated favorable outcomes with union rates comparable with those of autografts. [26][27][28][29][30][31] Furthermore, the use of allograft avoids donor site morbidity altogether from the iliac crest, yet still provides the osteoconductive properties associated with improved union rates, patient outcomes, and recovery 16 . Autograft obtained from the iliac crest often causes early postoperative donor-site pain, which has been associated with a delay in ambulation, longer hospital stays, later return to work and recreation, and overall larger healthcare costs 17,32 .…”

Reconstruction of Load-Bearing Segmental Bone Defects Using Carbonate Apatite Honeycomb Blocks

“…Autografts are the most effective bone fillers for healing bone defects via OWHTO. , However, autografts require iliac harvesting, which can cause pain and infection at the harvested site. , Therefore, routine use of autografts for OWHTO is not recommended. , Allografts have been used as substitutes for autografts. ,, However, implantation of allografts carries the risk of transmission of infection. , …”