No difference in union and recurrence rate between iliac crest autograft versus allograft following medial opening wedge high tibial osteotomy: a randomized controlled trial

Abstract

Purpose Using iliac crest autograft has been considered as gold standard for gap illing in medial opening wedge high tibial osteotomy (MOW-HTO) but is associated with donor site morbidity and pain. The purpose of this study was to compare the results of the use of iliac crest autograft versus allograft from the same anatomic site in terms of union and recurrence. Methods Forty-six patients with genovarum with or without medial compartment osteoarthritis were enrolled based on speciic inclusion and exclusion criteria and were randomly assigned into two groups. MOW-HTO was done using iliac crest allograft (23 patients) or autograft (23 patients) as void iller. Follow-up visits were done monthly for the irst 3 months and then every 3 months until 1 year and then at 5th and 8th postoperative year. The clinical assessment of union, anatomical indices of proximal tibia, complications and WOMAC score were assessed for both groups. ResultsThe amount of correction (degrees), recurrence, complication rates, time to get symptom-free, radiologic union and knee scores was similar in both groups. The symptom-free time was 6.1 (SD = 0.9) weeks in autograft group versus 6.2 (SD = 0.8) weeks in allograft group (p = 0.73, 95% CI -0.4 to 0.6). The time to radiologic union had a between-group diference of 0.3 weeks (p = 0.58, 95% CI -1.6 to 0.9). There was one case of surgical site infection in graft harvest site. No nonunion or delayed union was encountered in either group. Fifty-two percent of the autograft patients reported more intense postoperative pain in iliac graft harvest site than tibial osteotomy site. Conclusions According to our results, iliac crest allograft can be safely used in MOW-HTO with comparable eicacy and safety to iliac crest autograft. Clinical trial registry The clinical trial was approved by clinicaltrial.gov with identiier NCT00595712.

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

“…Synthetic bone and allogeneic bone block have been associated with fewer donor complications. 2 , 14 , 27 However, the synthetic bone may retard healing due to the inconsistent absorption rates of different raw materials. Although allogeneic bone has potential risks of immune response and disease transmission, it is still widely used in OWHTO due to its excellent osteoconductivity and resorption rate.…”

“…Therapeutics and Clinical Risk Management 2023:19 202 derived from the anterior superior iliac spine is currently considered the "gold standard" for filling grafts due to its osteoconduction, osteoinduction, and osteogenesis-inducing properties. 17,27 However, a series of donor complications and prolonged duration of surgery caused by the collection of materials also brings additional concerns. Synthetic bone and allogeneic bone block have been associated with fewer donor complications.…”

Iliac Crest Allograft with Plate Osteosynthesis for a Bone-Patellar Tendon-Bone Anterior Cruciate Ligament Donor-Site Fracture

“…26 These procedures have demonstrated favorable outcomes with union rates comparable with those of autografts. [26][27][28][29][30][31] Furthermore, the use of allograft avoids donor site morbidity altogether from the iliac crest, yet still provides the osteoconductive properties associated with improved union rates, patient outcomes, and recovery 16 . Autograft obtained from the iliac crest often causes early postoperative donor-site pain, which has been associated with a delay in ambulation, longer hospital stays, later return to work and recreation, and overall larger healthcare costs 17,32 .…”

“…26 These procedures have demonstrated favorable outcomes with union rates comparable with those of autografts. 26-31…”

Bone Healing and Clinical Outcome Following Medial Opening‐wedge High Tibial Osteotomy Using Wedge‐Shaped Cancellous Allograft

“…Recently, bone allograft has become the most widely used material and good results in terms of bone healing as well as fast rehabilitation were shown by some studies 33–35 . Several types of allogeneic bone graft material can be used, such as tricortical iliac crest allograft, allogenous bone chip or a structural allograft processed from allogenic femoral head intraoperatively 33,35–37 . At the same time, a wedge allograft has also been successfully used in high tibial osteotomy (HTO), and its wedge‐shaped structure fitting into the osteotomy gap is considered to have adequate stabilization and osteoconductive potential.…”