[Tibial valgus osteotomy using a tricalcium phosphate medial wedge: a minimally invasive technique].
OBJECTIVE
We present a minimally invasive technique for tibial valgus osteotomy using a medial wedge composed of tricalcium phosphate.


METHODS
The bone substitute is composed of slowly resorbable tricalcium phosphate material shaped to the desired form and having mechanical properties allowing stable osteotomy via a short incision and staple fixation. Intraoperative fluoroscopy enables a reliable and reproducible technique. A lateral fixation staple is required because there is a risk the lateral hinge could break. This technique was used for 58 knees in 55 patients (mean age 47 years). According to the Ahlback classification of femorotibial degeneration, there were 43 grade I knees, 12 grade II, and 3 grade III.


RESULTS
The implant was well tolerated in all cases. Bone healing was achieved in most cases without loss of the osteotomy angle. Complications were: rupture of the lateral hinge in four cases leading to nonunion in one, one low-grade infection. Implant resorption at mid term was significant: among the 22 patients with a follow-up of more than 5 years, the implant was barely visible in 18.


CONCLUSIONS
This technique provides an easy way to achieve tibial valgus osteotomy without compromising future intervention. The technique can be considered to be minimally invasive because of the size of the incision, the minimal fixation required, and the bone sparing effect of the bone substitute.
Bonnevialle
P
P
Service d'Orthopédie Traumatologie, Hôpital Purpan, place du Docteur-Baylac, 31052 Toulouse Cedex, France.
Abid
A
A
Mansat
P
P
Verhaeghe
L
L
Clement
D
D
Mansat
M
M
D000328:Adult; D000368:Aged; D001672:Biocompatible Materials / Q000009:adverse effects / Q000592:standards*; D018786:Bone Substitutes / Q000009:adverse effects / Q000592:standards*; D002130:Calcium Phosphates / Q000009:adverse effects / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D005599:Fractures, Ununited / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D020370:Osteoarthritis, Knee / Q000145:classification / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D010027:Osteotomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D011859:Radiography; D018805:Sepsis / Q000209:etiology; D012720:Severity of Illness Index; D013203:Staphylococcal Infections / Q000209:etiology; D013212:Staphylococcus epidermidis; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome
D001672:Biocompatible Materials; D018786:Bone Substitutes; D002130:Calcium Phosphates; C485817:beta-tricalcium phosphate; C018392:tricalcium phosphate