Resorbability of rigid beta-tricalcium phosphate wedges in open-wedge high tibial osteotomy: a retrospective radiological study

The open-wedge high tibial osteotomy (OWHTO) is a well accepted treatment modality for patients with osteoarthritis of the medial compartment associated with genu varum. To fill in the osteotomy gap 30% macroporosity rigid beta-tricalcium phosphate (β-TCP) is frequently used as a stable resorbable bone substitute. However, the resorbability of these β-TCP wedges is not known. The aim of this study was to investigate this. Twenty-one OWHTO procedures in seventeen patients were performed with the use of 30% macroporosity rigid β-TCP wedges. The osteotomies were fixed using an angle-stable locking plate. Conventional AP and lateral radiographs were examined in order to assess the resorbability of the 30% macroporosity rigid β-TCP wedges as a function of time. A radiological classification system consisting of five phases was used to monitor the resorption of the 30% macroporosity rigid β-TCP wedges. The mean duration of follow-up was 62 months (± 23 range of 28-99). In all 21 cases, remnants of the 30% macroporosity rigid β-TCP wedges were still present at maximum follow-up. Although the boundaries between 30% macroporosity rigid β-TCP wedges and bone remained slightly visible, all osteotomies were completely consolidated and full osseointegration took place. In 16 out of 21 knees the fixation system was removed after a mean duration of 32 months (± 19 range of 6-62). In six out of 21 knees a conversion to a knee arthroplasty was performed after a mean duration of 56 months (± 18 range of 37-82). The OWHTO did not interfere with the placement of knee prostheses. Complete resorption of 30% macroporosity rigid β-TCP wedges did not take place up to 8 years after operation. © 2008 Elsevier B.V. All rights reserved.