fulltext.study @t Gmail

Do we need synthetic osteotomy augmentation materials for opening-wedge high tibial osteotomy ☆

Paper ID Volume ID Publish Year Pages File Format Full-Text
9315 626 2008 6 PDF Available
Title
Do we need synthetic osteotomy augmentation materials for opening-wedge high tibial osteotomy ☆
Abstract

High tibial osteotomy (HTO) is an increasing popular method to treat unicompartimental osteoarthritis of the knee in younger, active patients. In so doing one tries to delay the need for total or unicompartimental joint replacement. The augmentation of HTO opening gaps with supporting material is discussed controversially, especially after the introduction of locking plates, which contribute to the decline of the non-union rate. Currently, we do not recommend synthetic augmentation, when using locking plates in HTO with opening angles less than 10°. In our recent randomized study we could histologically and radiologically demonstrate the complete rebuilding of lamelliform bone in patients without synthetic augmentation, whilst bony ingrowth into the hydroxyapatite/tricalcium phosphate (HA/TCP) wedge of augmented osteotomies just slowly progressed. In contrast to unaugmented osteotomies, there was no advantage in using HA/TCP wedges or the combination of HA/TCP wedges and platelet rich plasma (PRP) as supporting material after 12 months. In osteotomies where an opening angle bigger than 7.5° is chosen, rigid locking plates should be used. In our opinion, autologous iliac crest graft should be used in the high-risk patients (obese, smoker, opening angle bigger than 10°). Whether synthetic augmentation combined with PRP is equal or even superior to autologous iliac crest graft in openings bigger than 10° has not been proven yet.

Keywords
Osteoarthritis of the knee; High tibial osteotomy; Open wedge osteotomy; Supporting material; Hydroxyapatite; Synthetic augment
First Page Preview
Do we need synthetic osteotomy augmentation materials for opening-wedge high tibial osteotomy ☆
Publisher
Database: Elsevier - ScienceDirect
Journal: Biomaterials - Volume 29, Issue 26, September 2008, Pages 3497–3502
Authors
, , , ,
Subjects
Physical Sciences and Engineering Chemical Engineering Bioengineering