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J Knee Surg 2016; 29(08): 664-672
DOI: 10.1055/s-0036-1571802
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Open-Wedge High Tibial Osteotomy: RCT 2 Years RSA Follow-Up

Thomas Bruno Lind-Hansen
1   Clinical Institute, Aalborg University, Aalborg, Denmark
2   Department of Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
,
Martin Carøe Lind
3   Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
,
Poul Torben Nielsen
1   Clinical Institute, Aalborg University, Aalborg, Denmark
2   Department of Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
,
Mogens Berg Laursen
1   Clinical Institute, Aalborg University, Aalborg, Denmark
2   Department of Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
› Author Affiliations
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Publication History

24 May 2015

16 December 2015

Publication Date:
08 February 2016 (online)

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Abstract

We investigated the influence of three different bone grafting materials on stability and clinical outcome of the healing open-wedge high tibial osteotomy (OW-HTO) with immediate partial weight bearing. A total of 45 (3 × 15) patients were randomized to injectable calcium phosphate cement (Calcibon; Biomet-Merck Biomaterials GmbH, Darmstadt, Germany), local bone autograft, or iliac crest autograft. Stability of the bony healing was evaluated with radiostereometric analysis (RSA) up to 24 months postoperatively. Clinical outcome was evaluated with the knee injury and osteoarthritis outcome score (KOOS). RSA revealed translations and rotations close to zero regardless of bone grafting material, with no statistically significant differences between the groups. Clinically, the Calcibon group had lower quality of life KOOS subscore at 2 years follow-up. We conclude that with a stable implant and 6 weeks of partial weight bearing, local autografting is sufficient to achieve solid bone consolidation following OW-HTO.

