Faster union rate and better clinical outcomes using autologous bone graft after medial opening wedge high tibial osteotomy

Jung, Woon-Hwa; Takeuchi, Ryohei; Kim, Dong‐Hyun; Nag, Ramvilas

doi:10.1007/s00167-019-05463-w

Cited by 29 publications

(20 citation statements)

References 24 publications

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“…Similar to the studies of Luites et al, [18] and Hoell et al [19] the Lysholm score increased significantly both in grafted and non-grafted groups. Jung et al [20] stated that postoperative Lysholm and IKDC scores increased statistically significantly in 137 patients in 2019. In the present study, preoperative IKDC scores were 33 and 34 and postoperative IKDC scores were 78 and 79 in grafted and non-grafted groups, respectively.…”

Section: Discussionmentioning

confidence: 99%

Is iliac autogenous graft augmentation in medial open wedge high tibial osteotomies superior to no augmentation in terms of bone healing?

et al. 2020

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Osteoarthritis (OA) is a progressive and debilitating condition. [1,2] Varus deformity of knee joint increases the risk of progression of medial compartment OA. High tibial osteotomy (HTO) is a well-established surgical technique for individuals with medial OA and varus deformity. [3] The aim is to change the load distribution across the knee from the diseased medial part to the healthy lateral part in order to reduce pain, slow the degenerative process and delay the requirements for total knee replacement. [4] Osteotomy of the proximal tibia is becoming popular as compartmental OA of the knee is increasing in younger patients with malalignment of the joint. Open wedge high tibial osteotomy (OWHTO) on the medial side has been described as an effective surgical procedure in the treatment of medial compartmental OA. [5,6] Prevention of patella alta, easy correction of the deformity and no need for fibular osteotomy are the described advantages of medial sided osteotomy. Grafting the osteotomy site for quicker healing either with biologic resources or bone substitutes Objectives: This study aims to investigate if iliac autogenous graft augmentation in medial open wedge high tibial osteotomies (OWHTOs) is superior to no augmentation in terms of bone healing. Patients and methods: Twenty-five patients (14 males, 11 females; mean age 40.9±4.0 years; range, 33 to 48 years) with medial compartmental osteoarthritis of knee joint who underwent high tibial osteotomy with medial open wedge between January 2016 and December 2018 were included in this retrospective study. Twelve of the operated knees were the right knee. Graft was used in 13 patients (52%). Data including age, gender, body mass index (BMI), direction, follow-up period, union, Lysholm and International Knee Documentation Committee (IKDC) scores, pre-and postoperative femoral tibial angles (FTAs) and posterior tibial slopes were evaluated. Results: The mean BMI was 26.4±1.9 (range, 22.0 to 30.0). Only 48% of the patients were smoking. The mean follow-up period was 28.6±5.3 months (range, 24 to 38 months). No statistically significant difference was found between the grafted and nongrafted groups in terms of age, BMI, follow-up time, gender, side and smoking status (p>0.05) There was no statistically significant difference between two groups in terms of pre-and postoperative Lysholm scores, pre-and postoperative IKDC scores, or pre-and postoperative FTA values (p>0.050). Conclusion: Iliac autogenous graft augmentation in medial OWHTO has no effect on union but shortens the union time. Preoperative high varus degree adversely affects union. Therefore, routine use of iliac crest autograft is not recommended.

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Section: Discussionmentioning

confidence: 99%

Is iliac autogenous graft augmentation in medial open wedge high tibial osteotomies superior to no augmentation in terms of bone healing?

et al. 2020

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“…The repair of critical bone defect has always been a clinical challenge ( Zhao et al, 2009 ). Autologous bone grafting is the preferred treatment option in many cases of orthopedic surgeries ( Bauer and Muschler, 2000 ; Jung et al, 2020 ). But for critical sized bone defects, the donor sites for autologous bone harvest are always insufficient, and a second operation is sometimes needed, leading to additional pain and increased complication risks ( Arrington et al, 1996 ).…”

Section: Introductionmentioning

confidence: 99%

The Development of a Magnesium-Releasing and Long-Term Mechanically Stable Calcium Phosphate Bone Cement Possessing Osteogenic and Immunomodulation Effects for Promoting Bone Fracture Regeneration

Liu

Wang

et al. 2022

Front. Bioeng. Biotechnol.

