Is Bone Grafting Necessary in Opening Wedge High Tibial Osteotomy? A Meta-Analysis of Radiological Outcomes

Abstract

PurposeBone grafting in opening wedge high tibial osteotomy (OWHTO) is still controversial. The purpose of this study is to compare the radiological outcomes of OWHTO with bone graft (autogenous, allogenous, and synthetic bone graft) and those without bone graft.Materials and MethodsPubMed, MEDLINE, EMBASE and Cochrane Register of Studies databases were searched using specific inclusion and exclusion criteria for radiological studies involving OWHTO with bone graft and without bone graft groups. All reported delayed union, nonunion and correction loss were analyzed. Data were searched from the time period of January 2000 through July 2014. In addition, a modified Coleman methodology score (CMS) system was used to assess the methodological quality of the included studies.ResultsTwenty-five studies with a mean CMS value of 77 (range, 61 to 85 score) were included. In total, 1,841 patients underwent OWHTO using 4 different procedures for bone graft: autobone graft (n=352), allobone graft (n=547), synthetic bone graft (n=541) and no bone graft (n=401). There was a similar tendency for delayed union, nonunion and correction loss rate among the osteotomy space filling methods.ConclusionsThe meta-analysis showed there was a similar tendency for radiological union and correction maintenance among patients undergoing OWHTO regardless of the type of bone in all of the studies. However, the currently available evidence is not sufficient to strongly support the superiority of OWHTO with bone graft to OWHTO without bone graft.

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

“…A recent systematic review with a meta-analysis that included 25 studies corroborates this finding. 18 However, the authors warn about the fact that only one of these studies 6 has a grade 1 level of evidence. All the other 24 are case series or non-controlled comparative studies.…”

Editorial Commentary: Go Autologous or Go Home: Open-Wedge High Tibial Osteotomies Do Not Benefit From Synthetic Bone Grafting

“…The work by Nha et al 16 seems to support previous studies. [9][10][11] Nonetheless, based on the current published evidence, we can possibly conclude that bone grafting, whether with autologous or synthetic bone graft, is not needed for open-wedge HTOs with gaps <10 to 12 mm. Finally, this topic offers itself for a high-quality randomized prospective multicenter study.…”

“…Interestingly, autologous bone grafting for gaps <12 mm does not appear to make any differences in union and outcome. 8,9 Synthetic bone fillers are readily available and easy to use, provide osteoconduction, and can theoretically replace autologous boneda tempting proposition. In a systematic review, however, Lash et al 10 demonstrated significantly higher delayed union rates for synthetic bone grafts (4.5%) compared with autograft (2.6%).…”

Implant Alternatives for Tibial Osteotomies

“…Two recent systematic analyses compared historically reported groups of patients with autograft, allograft, synthetic material, and no bone graft, demonstrating comparable rates of nonunion or delayed union. 27,28 One recommendation was that in corrections <10 mm and with the use of locking-plate technology, bone graft may not be necessary. 28 However, the primary limitation with locking plates tends to be implant-related discomfort, which has been reported in a large proportion of patients, approaching approximately 40% in some series.…”