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Arthroscopy. 2018 Sep;34(9):2621-2630. doi: 10.1016/j.arthro.2018.03.008. Epub 2018 Aug 2.

A Retrospective Comparison of Union Rates After Open Wedge High Tibial Osteotomies With and Without Synthetic Bone Grafts (Hydroxyapatite and β-tricalciumphosphate) at 2 Years.

Author information

1
Department of Orthopedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea.
2
Department of Orthopedic Surgery, Mumbai Port Trust Hospital, Mumbai, India.
3
Department of Orthopedic Surgery, Ulsanjoongang Hospital, Ulsan, Republic of Korea.
4
Department of Orthopedic Surgery, Korea University College of Medicine, Ansan Hospital, Ansan, Republic of Korea.
5
Department of Orthopedic Surgery, Korea University College of Medicine, Ansan Hospital, Ansan, Republic of Korea. Electronic address: jgkim7437@gmail.com.

Abstract

PURPOSE:

To evaluate the clinical and radiological results of no bone graft (NBG) after opening wedge high tibial osteotomy (OWHTO) with a locking plate and to compare the bone union rate between the synthetic bone graft (SBG) group and the NBG group after OWHTO using serial radiographs.

METHODS:

From 2012 to 2015, OWHTOs were performed with SBG or without bone graft using long locking plates. Inclusion criteria were: (1) OWHTO for disease of the medial compartment with varus deformity, and (2) minimum 2-year follow-up and radiographs taken serially to 2 years. Exclusion criteria were: (1) follow-up period <2 years (n = 8) or (2) absence of at least 1 radiograph taken at each follow-up point (n = 14). We retrospectively reviewed radiographs taken preoperatively and at 6 weeks, 3 months, 6 months, 1 year, and 2 years postoperatively. Groups comprised those filled with a synthetic bone [hydroxyapatite (HA) and β-tricalciumphosphate (TCP), n=33, SBG group] or without a bone graft (n = 38, NBG group). We compared bone union rate between the 2 groups by measuring the union zone from zone 1 to zone 5 in serial radiographs using Fisher's exact test.

RESULTS:

OWHTO was performed in a total of 93 knees and 71 knees were included in this study. Both groups showed good clinical and radiological results without correction loss at 2 years. The entire NBG group and 93.9% of the SBG group showed union over zone 3 at 2 years. However, the NBG group showed significantly more incorporation than the SBG group at 6 months (P = .006), 1 year (P = .0003), and 2 years (P = .0003).

CONCLUSIONS:

Union without correction loss was obtained after OWHTO without bone graft. The NBG group showed significantly more incorporation than the SBG group (HA and β-TCP) within 2 years.

LEVEL OF EVIDENCE:

Level IV, case series.

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