Comparison of Puddu osteotomy with or without autologous bone grafting: a prospective clinical trial

Abstract

ObjectivesTo test the hypothesis that autologous iliac bone grafts do not enhance clinical results and do not decrease complication rates in patients undergoing medial opening-wedge high tibial osteotomy.MethodsForty patients allocated in a randomized, two-armed, double-blinded clinical trial were evaluated between 2007 and 2010. One group received bone graft, and the other group was left without filling the osteotomy defect. The primary outcome was the Knee Society Score. Radiographic measurement of the frontal anatomical femoral-tibial angle and the progression of osteoarthritis according to the modified Ahlback classification were used as secondary outcomes.ResultsThere was no difference in KSS scale between the graft group (64.4 ± 21.8) and the graftless group (61.6 ± 17.3; p = 0.309). There was no difference of angle between the femur and tibia in the frontal plane between the groups (graft = 184 ± 4.6 degrees, graftless = 183.4 ± 5.1 degrees; p = 1.0), indicating that there is no loss of correction due to the lack of the graft. There was significant aggravation of osteoarthritis in a greater number of patients in a graft group (p = 0.005).ConclusionAutologous iliac bone graft does not improve clinical outcomes in medium and long-term follow-up of medial opening-wedge high tibial osteotomy fixed with a first generation Puddu plate in the conditions of this study.

Opening-Wedge High Tibial Osteotomy Using Autograft versus Allograft: A Systematic Review and Meta-analysis

“…20 The majority of loss of correction occurred in the first year, without any correlation between the degrees of loss of correction and subject characteristics. In Passarelli et al's study 22 both the BG and NF groups demonstrated a progressive loss of correction following 6 months of surgery and a follow-up of >4 years, but the loss was equal in both groups. In accordance with our pooled results, no loss of correction was observed due to the lack of graft.…”

“…Elsayed et al and Passarelli et al 21,22 reported a significant increase in the KSS in both the BG and NF group compared with the preoperative score; however, no significant difference was observed in the BG or NF group, which suggests that bone grafting does not affect the postoperative function of the knee joint following OWHTO. In addition, Zorzi et al's study 18 showed no statistically significant difference in the meantime to clinical bone union between the BG ( 15,16 also showed no difference in time to clinical or radiologic union between the groups.…”

“…Among the RCTs, the study by Zorzi et al 18 described random grouping by software, and both patients and clinical investigators were blinded, and was determined to be a study of moderate quality. Passarelli et al's study 22 was randomly assigned, double-blinded divided, and the allocation was kept secret with a sealed envelope; this was considered a high-quality study. Ramin et al's study 16 described random grouping, but the blinding and allocation concealment were not mentioned, which we interpreted to be a low-quality study.…”

“…We assessed 10 studies [13][14][15][16][17][18][19][20][21][22] including three RCTs, four retrospective studies, and three comparative cohort studies in this article. The included studies were conducted in eight countries (Brazil, Thailand, Egypt, USA, Korea, China, Iran, and Canada) from 2010 to 2018 and involved 583 patients (146 patients treated using BG, 149 using NF, 131 using AU, and 157 using AL) aged 41.87 to 63.4 years.…”

“…Comparison of KSS function assessment between BG and NF was conducted among using the two included studies, 21,22 which included 132 patients (67 patients receiving BG and 65 patients receiving NF) shown in ►Fig. 3.…”