From the Research
Bone grafting is not routinely indicated in unilateral partial osteotomy, specifically high tibial osteotomy (HTO), as the bone typically heals well without additional grafting material, according to the most recent and highest quality study 1.
Introduction to the Decision-Making Process
When considering the use of bone grafts in HTO, it's essential to weigh the potential benefits against the risks and consider the individual patient's circumstances. The primary goal of HTO is to realign the knee and redistribute weight-bearing forces, which can often be achieved without the need for bone grafting.
Key Considerations
- The size of the correction needed and the resulting bone void
- The patient's bone quality and potential for healing
- The surgeon's assessment of the risk of delayed union or non-union
- The potential benefits and drawbacks of using autografts, allografts, or synthetic bone substitutes
Evidence-Based Recommendations
The most recent study 1 found that there was no significant difference in bone union outcomes between patients who received autografts, allografts, or no graft at all. However, another study 2 suggested that using allografts may reduce operative time compared to using autografts.
- In general, bone grafting may be considered in specific situations, such as:
- Large opening wedge that creates a significant bone void
- Poor bone quality
- Concern about delayed union or non-union
- The decision to use bone grafting should be individualized based on the specific surgical technique employed, the size of the correction needed, and the patient's bone quality.
Implications for Clinical Practice
The use of bone grafts in HTO should be approached with caution, and the decision to use them should be based on a thorough evaluation of the individual patient's needs and circumstances, as supported by the study 1.