Abstract
Bone grafting is a good alternative for filling the inevitable void that is created
following opening-wedge high tibial osteotomy (OWHTO). This systematic review and
meta-analysis evaluated whether bone grafting is necessary for OWHTO and the successful
outcomes of OWHTO using either autograft (AU) or allograft (AL). All analyzed studies
were acquired from PubMed, Medline, Embase, CNKI, Google Scholar, and Cochrane Library.
Data were independently extracted by two coauthors and were analyzed using RevMan5.3.
Mean differences, odds ratios, and 95% confidence intervals were calculated. Cochrane
Collaboration's Risk of Bias Tool and Newcastle–Ottawa Scale were used to assess the
risk of bias. In total, 10 studies were assessed including three randomized controlled
trials and seven observational studies. The methodological quality of the trials ranged
from low to high. The overall estimate demonstrated that the difference between OWHTO
using AU and AL 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. Pooled results of reoperations, lateral cortex breaches,
complications, and clinical function assessments showed no significant difference
between AU and AL materials. Using AL statistically reduced the operative time compared
with using AU. OWHTO with or without bone graft does not affect postoperative complications.
No loss of correction was observed due to the lack of bone grafting. In addition,
OWHTO without bone graft performs better for postoperative clinical function assessment.
Complications and clinical results of medial OWHTO were similar using AL and AU and
neither reported a median loss of correction of following OWHTO. Compared with using
AU, using AL avoids harvest site complications and reduces operative time. To sum
up, OWHTO without any bone graft is recommended for medial unicompartmental osteoarthritis
of the knee. Further large-sample, multicenter, high-quality, randomized controlled
trials are warranted to verify the outcomes of this meta-analysis.
Keywords
opening-wedge high tibial osteotomy - autograft - allograft - systematic review -
meta-analysis
