Dataset Information

Comparison of Puddu osteotomy with or without autologous bone grafting: a prospective clinical trial.

ABSTRACT:

Objectives

To test the hypothesis that autologous iliac bone grafts do not enhance clinical results and do not decrease complication rates in patients undergoing medial opening-wedge high tibial osteotomy.

Methods

Forty patients allocated in a randomized, two-armed, double-blinded clinical trial were evaluated between 2007 and 2010. One group received bone graft, and the other group was left without filling the osteotomy defect. The primary outcome was the Knee Society Score. Radiographic measurement of the frontal anatomical femoral-tibial angle and the progression of osteoarthritis according to the modified Ahlback classification were used as secondary outcomes.

Results

There was no difference in KSS scale between the graft group (64.4 ± 21.8) and the graftless group (61.6 ± 17.3; p = 0.309). There was no difference of angle between the femur and tibia in the frontal plane between the groups (graft = 184 ± 4.6 degrees, graftless = 183.4 ± 5.1 degrees; p = 1.0), indicating that there is no loss of correction due to the lack of the graft. There was significant aggravation of osteoarthritis in a greater number of patients in a graft group (p = 0.005).

Conclusion

Autologous iliac bone graft does not improve clinical outcomes in medium and long-term follow-up of medial opening-wedge high tibial osteotomy fixed with a first generation Puddu plate in the conditions of this study.

SUBMITTER: Passarelli MC

PROVIDER: S-EPMC5643891 | biostudies-literature | 2017 Sep-Oct

REPOSITORIES: biostudies-literature

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Publications

Comparison of Puddu osteotomy with or without autologous bone grafting: a prospective clinical trial.

Passarelli Marcus Ceregatti MC Filho José Roberto Tonelli JRT Brizzi Felipe Augusto Mendes FAM Campos Gustavo Constantino de GC Zorzi Alessandro Rozim AR Miranda João Batista de JB

Revista brasileira de ortopedia 20170914 5

<h4>Objectives</h4>To test the hypothesis that autologous iliac bone grafts do not enhance clinical results and do not decrease complication rates in patients undergoing medial opening-wedge high tibial osteotomy.<h4>Methods</h4>Forty patients allocated in a randomized, two-armed, double-blinded clinical trial were evaluated between 2007 and 2010. One group received bone graft, and the other group was left without filling the osteotomy defect. The primary outcome was the Knee Society Score. Radi ...[more]

PMID: 29062820

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Project description:Background contextPseudarthrosis following spinal fusion remains problematic despite modern surgical and grafting techniques. In surgical spinal fusion, new bone forms via intramembranous and endochondral ossification, with endochondral ossification occurring in the hypoxic zones of the fusion bed. During bone development and fracture healing, the key cellular mediator of endochondral ossification is the hypertrophic chondrocyte given its ability to function in hypoxia and induce neovascularization and ossification. We therefore hypothesize that hypertrophic chondrocytes may be an effective bone graft alternative.PurposeSpinal fusion procedures have increased substantially; yet 5% to 35% of all spinal fusions may result in pseudoarthrosis. Pseudoarthrosis may occur because of implant failure, infection, or biological failure, among other reasons. Advances in surgical techniques and bone grafting have improved fusion; however pseudarthrosis rates remain unacceptably high. Thus, the goal of this study is to investigate hypertrophic chondrocytes as a potential biological graft alternative.MethodsUsing a validated murine fracture model, hypertrophic chondrocytes were harvested from fracture calluses and transplanted into the posterolateral spines of identical mice. New bone formation was assessed by X-ray, microcomputed tomography (μCT), and in vivo fluorescent imaging. Results were compared against a standard iliac crest bone graft and a sham surgery control group. Funding for this work was provided by the Department of Orthopaedics and Rehabilitation, the OREF (Grant #16-150), and The Caitlin Lovejoy Fund.ResultsRadiography, μCT, and in vivo fluorescent imaging demonstrated that hypertrophic chondrocytes promoted bone formation at rates equivalent to iliac crest autograft. Additionally, μCT analysis demonstrated similar fusion rates in a subset of mice from the iliac crest and hypertrophic chondrocyte groups.ConclusionsThis proof-of-concept study indicates that hypertrophic chondrocytes can promote bone formation comparable to iliac crest bone graft. These findings provide the foundation for future studies to investigate the potential therapeutic use of hypertrophic chondrocytes in spinal fusion.

Dataset Information

Comparison of Puddu osteotomy with or without autologous bone grafting: a prospective clinical trial.

Objectives

Methods

Results

Conclusion

Publications

Comparison of Puddu osteotomy with or without autologous bone grafting: a prospective clinical trial.

Similar Datasets

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