2015 ISAKOS Biennial Congress ePoster #1721

Safety & Efficacy of a Novel Focal Posteromedial Opening Wedge High Tibial Osteotomy Autograft from the Distal Femoral Metaphysis

Christopher J. Vertullo, MBBS, PhD, FRACS(Orth), Gold Coast, QLD AUSTRALIA
Lahann Joseph Wijneyake, MBBS, Gold Coast AUSTRALIA
David Zbrojkiewicz, BSc, Gold Coast, Queensland AUSTRALIA
Knee Research Australia & Centre for Musculoskeletal Research Griffith University , Gold Coast, Queensland, AUSTRALIA

The FDA has not cleared the following pharmaceuticals and/or medical device for the use described in this presentation. The following pharmaceuticals and/or medical device are being discussed for an off-label use: Kaltec, Precision Bone Grafting System

Summary: Focal posteromedial Opening Wedge High Tibial Osteotomy grafting using autograft dowels from the distal femoral metaphysis had a low complication rate compared with other techniques and a high union rate.

Abstract:

Background

Opening wedge high tibial osteotomy (OWHTO) is a valuable surgical technique to relieve medial compartment Osteoarthritis(Osteoarthritis) pain in the young & active patient. Non-union and delayed union are an unfortunate complication. Iliac crest autograft remains the Gold Standard, but has a significant complication rate and involves a secondary surgical site. This study investigates a novel posteromedial OWHTO focal autografting technique with distal femoral dowels taken via a mini-incision.

Methods

Forty two consecutive patients (mean age 50.8) with medial OA were prospectively followed after OWHTO & simultaneous distal femoral autograft dowel harvest & bone grafting from the distal femoral metaphysis. OWHTO was undertaken under image intensification, with the knee in extension. Mean correction size was 11.07 mm (SD 1.49), with fixation by a locked Ti Puddu Plate. 92.3% had Grade IV osteoarthritis and underwent simultaneous marrow stimulation. 19.2% of patients underwent concurrent ACLR or Revision. 6 or 8mm diameter dowels were harvested from the distal femur & applied posterior to the Puddu plate, and along the posterior cortical osteotomy.

Results

Mean graft volume was 43 mm3. Female, age & shorter stature was related to smaller graft volume. There were no non-unions. One patient suffered a PE. Two patients required a repeat arthroscopy due to reduced range after combined ACLR. Two patients complained of altered sensation at the medial femoral harvest site at 3 months which resolved by 6 months. 92 % of patients described altered sensation at the tibial osteotomy site. Average incision size at harvest was 22 mm. Average inpatient stay was 1.4 days. Average time to radiologic union was 101 days. Two patients had a delayed union. No non-unions occurred.

Conclusion

Focal posteromedial HTO grafting using autograft dowels from the distal femoral metaphysis had a low complication rate compared with other techniques and a high union rate.