Abstract

High  tibial  osteotomy  has  been  established as an effective surgical intervention in patients with uni- compartment osteoarthritis of the knee associated with varus deformity and abnormal load through the medial compartment. The aims of this study were to report the result of open-wedge osteotomy performed with allograft bone and also to evaluate the postoperative clinical results in a series of patients. There are still little medical litera- tures regarding the use of an allograft bone transplant in open-wedge osteotomy. 37 consecutive cases that had undergone opening wedge osteotomy using allograft bone were studied. They were followed each 2 months after surgery until 6 month. There were 7 men and 30 women, aged ranging from 16 to 66. All patients were followed 6 months after surgery until clinical and radiographic healing of the osteotomy site. All patients could stand and walk on operated limb 6 months after operation, but 11 of them had still pain after this duration. There were no cases of non-union or osteotomy site collapse associated with the use of allograft. Moreover, no significant complication has been detected in these patients with choosing appropriate patients and performing good surgical technique, and the 

proximal tibial wedge allograft is a satisfactory choice that provides effective clinical and radiographic bone union.

Keywords High tibial osteotomy · Allograft ·
Osteoarthritis

Introduction

Unicompartment osteoarthritis of the knee is associated with varus deformity and abnormal load through the medial compartment. An osteotomy for the proximal aspect of the tibia can correct the abnormal loading stresses on the knee caused by an altered femorotibial angle. High tibial oste- otomy has been established as an effective surgical inter- vention in these patients and for unloading the medial compartment after cartilage restoration that could improve quality of life and cause high patients satisfaction rate [1–3].
In surgical procedure of the medial compartment, good long-term results depend on the ultimate correction, which is ideally 2–8 degree of valgus of the tibiofemoral angle [2, 4]. There are two known surgical methods for this proce- dure. The first one is the lateral closing wedge osteotomy of the proximal tibia that provides a stable construct for earlier weight-bearing and bone union; however, problem related to fibular osteotomy, disruption of the tibiofibular joint, detachment of the extensor muscle, proneal nerve injuries, and shortening of the limb have been reported with this procedure [2, 5]. Today medial opening wedge as the second type of the procedure is becoming more popular because it is simpler and avoids these problems [6, 7]. It can be combined with an anterior cruciate ligament reconstruction through the same incision and has length- ening effect. Despite these benefits, longer union time and

need for the bone graft are associated with this method. Patients’ selection, surgical technique, type of fixation, use of supplement for fixation, and the choice of material or bone graft to fill the osteotomy defect are the important factors that are related to these complications [8]. With regard to the use of bone graft, autogenous iliac crest has been the preferred graft because of its structural charac- teristics [9]. Autogenous bone graft harvest from the iliac crest has been associated with morbidity and potential complications such as deep wound infection, gluteal artery injury, and sciatic nerve injury [7, 10–16]. The use of an allograft bone wedge could eliminate these problems. There are still little medical literatures regarding the use of an allograft bone transplant in open-wedge osteotomy.
The aim of this study was to report the result of open- wedge osteotomy performed with allograft bone. We also aimed to evaluate the postoperative clinical results in a series of patients.