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Randomized Controlled Trial
. 2024 Jul;144(7):3053-3061.
doi: 10.1007/s00402-024-05410-6. Epub 2024 Jul 3.

Equal rates of bone healing and reduced surgical time with iliac crest allograft compared to autograft in medial opening wedge high tibial osteotomy: a randomized controlled clinical trial

Rafael Erthal de Paula  1 , Rodrigo Sattamini Pires E Albuquerque  2 , Alan de Paula Mozella  2 , Ricardo Duran Sobral  2 , Phelippe Augusto Valente Maia  2 , Rafael Augusto Dantas Prinz  3 , Arnaldo Cézar Couto  4 , Idemar Monteiro da Palma  5 , Hugo Alexandre de Araujo Barros Cobra  2 , Eduardo Branco de Sousa  2 , Aline Cordeiro  4
Affiliations
Randomized Controlled Trial

Equal rates of bone healing and reduced surgical time with iliac crest allograft compared to autograft in medial opening wedge high tibial osteotomy: a randomized controlled clinical trial

Rafael Erthal de Paula et al. Arch Orthop Trauma Surg. 2024 Jul.

Abstract

Introduction: Iliac crest autograft is frequently used to fill in bone defects after osteotomies. Nonetheless, surgery for bone autograft procurement is associated with morbidity and pain at the donor site. Alternatives to it have been explored, but there is no consensus to guide their application as a routine practice in several orthopedic procedures. Thus, this study was designed to compare the efficacy and safety between iliac crest autograft and allograft in medial opening wedge high tibial osteotomy.

Materials and methods: Forty-seven patients with a symptomatic unilateral genu varum and an indication for high tibial osteotomy were randomly assigned to receive either autograft or allograft to fill the osteotomy site. Operative time, bone healing, and complication rates (delayed union, nonunion, superficial and deep infection, loss of correction, and hardware failure) were recorded after a one-year follow-up. Data were expressed as Mean ± Standard Deviation and considered statistically significant when p < 0.05.

Results: The time to radiologic union was similar between both groups (Allograft: 2.38 ± 0.97 months vs. Autograft: 2.45 ± 0.91 months; p = 0.79). Complication rates were also similar in both groups, with one infection in the allograft group and two in the autograft group, two delayed unions in the allograft group, and three in the autograft group. The operative time differed by 11 min between the groups, being lower in the allograft group (Allograft: 65.4 ± 15.1 min vs. Autograft: 76.3 ± 15.2 min; p = 0.02).

Conclusion: Iliac crest allografts can be safely and effectively used in medial opening wedge high tibial osteotomy as it promotes the same rates of bone union as those achieved by autologous grafts, with the benefits of a shorter operative time.

Trial registration number: U1111-1280-0637 1 December 2022, retrospectively registered.

Keywords: Allograft; Autograft; Bone healing; Genu varum; Osteotomy.

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References

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