Purpose

Using iliac crest autograft has been considered as gold standard for gap filling in medial opening wedge high tibial osteotomy (MOW-HTO) but is associated with donor site morbidity and pain. The purpose of this study was to compare the results of the use of iliac crest autograft versus allograft from the same anatomic site in terms of union and recurrence.

Methods

Forty-six patients with genovarum with or without medial compartment osteoarthritis were enrolled based on specific inclusion and exclusion criteria and were randomly assigned into two groups. MOW-HTO was done using iliac crest allograft (23 patients) or autograft (23 patients) as void filler. Follow-up visits were done monthly for the first 3 months and then every 3 months until 1 year and then at 5th and 8th postoperative year. The clinical assessment of union, anatomical indices of proximal tibia, complications and WOMAC score were assessed for both groups.

Results

The amount of correction (degrees), recurrence, complication rates, time to get symptom-free, radiologic union and knee scores was similar in both groups. The symptom-free time was 6.1 (SD = 0.9) weeks in autograft group versus 6.2 (SD = 0.8) weeks in allograft group (p = 0.73, 95% CI – 0.4 to 0.6). The time to radiologic union had a between-group difference of 0.3 weeks (p = 0.58, 95% CI – 1.6 to 0.9). There was one case of surgical site infection in graft harvest site. No nonunion or delayed union was encountered in either group. Fifty-two percent of the autograft patients reported more intense postoperative pain in iliac graft harvest site than tibial osteotomy site.

Conclusions

According to our results, iliac crest allograft can be safely used in MOW-HTO with comparable efficacy and safety to iliac crest autograft.

Clinical trial registry

The clinical trial was approved by clinicaltrial.gov with identifier NCT00595712.

中文翻译：

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胫骨内侧开口楔形高位截骨术后自体髂骨与同种异体骨的愈合率和复发率无差异：一项随机对照试验。

目的

使用髂嵴自体移植物被认为是内侧开口楔形高位胫骨截骨术（MOW-HTO）间隙填充的金标准，但与供区发病率和疼痛有关。本研究的目的是比较自体髂嵴与同种异体髂嵴在愈合和复发方面的结果。

方法

根据特定的纳入和排除标准招募了 46 名伴有或不伴有内侧间室骨关节炎的 genovarum 患者，并随机分为两组。MOW-HTO 使用髂嵴同种异体移植物（23 名患者）或自体移植物（23 名患者）作为空隙填充物。前 3 个月每月进行一次随访，然后每 3 个月进行一次随访，直至 1 年，然后在术后第 5 年和第 8 年进行。评估两组的愈合情况、胫骨近端解剖指标、并发症和WOMAC评分。

结果

两组的矫正量（度）、复发、并发症发生率、无症状时间、影像学愈合和膝关节评分相似。自体移植组的无症状时间为 6.1 (SD = 0.9) 周，而同种异体移植组为 6.2 (SD = 0.8) 周 ( p  = 0.73, 95% CI – 0.4 to 0.6)。影像学联合的时间组间差异为 0.3 周（p  = 0.58, 95% CI – 1.6 至 0.9）。移植物收获部位有1例手术部位感染。两组均未出现不愈合或延迟愈合。52% 的自体移植患者报告说，髂骨移植部位的术后疼痛比胫骨截骨部位更剧烈。

结论

根据我们的结果，髂嵴同种异体移植物可以安全地用于MOW-HTO，其疗效和安全性与自体髂嵴移植物相当。

临床试验登记处

该临床试验由clinicaltrial.gov批准，标识符为NCT00595712。