Knee Surg Relat Res.  2015 Dec;27(4):207-220. 10.5792/ksrr.2015.27.4.207.

Is Bone Grafting Necessary in Opening Wedge High Tibial Osteotomy? A Meta-Analysis of Radiological Outcomes

• Han JH
• Kim HJ
• Song JG
• Yang JH
• Bhandare N
• Fernandez
• Park HJ
• Nha KW

• KMID: 2149674
• DOI: http://doi.org/10.5792/ksrr.2015.27.4.207

Abstract

PURPOSE
Bone grafting in opening wedge high tibial osteotomy (OWHTO) is still controversial. The purpose of this study is to compare the radiological outcomes of OWHTO with bone graft (autogenous, allogenous, and synthetic bone graft) and those without bone graft.
MATERIALS AND METHODS
PubMed, MEDLINE, EMBASE and Cochrane Register of Studies databases were searched using specific inclusion and exclusion criteria for radiological studies involving OWHTO with bone graft and without bone graft groups. All reported delayed union, nonunion and correction loss were analyzed. Data were searched from the time period of January 2000 through July 2014. In addition, a modified Coleman methodology score (CMS) system was used to assess the methodological quality of the included studies.
RESULTS
Twenty-five studies with a mean CMS value of 77 (range, 61 to 85 score) were included. In total, 1,841 patients underwent OWHTO using 4 different procedures for bone graft: autobone graft (n=352), allobone graft (n=547), synthetic bone graft (n=541) and no bone graft (n=401). There was a similar tendency for delayed union, nonunion and correction loss rate among the osteotomy space filling methods.
CONCLUSIONS
The meta-analysis showed there was a similar tendency for radiological union and correction maintenance among patients undergoing OWHTO regardless of the type of bone in all of the studies. However, the currently available evidence is not sufficient to strongly support the superiority of OWHTO with bone graft to OWHTO without bone graft.

Keyword

Knee; Osteoarthritis; Osteotomy; Bone graft; Meta-analysis

MeSH Terms

Bone Transplantation*
Humans
Knee
Osteoarthritis
Osteotomy*
Transplants