Structural allograft impaction enables fast rehabilitation in opening-wedge high tibial osteotomy: a consecutive case series with one year follow-up

Abstract

Purpose Painful and slow recovery are the presumed disadvantages after opening-wedge high tibial osteotomy (HTO) and play a role in favouring arthroplasty as treatment for moderate isolated medial knee arthritis. The primary study objective was to investigate the efect of press-it structural impacted bone allograft with locking plate ixation on early ambulation, postoperative pain levels, and resumption of daily-life activities in opening-wedge HTO. Methods A prospective consecutive opening-wedge HTO case series was conducted, including 103 patients with inal follow-up at 1 year. Weight-bearing was allowed from the day after surgery "as tolerated" by the patient. Clinical assessment included the Numeric Rating Scale (NRS), Knee injury and Osteoarthritis Outcome Score (KOOS), and Lysholm score. Additionally, the Knee Society Score (KSS) was assessed during consultation at 1, 3, and 12 months postoperatively with special attention for clinical anchor questions. Required sample size was calculated and a linear mixed-efect model was used for repeated measures over time of the clinical scores. ResultsThe NRS decreased by 1.5 at 1 month (p < 0.01) and 2.1 at 3 months (p < 0.01), while KOOS pain signiicantly improved with 19.2 (p < 0.01) by this time compared to baseline. Under reduced pain levels, 98% were able to walk > 500 m without support, while all patients were able to climb up and down the stairs 3 months postoperatively. ConclusionThe study strongly supports the initial hypothesis that applying structural triangular bone allograft in HTO leads to low postoperative pain levels, early ambulation, and excellent short-term clinical outcomes. Study results have the potential to alter the general perception about HTO being a painful procedure with painstakingly slow recovery and consequently encourage the consideration of HTO as a highly valuable joint-preserving option, while treating unicompartmental knee arthritis. Level of evidence IV (case series).

Vancomycin-soaked femoral head allograft in opening wedge high tibia osteotomy enables earlier postoperative recovery and reduces infection rates compared to allogenic bone chips

“…Patients receiving the vancomycin‐soaked femoral head allograft were three times more likely to participate in physiotherapy on POD1—allowing for greater ambulatory distance and reduction in PCA use. Pain reduction with the use of an impacted allograft was similarly demonstrated by Van Genechten et al [33] who demonstrated an improvement of pain scores from preoperative baseline as early as the first‐week postoperatively. Suggesting that the well‐fitted allograft confers improved stability over the osteotomy site and redistributes axial loading forces on the load‐bearing plate and screws to the reduced pain and enable early ambulation by their study cohort [33].…”

“…Osteotomy gap fillers such as PEEK implants, structural allografts (e.g. Femoral head allografts) and autografts have shown similar benefit in reducing postoperative pain [19, 23, 33]. Polacek et al [23] successfully achieved day‐case surgery for MOW‐HTO using intraosseous PEEK implants, making day cases for MOW‐HTO is possible, with minimal complications.…”

“…The use of an osteotomy gap filler has gained popularity owing to its efficacy in reducing perioperative pain by conferring structural support in MOW‐HTO [33]. Polacek et al [23] reported successful use of an intraosseous polyether ether ketone (PEEK) implant in day‐case MOW‐HTO—achieving adequate postoperative pain control and reducing readmission rates.…”

“…Polacek et al [23] reported successful use of an intraosseous polyether ether ketone (PEEK) implant in day‐case MOW‐HTO—achieving adequate postoperative pain control and reducing readmission rates. Van Genechten et al [33] recently proposed the use of applying a structural triangular bone allograft in HTO reporting low postoperative pain levels, early ambulation and excellent short‐term clinical outcomes.…”

Research on the Influence of the Allogeneic Bone Graft in Postoperative Recovery After MOWHTO: A Retrospective Study

“… 17 , 23 Van Genechten et al showed that the graft provides additional stability to the osteotomy site, redistributes the axial load, shares the pressure on the locking screw and plate, and reduces post-operative pain. 24 Previous studies recommended bone graft filling for high-risk patients with large correction angles, severe obesity, heavy smoking history, and low bone mineral density. 16 , 17 , 25 In this study, we found that allogeneic bone graft, opening width, and history of diabetes were independent factors affecting the progress of early post-operative healing at 6 months post-surgery.…”