Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2015 Dec;27(4):207-20.
doi: 10.5792/ksrr.2015.27.4.207. Epub 2015 Dec 1.

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

Jae Hwi Han  1 , Hyun Jung Kim  2 , Jae Gwang Song  1 , Jae Hyuk Yang  3 , Nikhl N Bhandare  4 , Aldrich Raymund Fernandez  5 , Hyung Jun Park  1 , Kyung Wook Nha  1
Affiliations
Review

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

Jae Hwi Han et al. Knee Surg Relat Res. 2015 Dec.

Abstract

Purpose: Bone 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 methods: PubMed, 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.

Results: Twenty-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.

Conclusions: The 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.

Keywords: Bone graft; Knee; Meta-analysis; Osteoarthritis; Osteotomy.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. Flowchart of identification of opening wedge high tibial osteotomy studies. HTO: high tibial osteotomy. Reprint from Moher et al.
Fig. 2
Fig. 2. Bone union period. No: no filling, Auto: autogenous bone graft, Allo: allogenous bone graft, Synthetic: synthetic material filling.
Fig. 3
Fig. 3. Bone union period of autogenous bone graft group and no filling group. Forest plot of mean difference and 95% confidence interval (CI) for constant scores among patients assigned to Auto group or no filling group for opening wedge high tibial osteotomy. Mean difference: 8.68 (day)=heterogeneity (I2)=0, p=0.372. a)Weights are from random effrects analysis.
See this image and copyright information in PMC

References

    1. Niemeyer P, Koestler W, Kaehny C, Kreuz PC, Brooks CJ, Strohm PC, Helwig P, Suedkamp NP. Two-year results of open-wedge high tibial osteotomy with fixation by medial plate fixator for medial compartment arthritis with varus malalignment of the knee. Arthroscopy. 2008;24:796–804. - PubMed
    1. Staubli AE, De Simoni C, Babst R, Lobenhoffer P. TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia: early results in 92 cases. Injury. 2003;34(Suppl 2):B55–B62. - PubMed
    1. Lobenhoffer P, Agneskirchner JD. Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2003;11:132–138. - PubMed
    1. Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H. The long-term outcome of high tibial osteotomy: a ten- to 20-year follow-up. J Bone Joint Surg Br. 2008;90:592–596. - PubMed
    1. Chae DJ, Shetty GM, Wang KH, Montalban AS, Jr, Kim JI, Nha KW. Early complications of medial opening wedge high tibial osteotomy using autologous tricortical iliac bone graft and T-plate fixation. Knee. 2011;18:278–284. - PubMed

LinkOut - more resources