ADDITION TIBIAL OSTEOTOMY USING DEHYDRATED CORTICOCANCELLOUS ALLOGRAFTS: LONG-TERM RESULTS

Abstract

Purpose: Development of knee arthroplasty has led surgeons to reconsider their tibial osteotomy techniques. Closed wedge subtraction which can lead to a deformed epiphyseal callus and an oblique joint space have been progressively replaced by more anatomic open wedge techniques. The bone gap created by open osteotomy is general filled with an iliac autograft, implying morbidity of the harvesting site, or inert material. For the last eleven years, we have used dehydrated corticocancellous grafts which maintain the collagenous framework and mechanical properties as well as the ingrowth properties close to autografts without the inconvenience of bone harvesting. After making the horizontal osteotomy cut above the tubercle, tricortical allografts are fashioned at the operative site and implanted without impaction. Fixation is achieved by staples or plate screwing. Mechanical stability is always achieved within the usual time allowing weight bearing at 40 days.

Material and methods: Twenty patients who underwent this procedure more than nine years earlier were reviewed for this study.

Results: Two patients died. One underwent a second procedure for a tri-compartmental prosthesis seven years after osteotomy. There were no local or general complications at short- or long-term. Radiological ingrowth was observed 12 to 24 months postoperatively allowing removal of the osteosynthesis material and bone biopsies which proved bone ingrowth. Control gonometry at 45 days and one year validated the reliability of the technique and achievement of the desired biomechanical objective, confirming the absence of lost correction.

Discussion: This simple and reliable technique has several advantages: simple less aggressive surgery, immediate mechanical stability, absence of material-related complications, constant radiographic ingrowth proven histologically.

Conclusion: The quality of the long-term results make this technique a reasonable alternative for iliac autografting. It should be preferred over non-inhabitable inert material and over heterografting which has its own complications (mechanical instability, pseudoseptic lysis).