Opening wedge high tibial osteotomies: Calcium-phosphate ceramic spacer versus autologous bonegraft - 09/09/10

Doi : 10.1016/j.otsr.2010.03.022

F. Gouin ^a,^⁎,^b , F. Yaouanc ^a, D. Waast ^a, B. Melchior ^c, J. Delecrin ^a, N. Passuti ^a,^b
^a Orthopaedic surgery and traumatology Clinic, Musculo-skeletal Department, Hôtel-Dieu Teaching Medical Center, 1, place A.-Ricordeau, 44093 Nantes cedex, France
^b Bone loss physiopathology research laboratory and primary bone tumours therapy unit, EA3822, Inserm U957, Medical School, Nantes University, Nantes, France
^c Atlantic Multispecialty Private Hospital, avenue C.-Bernard, BP 419, 44819 Saint-Herblain cedex, France

Correspondant author.

connectez-vous ou créez un compte

Bienvenue sur EM-consulte, la référence des professionnels de santé.
Article gratuit.

Connectez-vous pour en bénéficier!

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 09 September 2010
Cet article a été publié dans un numéro de la revue, cliquez ici pour y accéder

Summary

Introduction

Valgus tibial osteotomy (VTO) is a well-known procedure for the treatment of medial compartment femoro-tibial osteoarthritis. Good and very good results have been reported with calcium phosphate wedges, which avoid the inconveniences of autologous grafts use. The hypothesis of this study is that with equivalent results in the treatment of osteoarthritis of the knee, the use of calcium phosphate wedges (BMCaPh) to fill the bone defect created by osteotomy would result in fewer specific complications and less pain associated with autologous grafts (AUTO) harvesting.

Patients and methods

This prospective, controlled, randomised study included one arm that received a macroporous, biphasic calcium phosphate wedge (BMCaPh group) and one arm that received an autologous tricortical graft (AUTO group) for filling. The same plate with locked screws was used for fixation in all cases. All patients underwent at least two years of clinical and radiographic post-operative follow-up.

Results

Forty patients were included. Loss of correction occurred in six of the twenty-two patients in the BMCaPh group (27%), resulting in three early surgical revisions, compared to one loss of correction in the AUTO group. Lateral cortical hinge tears were a risk factor for loss of correction for the entire cohort and in the BMCaPh group. (relative risk 13.3 [1.9–92]. Moreover, union took significantly longer and pain lasted significantly longer in the BMCaPh group, although results were comparable at 6 months.

Discussion

A significant number of undesirable events (loss of correction) occurred in this study, limiting the number of included patients. Nevertheless, the results show that although there was no difference in the two groups for overall complications, number of revisions all causes combined, or clinical results, filling with BMCaPh was less tolerated and increased the risk of loss of correction when local mechanical conditions of the knee were unfavourable (lateral cortical hinge tears). Moreover, although it is not possible to draw a conclusion because of methodology bias in this study, early weight-bearing resumption on the knee also seemed to favour these complications.