Open Wedge High Tibial Osteotomy With Or Without Bone Graft:A Meta-analysis

Objective:Open wedge high tibial osteotomy(OWHTO)for bone transplantation is still controversial.The purpose of this study was to compare the excellent and good rates of autologous bone,allogeneic bone,substitute materials and non-bone transplantable plants,and to draw a conclusion by comparing the postoperative non-healing rate,delayed healing rate and corrected loss rate.Methods:To retrieve all the literatures reported in the pubmed,medline,embase and cochrane databases from January 2008 to January 2008,and to analyze the delayed healing,nonunion and corrective loss of bone tissue by using inclusion and exclusion criteria.Coleman scoring system was used to analyze the quality of evaluation research.The evaluation indexes were analyzed by meta with revman 5.3 software.Results:This paper included 22 articles,including 25 studies.1632 cases were grafted with autologous bone graft(n=277),allograft bone(n=796),substitute bone graft(n=254)and ungrafted bone(n=305).In all studies,there were only three types of osteotomy filling methods,one study on allograft,one study on autograft,and one study on no graft.It is worth noting that the healing time is longer in the group without bone graft.The healing time of autogenous bone was basically the same as that of allogeneic bone.According to the type of graft in osteotomy space,there was a similar trend in nonunion rate and delayed healing rate.According to the analysis of nonunion rate and delayed healing rate of osteotomy gap based on locking plate and non-locking plate,it was found that there was no significant difference in healing rate and delayed healing rate between locking plate and non-locking plate,and there was no significant difference in healing rate and delayed healing rate between locking plate and non-locking plate.The heterogeneity of correction loss rate(I~2>50%)was not consistent.The incidence of post-operative correction loss of non-locking plate was significantly higher than that of locking plate.Conclusion:This meta-analysis evaluated the nonunion rate,delayed healing rate and correction loss rate of four types of OWHTO osteotomy space graft(autologous bone transplantation,allograft transplantation,substitute material and non-bone graft group).There is a similar trend in bone healing rate and nonunion rate between locking plate and unlocked plate,and there is inconsistency in correcting loss rate.