Note: To access the videos accompanying this report, visit the December issue of Arthroscopy at www.arthroscopyjournal.org.
Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original Article With Video IllustrationRadiographic Healing With Hemispherical Allogeneic Femoral Head Bone Grafting for Opening-Wedge High Tibial Osteotomy
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.
References (26)
Upper tibial osteotomy for gonarthrosisThe evolution of the operation in the last 18 years and long-term results
Orthop Clin North Am
(1979)- et al.
The use of allografts in high tibial osteotomy: Opening wedge technique
Oper Tech Sports Med
(2007) - et al.
Open wedge tibial osteotomy with acrylic bone cement as bone substitute
Knee
(2001) - et al.
Biplanar medial open-wedge high-tibial osteotomy for medial compartment osteoarthritis of the knee: A novel technique and follow-up
Oper Tech Orthop
(2007) - et al.
Tricalcium phosphate granules or rigid wedge preforms in open wedge high tibial osteotomy: A radiological study with a new evaluation system
Knee
(2004) - et al.
Open-wedge high-tibial osteotomy with rigid plate fixation
Tech Knee Surg
(2002) - et al.
Improvements in surgical technique of valgus high-tibial osteotomy
Knee Surg Sports Traumatol Arthrosc
(2003) Valgus osteotomy for osteoarthritis of the knee
Clin Orthop Relat Res
(1976)- et al.
Union of medial opening-wedge high tibial osteotomy using a corticocancellous proximal tibial wedge allograft
Am J Sports Med
(2008) - et al.
The effect of lateral cortex disruption and repair on the stability of the medial opening wedge high tibial osteotomy
Am J Sports Med
(2005)
Opening wedge high tibial osteotomy: An operative technique and rehabilitation program to decrease complications and promote early union and function
Am J Sports Med
Delayed- and non-union following opening wedge high tibial osteotomy: Surgeons' results from 182 completed cases
Knee Surg Sports Traumatol Arthrosc
Acute and long-term benefits of iliac crest donor site perfusion with local anesthetics
Anesth Analg
Cited by (18)
Lateral hinge fracture delays healing of the osteotomy gap in opening wedge high tibial osteotomy with a beta-tricalcium phosphate block
2020, KneeCitation Excerpt :A porous beta-tricalcium phosphate (β-TCP) is widely used as a bone graft material due to good biocompatibility, absorbability, and osteoconductivity [10,11]. As a disadvantage, the β-TCP shows less rapid progression of the bone remodeling process than osseous graft materials [12,13]. Some studies showed that the autograft was superior to the synthetic graft in terms of bone union [5,6], but others showed a similar tendency for radiological union and correction maintenance regardless of the type of bone [4].
Opening-wedge high tibial osteotomy with a secure bone allograft (Osteopure™) and locked plate fixation: Retrospective clinical and radiological evaluation of 69 knees after 7.5 years follow-up
2015, Orthopaedics and Traumatology: Surgery and ResearchCitation Excerpt :The evaluation of GESTO criteria in this case-series confirmed these advantages: the healing and resorption rates were similar to those seen with autografts, with no allograft-related morbidity or specific complications (in particular, no infections). These findings are in accordance with earlier reports [42–44,47–50]. Finally, the use of this high-safety bone allograft ensures the availability of a good bone stock in the event of subsequent revision surgery for TKA.
Opening-wedge high tibial osteotomy with a secure bone allograft (Osteopure<sup>tm</sup>) and locked plate fixation: Retrospective clinical and radiological evaluation of 69 knees after 7.5 years follow-up
2015, Revue de Chirurgie Orthopedique et TraumatologiqueBone grafts and bone substitutes for opening-wedge osteotomies of the knee: A systematic review
2015, Arthroscopy - Journal of Arthroscopic and Related SurgeryCitation Excerpt :However, 32 articles did not specify whether a void filler was used or, if specified, did not give sufficient detail to allow appropriate data extraction. Thus 56 studies met the inclusion criteria with sufficient detail to allow adequate data extraction (Fig 1).7-62 Of the 56 included studies, 30 were prospective and 26 were retrospective.
Tibial condylar valgus osteotomy combined with arthroscopic debridement in the treatment of varus knee:A case report
2022, Fudan University Journal of Medical Sciences
The authors report no conflict of interest.