Document Detail


Open wedge high tibial osteotomies: Calcium-phosphate ceramic spacer versus autologous bonegraft.
MedLine Citation:
PMID:  20832381     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
LEVEL OF EVIDENCE: Level II. Prospective randomized study.
Authors:
F Gouin; F Yaouanc; D Waast; B Melchior; J Delecrin; N Passuti
Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial     Date:  2010-09-15
Journal Detail:
Title:  Orthopaedics & traumatology, surgery & research : OTSR     Volume:  96     ISSN:  1877-0568     ISO Abbreviation:  Orthop Traumatol Surg Res     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2011-03-17     Completed Date:  2011-07-27     Revised Date:  2013-10-31    
Medline Journal Info:
Nlm Unique ID:  101494830     Medline TA:  Orthop Traumatol Surg Res     Country:  France    
Other Details:
Languages:  eng     Pagination:  637-45     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 Elsevier Masson SAS. All rights reserved.
Affiliation:
Orthopaedic surgery and traumatology Clinic, Musculo-skeletal Department, Hôtel-Dieu Teaching Medical Center, 1, place A.-Ricordeau, 44093 Nantes cedex, France. fgouin@chu-nantes.fr
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Biocompatible Materials*
Bone Malalignment / surgery*
Bone Substitutes*
Bone Transplantation*
Calcium Phosphates*
Ceramics*
Cohort Studies
Female
Follow-Up Studies
Humans
Male
Middle Aged
Osteoarthritis, Knee / surgery*
Osteotomy / methods*
Postoperative Complications / etiology
Prospective Studies
Risk Factors
Tibia / surgery*
Chemical
Reg. No./Substance:
0/Biocompatible Materials; 0/Bone Substitutes; 0/Calcium Phosphates; 0/Ceramics; L11K75P92J/dicalcium phosphate anhydrous
Comments/Corrections
Comment In:
Orthop Traumatol Surg Res. 2011 May;97(3):353; author reply 354-5   [PMID:  21478067 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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