Original Article With Video Illustration
Radiographic Healing With Hemispherical Allogeneic Femoral Head Bone Grafting for Opening-Wedge High Tibial Osteotomy

https://doi.org/10.1016/j.arthro.2010.05.025Get rights and content

Purpose

The aim of this study was to investigate the remodeling process after hemispherical femoral head allograft grafting in opening-wedge high tibial osteotomy with a plate and screw.

Methods

The study group included 105 knees in 92 women and 7 knees in 7 men from January 2007 through December 2007. The radiographic bone remodeling process was determined by use of a modification of the radiologic rating system described previously by van Hemert et al. in 4 groups: group A, 7-mm plate correction; group B, 9-mm plate correction; group C, 11-mm plate correction; and group D, 13-mm plate correction.

Results

The postoperative femorotibial angle and tibial slope were not significantly changed at latest follow-up in comparison to immediate postoperative status. The mean follow-up period was 25.4 months (range, 18 to 30 months). In all groups radiologic bone healing higher than phase 3 was successfully achieved between 3 and 6 months. The healing process slowed with increasing correction angle.

Conclusions

A hemispherical femoral head allograft is a good alternative osseous graft material when patients are selected appropriately with the following criteria: body mass index lower than 40, no symptomatic osteoarthritis of the patellofemoral joint and lateral compartment, no systemic inflammatory arthritis, no history of fracture or previous open surgery to the lower limb, and no flexion contracture.

Level of Evidence

Level IV, therapeutic case series.

Section snippets

Patient Selection

One hundred forty-seven consecutive cases treated with an opening-wedge HTO using an Aescula open-wedge plate (Aescula, a division of B. Braun Melsungen, Melsungen, Germany) and hemispherical femoral head allograft by the senior author or under supervision of the senior author were examined prospectively from January 2007 to December 2007. Among the 147 patients, 10 patients with a lateral cortical fracture and 25 patients with an inadequate radiologic series at follow-up were excluded. The

FTA and Tibial Slope

The FTA had a mean varus of 1.11° ± 2.92° (range, –11.04° to 5.53°) preoperatively, which was corrected significantly to a mean valgus of 9.78° ± 2.46° (range, 4.78° to 18.33°) (P < .001) immediately after surgery. A mean valgus of 9.16° ± 2.63° (range, 3.79° to 17.30°) was observed at the final follow-up. The mean tibial posterior slope was 9.49° ± 3.67° (range, 2.31° to 18.83°) preoperatively, which increased to 11.60° ± 3.44° (range, 1.63° to 21.96°) and 11.89° ± 3.51° (range, 1.81° to

Discussion

This study examined radiographic results in HTO with a hemispherical femoral head allograft. A corticocancellous hemispherical femoral head allograft was used successfully as a filling material with bone union between 3 and 6 months without nonunion or graft-related complications within the entire group. To our knowledge, this is the first study to examine the incorporation and remodeling potential of a femoral head allograft using a standardized radiographic follow-up.

Several osseous

Conclusions

A hemispherical femoral head allograft is a good alternative osseous graft material when the patients are selected appropriately with the following criteria: BMI lower than 40, no symptomatic osteoarthritis of the patellofemoral joint and lateral compartment, no systemic inflammatory arthritis, no history of fracture or previous open surgery to the lower limb, and no flexion contracture.

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    The authors report no conflict of interest.

    Note: To access the videos accompanying this report, visit the December issue of Arthroscopy at www.arthroscopyjournal.org.

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