From the Research
Bone grafting is not routinely indicated in standard high tibial osteotomy (HTO) procedures, as most HTOs can be performed successfully without it, particularly with modern fixation techniques and stable internal fixation, as supported by the most recent study 1.
Key Considerations
- The decision to use bone graft should be individualized based on patient factors, the specific surgical technique being used, and the surgeon's assessment of stability and healing potential.
- Bone grafting may be considered in specific situations, including large correction angles (typically greater than 10-12 degrees) where a significant opening wedge is created, cases with poor bone quality or osteoporosis, or when there is concern about delayed healing or non-union risk.
- Options for bone grafting include autograft (typically from the iliac crest), allograft, or synthetic bone substitutes.
- The primary purpose of bone grafting in HTO is to provide structural support to the osteotomy site and to potentially enhance bone healing.
Evidence Summary
- A systematic review and meta-analysis 1 found that the difference between OWHTO using autograft and allograft groups and OWHTO using no filling group was not statistically significant for the loss of correction and complications, but OWHTO using no filling group statistically showed better knee society score.
- Another study 2 found that autografts resulted in superior bone union outcomes compared to allografts and no graft at 1 year postoperatively, but no bone graft achieved similar outcomes to allografts, suggesting that routine use of allografts should not be recommended.
- An older study 3 found that the use of an autogenous iliac crest bone graft prevented delayed union or nonunion, allowed early rehabilitation and weightbearing, and prevented knee arthrofibrosis and patella infera.
Recommendations
- Most HTO procedures can be performed without bone grafting, and the decision to use bone graft should be made on a case-by-case basis, considering the individual patient's needs and the surgeon's assessment of stability and healing potential.
- When bone grafting is used, autograft may be a better option than allograft, but the choice of graft material should be individualized based on patient factors and the specific surgical technique being used.