Analysis and quantification of bone healing after open wedge high tibial osteotomy

Abstract

SummaryBackgroundThe aim of this study was to analyze radiographic imaging techniques and to quantify bone ossification in the osteotomy gap after high tibial osteotomy.Material and methodsStudy phase 1: high tibial osteotomy was performed on six lower extremities of human body donors and experimental X‑rays and computed tomography (CT) scans were applied. Different techniques were evaluated by three specialists for best representation of the osteotomy gap.Study phase 2: optimized radiological techniques were used for follow-up on 12 patients. The radiographs were examined by 3 specialists measuring 10 different parameters. The CT scans were analyzed with semiautomatic computer software for quantification of bone ossification.ResultsThe osteotomy gap was best represented in 30° of flexion in the knee and 20° internal rotation of the leg. There were significant changes of the medial width over time (p < 0.019) as well as of the length of fused osteotomy, the Schröter score, sclerosis, trabecular structure and zone area measurements. Sclerosis, medial width of the osteotomy and area measurements were detected as reproducible parameters. Bone mineral density was calculated using CT scans, showing a significantly higher value 12 weeks postoperatively (112.5 mg/cm3) than at baseline (54.6 mg/cm3). The ossification of the gap was visualized by color coding.ConclusionSclerosis and medial width of the osteotomy gap as well as area measurements were determined as reproducible parameters for evaluation of bone healing. Quantification of bone ossification can be calculated with CT scans using a semiautomatic computer program and should be used for research in bone healing.

Recombinant Human BMP6 Applied Within Autologous Blood Coagulum Accelerates Bone Healing: Randomized Controlled Trial in High Tibial Osteotomy Patients

“…(21) The sample of 20 patients (ABGS/PBO randomized in 1:1 ratio) was selected to provide 80% power to detect an average difference between ABGS and PBO of around 30% in defect healing. The bonehealing acceleration effect was estimated using X-ray analyses according to the established radiological scoring system, (16,22) and the bone mineral density (BMD), which reflected the bone formation in the defect area, was measured by CT scans using ITK-SNAP program. (16,23) This clinical model allows estimation of new bone formation within a bone defect protected by a locking plate to eliminate possible influence of mechanical stimuli.…”

“…The bonehealing acceleration effect was estimated using X-ray analyses according to the established radiological scoring system, (16,22) and the bone mineral density (BMD), which reflected the bone formation in the defect area, was measured by CT scans using ITK-SNAP program. (16,23) This clinical model allows estimation of new bone formation within a bone defect protected by a locking plate to eliminate possible influence of mechanical stimuli. As healing was expected in all cases, no end points of mechanical failure have been determined.…”

“…HTO is a surgical procedure performed to correct varus malalignment of the lower limb in order to delay the progression of medial osteoarthritis of the knee. (12)(13)(14)(15)(16) HTO involves creating a wedge defect mainly in the proximal metaphyseal region of the tibia for which iliac crest autograft is used to accelerate bone healing and regeneration, (17) but it is not preferred. (18) This study was a randomized, double-blind, placebo-controlled phase I/II trial.…”

Musculoskeletal medicine: an Austrian perspective part II

“…In their study Nemecek et al aimed to analyze radiographic imaging techniques and to quantify bone ossification in the osteotomy gap after high tibial osteotomy [2,6]. The authors were able to determine sclerosis and medial width of the osteotomy gap as well as area measurements as reproducible parameters for evaluation of bone healing and to show that quantification of bone ossification can be calculated with computed tomography (CT) scans using a semiautomatic computer program.…”

“…The authors were able to determine sclerosis and medial width of the osteotomy gap as well as area measurements as reproducible parameters for evaluation of bone healing and to show that quantification of bone ossification can be calculated with computed tomography (CT) scans using a semiautomatic computer program. They therefore recommend these methods for diagnosis and research in bone healing [2,6].…”