Keywords

HTO - bone graft materials - RSA - OA
 

  • References

  • 1 Lobenhoffer P, Agneskirchner JD. Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2003; 11 (3) 132-138
    CrossrefPubMedSearch in Google Scholar
  • 2 Hernigou P, Medevielle D, Debeyre J, Goutallier D. Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study. J Bone Joint Surg Am 1987; 69 (3) 332-354
    CrossrefPubMedSearch in Google Scholar
  • 3 Devgan A, Marya KM, Kundu ZS, Sangwan SS, Siwach RC. Medial opening wedge high tibial osteotomy for osteoarthritis of knee: long-term results in 50 knees. Med J Malaysia 2003; 58 (1) 62-68
    PubMedSearch in Google Scholar
  • 4 Khairoun I, Boltong MG, Driessens FC, Planell JA. Effect of calcium carbonate on clinical compliance of apatitic calcium phosphate bone cement. J Biomed Mater Res 1997; 38 (4) 356-360
    CrossrefPubMedSearch in Google Scholar
  • 5 Koshino T, Murase T, Takagi T, Saito T. New bone formation around porous hydroxyapatite wedge implanted in opening wedge high tibial osteotomy in patients with osteoarthritis. Biomaterials 2001; 22 (12) 1579-1582
    CrossrefPubMedSearch in Google Scholar
  • 6 Hernigou P, Ma W. Open wedge tibial osteotomy with acrylic bone cement as bone substitute. Knee 2001; 8 (2) 103-110
    CrossrefPubMedSearch in Google Scholar
  • 7 Gaasbeek RDA, Toonen HG, van Heerwaarden RJ, Buma P. Mechanism of bone incorporation of beta-TCP bone substitute in open wedge tibial osteotomy in patients. Biomaterials 2005; 26 (33) 6713-6719
    CrossrefPubMedSearch in Google Scholar
  • 8 Staubli AE, De Simoni C, Babst R, Lobenhoffer P. TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia—early results in 92 cases. Injury 2003; 34 (Suppl. 02) B55-B62
    CrossrefPubMedSearch in Google Scholar
  • 9 Dallari D, Savarino L, Stagni C , et al. Enhanced tibial osteotomy healing with use of bone grafts supplemented with platelet gel or platelet gel and bone marrow stromal cells. J Bone Joint Surg Am 2007; 89 (11) 2413-2420
    CrossrefPubMedSearch in Google Scholar
  • 10 Stoffel K, Stachowiak G, Kuster M. Open wedge high tibial osteotomy: biomechanical investigation of the modified Arthrex Osteotomy Plate (Puddu Plate) and the TomoFix Plate. Clin Biomech (Bristol, Avon) 2004; 19 (9) 944-950
    CrossrefPubMedSearch in Google Scholar
  • 11 Dorsey WOP, Miller BS, Tadje JP, Bryant CR. The stability of three commercially available implants used in medial opening wedge high tibial osteotomy. J Knee Surg 2006; 19 (2) 95-98
    Thieme ConnectPubMedSearch in Google Scholar
  • 12 Frankenburg EP, Goldstein SA, Bauer TW, Harris SA, Poser RD. Biomechanical and histological evaluation of a calcium phosphate cement. J Bone Joint Surg Am 1998; 80 (8) 1112-1124
    CrossrefPubMedSearch in Google Scholar
  • 13 Ooms EM, Wolke JGC, van de Heuvel MT, Jeschke B, Jansen JA. Histological evaluation of the bone response to calcium phosphate cement implanted in cortical bone. Biomaterials 2003; 24 (6) 989-1000
    CrossrefPubMedSearch in Google Scholar
  • 14 Ooms EM, Wolke JGC, van der Waerden JPCM, Jansen JA. Trabecular bone response to injectable calcium phosphate (Ca-P) cement. J Biomed Mater Res 2002; 61 (1) 9-18
    CrossrefPubMedSearch in Google Scholar
  • 15 Lobenhoffer P, Gerich T, Witte F, Tscherne H. Use of an injectable calcium phosphate bone cement in the treatment of tibial plateau fractures: a prospective study of twenty-six cases with twenty-month mean follow-up. J Orthop Trauma 2002; 16 (3) 143-149
    CrossrefPubMedSearch in Google Scholar
  • 16 Lind-Hansen T, Nielsen PT, Petruskevicius J , et al. Calcium phosphate cement enhances primary stability of open-wedge high-tibial osteotomies. Knee Surg Sports Traumatol Arthrosc 2009; 17 (12) 1425-1432
    CrossrefPubMedSearch in Google Scholar
  • 17 Selvik G. Roentgen stereophotogrammetry. A method for the study of the kinematics of the skeletal system. Acta Orthop Scand Suppl 1989; 232: 1-51
    PubMedSearch in Google Scholar
  • 18 Gaasbeek RDA, Welsing RTC, Verdonschot N, Rijnberg WJ, van Loon CJM, van Kampen A. Accuracy and initial stability of open- and closed-wedge high tibial osteotomy: a cadaveric RSA study. Knee Surg Sports Traumatol Arthrosc 2005; 13 (8) 689-694
    CrossrefPubMedSearch in Google Scholar
  • 19 Tjörnstrand B, Selvik G, Egund N, Lindstrand A. Roentgen stereophotogrammetry in high tibial osteotomy for gonarthrosis. Arch Orthop Trauma Surg 1981; 99 (2) 73-81
    CrossrefPubMedSearch in Google Scholar
  • 20 Magyar G, Toksvig-Larsen S, Lindstrand A. Changes in osseous correction after proximal tibial osteotomy: radiostereometry of closed- and open-wedge osteotomy in 33 patients. Acta Orthop Scand 1999; 70 (5) 473-477
    CrossrefPubMedSearch in Google Scholar
  • 21 Söderkvist I, Wedin PA. Determining the movements of the skeleton using well-configured markers. J Biomech 1993; 26 (12) 1473-1477
    CrossrefPubMedSearch in Google Scholar
  • 22 Valstar ER, Gill R, Ryd L, Flivik G, Börlin N, Kärrholm J. Guidelines for standardization of radiostereometry (RSA) of implants. Acta Orthop 2005; 76 (4) 563-572
    CrossrefPubMedSearch in Google Scholar
  • 23 Ryd L. Micromotion in knee arthroplasty. A roentgen stereophotogrammetric analysis of tibial component fixation. Acta Orthop Scand Suppl 1986; 220: 1-80
    PubMedSearch in Google Scholar
  • 24 Moreland JR, Bassett LW, Hanker GJ. Radiographic analysis of the axial alignment of the lower extremity. J Bone Joint Surg Am 1987; 69 (5) 745-749
    PubMedSearch in Google Scholar
  • 25 Ahlbäck S. Osteoarthrosis of the knee. A radiographic investigation. Acta Radiol Diagn (Stockh) 1968; 277 , 7–72
    PubMedSearch in Google Scholar
  • 26 Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee injury and osteoarthritis outcome score (KOOS)—development of a self-administered outcome measure. J Orthop Sports Phys Ther 1998; 28 (2) 88-96
    CrossrefPubMedSearch in Google Scholar
  • 27 Roos EM, Roos HP, Ekdahl C, Lohmander LS. Knee injury and osteoarthritis outcome score (KOOS)—validation of a Swedish version. Scand J Med Sci Sports 1998; 8 (6) 439-448
    CrossrefPubMedSearch in Google Scholar
  • 28 Roos EM, Roos HP, Lohmander LS. WOMAC osteoarthritis index—additional dimensions for use in subjects with post-traumatic osteoarthritis of the knee. Western Ontario and MacMaster Universities. Osteoarthritis Cartilage 1999; 7 (2) 216-221
    CrossrefPubMedSearch in Google Scholar
  • 29 Roos EM, Toksvig-Larsen S. Knee injury and osteoarthritis outcome score (KOOS) - validation and comparison to the WOMAC in total knee replacement. Health Qual Life Outcomes 2003; 1: 17
    CrossrefPubMedSearch in Google Scholar
  • 30 W-Dahl A, Toksvig-Larsen S, Roos EM. A 2-year prospective study of patient-relevant outcomes in patients operated on for knee osteoarthritis with tibial osteotomy. BMC Musculoskelet Disord 2005; 6: 18
    CrossrefPubMedSearch in Google Scholar
  • 31 Roos EM, Lohmander LS. The knee injury and osteoarthritis outcome score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes 2003; 1: 64
    CrossrefPubMedSearch in Google Scholar
  • 32 Kamme C, Lindberg L. Aerobic and anaerobic bacteria in deep infections after total hip arthroplasty: differential diagnosis between infectious and non-infectious loosening. Clin Orthop Relat Res 1981; (154) 201-207
    PubMedSearch in Google Scholar
  • 33 Koshino T, Murase T, Saito T. Medial opening-wedge high tibial osteotomy with use of porous hydroxyapatite to treat medial compartment osteoarthritis of the knee. J Bone Joint Surg Am 2003; 85-A (1) 78-85
    PubMedSearch in Google Scholar