Opening-wedge high tibial osteotomy without bone graft

Abstract

Open wedge high tibial osteotomy has become the trend for correction of varus knee deformities. The drawbacks were the need of autogenous bone graft with its associated morbidity, and later the use of bone substitutes with their cost and delayed healing. In this study, a total of 58 consecutive patients underwent high tibial osteotomy with internal fixation by wedge (toothed) plate and screws without bone graft, from 2004 to 2008. Age of the patients ranged from 24 to 65 years. There were 37 women and 21 men. The osteotomy opening size ranged from 8 to 14 mm. The mean follow-up was 38 months. The osteotomy united in all patients. Average time to union was 12.4 weeks (range 8-16 weeks). Partial loss of correction occurred in one osteotomy. There was significant difference between the healing time and the size of the osteotomy opening. The results at the final follow-up using the HSS score were excellent in 51 knees (88%) and good in seven knees (12%). Despite the routine addition of bone graft as a part of the high tibial osteotomy procedure, this study supports medial opening-wedge high tibial osteotomy up to 14 mm without bone graft or bone substitutes, which shortens the operative time and avoids unnecessary morbidity.

Is overcorrection preferable for repair of degenerated articular cartilage after open-wedge high tibial osteotomy?

“…With regard to clinical relevance, this study supported the reasonableness of the most frequently used target of limb alignment after HTO, which is a femorotibial angle of 170° or a mechanical axis crossing the tibia plateau at 62 % from the medial edge of the tibial plateau to its entire width [3,6,7,23,24], because no significant differences were observed in terms of the ratio of cartilage repair in the medial compartment of the femorotibial joint.…”

Medial Open Wedge High Tibial Osteotomy: Can Delayed or Nonunion Be Predicted?

“…Earlier studies pointed to a concern about the risk of nonunion with this approach [20,23], whereas some more recent work has suggested that the risk of nonunion for opening wedge HTO is not higher than that for the closed wedge technique [3,6,10].…”

Comparison of Bone Healing in Open-Wedge High Tibial Osteotomy between the Use of Allograft Bone Chips with Autologous Bone Marrow and the Use of Allograft Bone Chips Alone for Gap Filling

“…3,6,20 A vacant osteotomy gap has been reported to remain stable with locking plate fixation, without implant failure. 2,9 However, some studies have reported complications, including correction loss and screw breakage. 8,9 The method of gap filling using an autologous bone graft is considered as the gold standard approach.…”

“…2,9 However, some studies have reported complications, including correction loss and screw breakage. 8,9 The method of gap filling using an autologous bone graft is considered as the gold standard approach. 21,22 However, in the process of harvesting the bone, several issues, such as donor-site pain, meralgia paresthetica, increased blood loss, increased operation time, and potential for donor-site infection, might occur.…”