Opening-wedge high tibial osteotomy with and without bone graft

Area of Science:

• Orthopedic Surgery
• Biomechanics
• Bone Healing

Background:

• Medial opening-wedge high tibial osteotomy (MOWHTO) is a popular surgical technique.
• Traditionally, autologous iliac bone grafts are used to fill the tibial gap in MOWHTO to prevent complications.
• No prior studies have directly compared outcomes of grafted versus nongrafted MOWHTO.

Purpose of the Study:

• To investigate whether autologous bone grafting is necessary for MOWHTO with a gap size less than 12.5 mm.
• To compare the rates of complications, specifically correction loss and delayed bone union, between grafted and nongrafted MOWHTO.
• To determine if bone grafting influences the time to clinical bone union in MOWHTO.

Main Methods:

• A prospective randomized clinical trial involving 46 patients undergoing MOWHTO.
• Patients were randomly assigned to either a grafted group (Group A) or a nongrafted group (Group B).
• All osteotomies were fixed with a Puddu plate and screws; blinded investigators performed regular clinical and radiographic evaluations.

Main Results:

• No statistically significant difference in the mean time to clinical bone union between Group A (12.4 weeks) and Group B (13.7 weeks).
• Correction loss occurred in 4.35% of patients in the grafted group and 8.70% in the nongrafted group, with no significant difference.
• All osteotomies in both groups achieved bone union.

Conclusions:

• Autologous bone grafting is not statistically necessary for medial opening-wedge high tibial osteotomy when the gap is less than 12.5 mm.
• The use of bone graft does not significantly impact the time to bone union or the rate of correction loss in MOWHTO.
• These findings suggest a potential to simplify the MOWHTO procedure by omitting bone grafting in specific cases.