The Use of Bone Void Fillers May Not Impact Outcomes After Medial Opening Wedge High Tibial Osteotomy: A Systematic Review.
The use of bone void fillers in medial opening wedge high tibial osteotomy does not appear to significantly impact surgical outcomes, especially when the gap size is less than 10 mm.
Where it sits
this study against the rest of the mk-677 (ibutamoren) corpusSummary and findings
This systematic review examined the impact of bone void fillers on outcomes after medial opening wedge high tibial osteotomy (OWHTO) in patients with gap sizes less than 10 mm. A total of 1640 knees were analyzed across 28 studies. The findings suggest that the use of bone void fillers does not significantly influence outcomes.
Abstract
<h4>Purpose</h4>To examine whether the use of bone void filler significantly influences outcomes of medial opening wedge high tibial osteotomy (OWHTO), with a specific emphasis on gap sizes less than 10 mm.<h4>Methods</h4>A systematic review of the literature was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Databases searched included PubMed, MedLine, EMBASE, and Web of Science. Studies were included if they met the following criteria: patients treated by OWHTO, clearly described surgical technique (including osteotomy gap size), filler type (synthetic, allograft, autograft), fixation type (locking versus nonlocking plate), type of plate (e.g., Tomofix, Puddu, Orthomed), and the degree of varus correction. The levels of evidence of the included studies ranged from Level I to Level IV according to the Oxford Centre for Evidence-Based Medicine classification. The studies must have also been reported in English, peer-reviewed, and originated in the United States or countries that offer the same procedures, protocol, and outcome reporting.<h4>Results</h4>Twenty-eight of 253 identified studies met inclusion criteria. A total of 1640 knees underwent OWHTO in the 28 studies: 598 (36.4%) had allograft, 488 (29.8%) had no bone void filler, 359 (21.9%) had synthetic, and 195 (11.9%) had autograft. Of the total patients, 963 (58.7%) were women and 676 (41.3%) were men. Different types of bone void fillers were used in each study, with no filler being most common (13/28), followed by allograft (12/28). Complications such as nonunion, loss of correction, infection, and lateral hinge fracture were reported across studies, although the overall rates were low in all groups. Most investigations described satisfactory healing regardless of whether a bone void filler was used. Several studies noted that outcomes in procedures performed without bone void filler, particularly when the osteotomy gap was less than 10 mm, were comparable to or slightly better than those in which a filler was used.<h4>Conclusions</h4>This study revealed that the utilization or absence of bone void filler does not impact the outcomes of OWHTO. In the setting of OWHTO with gap sizes less than 10 mm, placement of a bone void filler may contribute to higher complication rates. Despite the lack of functional advantage of using a bone void filler, OWHTO is still completed with bone void filler in more than 50% of cases.<h4>Level of evidence</h4>Level IV, systematic review of Level I to IV studies.
Background
The clinical question addressed by this paper is whether the use of bone void fillers affects outcomes in medial opening wedge high tibial osteotomy (OWHTO). Prior knowledge indicated that the choice of filler could potentially influence healing and complication rates. This study is significant as it systematically reviews existing literature to clarify the role of bone void fillers in this surgical context.
Methods
This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, analyzing studies from databases such as PubMed and EMBASE. Inclusion criteria required studies to involve patients treated by OWHTO with clearly described surgical techniques and filler types. The review included 28 studies with a total of 1640 knees analyzed.
Results
The review found that 36.4% of knees received allograft, 29.8% had no filler, 21.9% received synthetic fillers, and 11.9% had autograft. Complications were reported across studies, but overall rates were low. Healing outcomes were satisfactory regardless of filler use, and procedures without fillers showed comparable or slightly better outcomes.
Interpretation
These findings suggest that the use of bone void fillers may not provide a functional advantage in OWHTO, particularly in cases with smaller gap sizes. While the results are statistically significant, the clinical relevance may be limited given the low complication rates across all groups. Confounding factors include the variability in study designs and the inclusion of studies with different levels of evidence.
Key findings
- 28 of 253 identified studies met inclusion criteria.
- 1640 knees underwent OWHTO in the 28 studies: 598 (36.4%) had allograft, 488 (29.8%) had no bone void filler, 359 (21.9%) had synthetic, and 195 (11.9%) had autograft.
- Most investigations described satisfactory healing regardless of whether a bone void filler was used.
- Outcomes in procedures performed without bone void filler, particularly with osteotomy gap less than 10 mm, were comparable to or slightly better than those with filler.
Limitations
- The review included studies with varying levels of evidence.
- Not all studies reported complication rates for each filler type.
- Some studies may have small sample sizes affecting generalizability.