No difference in union and recurrence rate between iliac crest autograft versus allograft following medial opening wedge high tibial osteotomy: a randomized controlled trial.

Abstract

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. 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. 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 0.3weeks (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. According to our results, iliac crest allograft can be safely used in MOW-HTO with comparable efficacy and safety to iliac crest autograft. The clinical trial was approved by clinicaltrial.gov with identifier NCT00595712.