Union of Medial Opening-Wedge High Tibial Osteotomy Using a Corticocancellous Proximal Tibial Wedge Allograft

Abstract

Medial opening-wedge high tibial osteotomy has been gaining popularity in recent years, and autogenous iliac crest bone is the gold standard graft; however, the surgical time, risk, and morbidity associated with its harvest are significant. The question of a satisfactory bone-graft substitute has yet to be clearly answered. A corticocancellous proximal tibial wedge allograft is a satisfactory graft choice when evaluating union in medial opening-wedge high tibial osteotomy. Case series; Level of evidence, 4. Fifty consecutive patients who underwent medial opening-wedge high tibial osteotomy from May 2001 to May 2006 were included in the study. The amount of correction ranged from 5° to 17.5°, with a mean of 10.1°. Forty patients had fixation with a stainless steel plate and screws and 10 with a titanium interlocking plate and screws. The graft used in each case was a corticocancellous proximal tibial wedge allograft. No osteoinductive supplements were added. Patients started continuous passive motion immediately after surgery and began weightbearing at 8 weeks (if bone healing was progressing). Clinical and radiographic evaluation was performed monthly until full union and twice thereafter. Follow-up ranged from 5 months to 6 years, with a mean of 2.1 years. The average time to bone union was 12.1 weeks (range, 8–24). Two patients (4%) had a nonunion, defined as not healed at 6 months. Only 1 patient (a nonunion patient) had loss of correction at the osteotomy site, defined as collapse of the opening wedge (this occurred at 6 months after surgery). There were no cases of infection, no wound-healing problems, no cases of arthrofibrosis, and no neurovascular injuries. When union is assessed, a corticocancellous proximal tibial wedge allograft is a satisfactory graft choice in medial opening-wedge high tibial osteotomy.