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Bone grafts are commonly used for the treatment of critical sized bone defects. Since the supply of autologous bone is insufficient, allogeneic bone grafts have been used most of the time. However, the poor osteogenic property of allogeneic bone grafts after pretreatment results in delayed union, non-union, or even occasional deformity. Calcium phosphate cement (CPC) is one of the most promising bone filling materials due to its good biocompatibility and similar chemical components as natural bone. However, clinical applications of CPC were hampered by limited osteogenic effects, undesired immune response which results in resorption, and poor mechanical stability in vivo. Magnesium (Mg) has been proven to trigger bone regeneration through modulating cell behaviors of mesenchymal stem cells and macrophages significantly. Unfortunately, the degradation raters of pure Mg and Mg oxide are extremely fast, resulting in early collapse of Mg contained CPC. In this study, we developed a novel magnesium contained calcium phosphate bone cement (Mg-CPC), possessing long-term mechanical stability and osteogenic effects through sustained release of Mg. Furthermore, in vitro studies showed that Mg-CPC had no cytotoxic effects on hBMMSCs and macrophage RAW 264.7, and could enhance the osteogenic differentiation as determined by alkaline phosphate (ALP) activity and calcium nodule staining, as well as suppress the inflammatory as determined by expression of anti-inflammatory cytokine IL-1RA. We also found that Mg-CPC promoted new bone formation and bone maturation in vivo. These results suggest that Mg-CPC should be a good substitute material for bone grafts in clinical use.

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“…UKA not only cannot preserve the original structure of the knee compartment, but also needs to consider that the prosthesis may require revision and restricts joint movement after surgery. 21 , 22 Although the postoperative recovery process is still longer than UKA and arthroscopic knee debridement. Patients with severe OA in the later stage of disease require total knee arthroplasty (TKA) to relieve symptoms and ensure quality of life.…”

Section: Discussionmentioning

confidence: 99%

Research on the Influence of the Allogeneic Bone Graft in Postoperative Recovery After MOWHTO: A Retrospective Study

Zhong¹,

Yu²,

Wang³

et al. 2023

TCRM

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Purpose To compare the effects of an allogeneic bone graft and a non-filled bone graft on the rate of osteotomy gap union in medial opening wedge high tibial osteotomy (MOWHTO) with an opening width less than 10 mm. Methods A total of 65 patients undergoing MOWHTO between January 2018 and December 2020 were enrolled in this retrospective study. The patients were divided into two groups: the allograft group (MOWHTO with allogeneic bone grafting, 30 patients) and the non-filling group (MOWHTO without bone void fillers, 35 patients). The clinical outcomes, including the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC), Lysholm score, and post-operative complications, were compared. The radiographic evaluation included changes in hip–knee–ankle angle (HKA), medial proximal tibial angle (MPTA), femorotibial angle (FTA), and weight-bearing line ratio (WBLR) at pre-operation, at two-day post-operation, and the last follow-up. Radiographs were obtained at three, six and twelve months post-surgery, and at the time of the last follow-up to assess the fill area of the osteotomy gap. The union rate of the osteotomy gap was calculated and compared, and risk factors that may affect the rate of osteotomy gap union were also discussed. Results The rate of osteotomy gap union at 3 and 6 months after the operation in the allograft group was significantly higher compared with the non-filling group (all P<0.05), while no significant difference was found after the 1-year post-operative and at the last follow-up. Also, the WOMAC and Lysholm scores of the allograft group were significantly higher than those of the non-filling group (all P<0.05), and there was no significant difference between the two groups at the last follow-up. Conclusion Filling the gaps with the allograft bones may accelerate the union of osteotomy gap, improve clinical outcomes, and have important implications for patient rehabilitation in the early post-operative course. Bone grafting did not affect the final rate of osteotomy gap union and the clinical score of patients.

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Faster union rate and better clinical outcomes using autologous bone graft after medial opening wedge high tibial osteotomy

Cited by 29 publications

References 24 publications

Is iliac autogenous graft augmentation in medial open wedge high tibial osteotomies superior to no augmentation in terms of bone healing?

Is iliac autogenous graft augmentation in medial open wedge high tibial osteotomies superior to no augmentation in terms of bone healing?

The Development of a Magnesium-Releasing and Long-Term Mechanically Stable Calcium Phosphate Bone Cement Possessing Osteogenic and Immunomodulation Effects for Promoting Bone Fracture Regeneration

Research on the Influence of the Allogeneic Bone Graft in Postoperative Recovery After MOWHTO: A Retrospective Study

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