Biointegrative Fixation for Tibial Tubercle Osteotomy Is Effective and May Lower Removal Rate

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Medical Device Technology

Background:

• Tibial tubercle osteotomy (TTO) is a common orthopedic procedure.
• Traditional fixation methods using metal screws can lead to complications and require hardware removal.
• There is a need for alternative fixation materials with improved biocompatibility and reduced complications.

Purpose of the Study:

• To evaluate the safety and efficacy of novel biointegrative fiber-reinforced implants for TTO.
• To compare outcomes between biointegrative and traditional metal screw fixation.
• To conduct a cost-benefit analysis of biointegrative implants in TTO.

Main Methods:

• Retrospective review of patients undergoing TTO between May 2017 and July 2024.
• Comparison of fixation using 4.5-mm metal screws versus 4.0-mm biointegrative headless compression screws (mineral fibers bound by PLDLA).
• Longitudinal follow-up for osseous union, recurrent instability, and need for revision surgery.

Main Results:

• Sixty-two TTOs analyzed (44 metal, 18 biointegrative); median age 23.3 years.
• No significant difference in time to clinical union between fixation types (P = .159).
• Significantly lower hardware removal rates in the biointegrative group (0% vs 29.5%, P = .009); infection rates were comparable.

Conclusions:

• Biointegrative screws demonstrate safety and efficacy as an alternative to metal screws for TTO in short-term follow-up.
• This fixation method may decrease the incidence of secondary hardware removal.
• While potentially effective, the higher initial cost of biointegrative implants requires consideration in health system cost-benefit analyses.