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Title: Bone grafts and bone substitutes for opening-wedge osteotomies of the knee: a systematic review
Epworth Authors: Lash, Nicholas
Feller, Julian
Batty, Lachlan
Wasiak, Jason
Richmond, Anneka
Keywords: Void Fillers
Opening-Wedge Osteotomy
Knee Joint
Bone Grafting
Tibial Osteotomy
Femoral Osteotomy
Bone Substitute
Opening Osteotomy
Opening Wedge
Musculoskeletal Clinical Institute, Epworth HealthCare, Victoria, Australia
Issue Date: Apr-2015
Citation: Arthroscopy. 2015 Apr;31(4):720-30
Abstract: To establish the rate of use of various void fillers in the setting of opening-wedge osteotomy around the knee, the types of fixation used, and the rates of delayed union or nonunion related to these variables. In addition, this review addressed short-term to midterm outcomes and complication rates associated with such procedures. The electronic databases Medline, Embase, and PubMed were searched using the methodology for systematic review as recommended by the Cochrane Collaboration. The search terms used were as follows: knee, osteotomy, knee joint, bone grafting, opening osteotomy, opening wedge, tibial osteotomy, femoral osteotomy, and bone substitute. We screened 1,383 articles and applied exclusion criteria. Fifty-six articles were included. We included 3,033 cases of osteotomy in 2,910 patients. The mean age of patients was 50 years, with a mean follow-up period of 42 months. Male patients comprised 52% of patients. The mean alignment change was 10.8°, shifting the mechanical axis to 5.1° valgus. Delayed union/nonunion rates were 2.6%, 4.6%, and 4.5% for autograft, allograft bone, and synthetic bone substitutes, respectively (P = .03). Delayed union/nonunion rates were significantly lower for autograft compared with allograft (P = .03) and for autograft and allograft compared with synthetic bone substitutes (P < .0001). Non-locking plates (n = 2,148) had a rate of delayed union/nonunion of 3.7% and a mean loss of correction over time of 0.5°. Locking plates (n = 681) had a rate of delayed union/nonunion of 2.6% and a loss of correction of 2.3°. All mean knee outcome scores improved, and an overall complication rate of 14% was found. Opening-wedge osteotomy had good short-term to midterm outcomes with acceptable complication rates. The lowest rates of delayed union/nonunion were in autograft bone-filled osteotomies. Plate type does not appear to affect osteotomy union or loss of correction
DOI: 10.1016/j.arthro.2014.09.011
PubMed URL:
ISSN: 0749-8063
Journal Title: Arthroscopy: The Journal of Arthroscopy and Related Surgery
Type: Journal Article
Type of Clinical Study or Trial: Systematic Reviews
Appears in Collections:Musculoskeletal

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