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Calcium phosphate cement enhances primary stability of open-wedge high-tibial osteotomies

  • Knee
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

We investigated if injectable calcium phosphate cement improves primary stability in open-wedge high-tibial osteotomy. A 10 mm open-wedge osteotomy was performed on eight pairs of preserved cadaver tibiae and seven pairs of composite (Sawbone) left tibiae. Osteosynthesis was performed with the Dynafix plate system. The gap resulting from surgery either was filled with 15 g injectable calcium phosphate cement in half the bones or was left untreated. The composite tibiae were loaded at a ramp speed of 20 mm/min up to 20 kN. The cadaver tibiae were exposed to 100 cycles with a maximum compressive force of 2,250 N. After 100 cycles of loading with 2,250 N, the final loaded displacement was 1.2 mm for the cadaver tibiae treated with injectable calcium phosphate cement as compared with 3.6 mm for the empty defects (P = 0.028). All the seven empty defect composite specimens failed prior to 20 kN (median 2.8 kN) as compared with five of the injectable calcium phosphate cement specimens (median 17 kN) (P = 0.005). The injection of injectable calcium phosphate cement following open-wedge osteotomy of the proximal tibia increases the initial stability of the bone as measured by load-to-failure and displacement after cyclic loading. Clinical studies are ongoing to investigate whether injectable calcium phosphate cement also has clinical advantage on wedge healing and stability.

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Acknowledgments

The authors wish to thank: The Program of Body Donation to Medical Science, Institute of Anatomy, Aarhus University. The study was financially supported by the following non-commercial institutions: WSF, Western Denmark Health Research grant of Aarhus University, Danish Rheumatism Association, The Opel Family Foundation, The Spar Nord Foundation. The study have benefited from institutional research support from the following company with commercial interests in this research area: Biomet Denmark

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Authors and Affiliations

  1. Orthopaedic Division, North Denmark Region, Aalborg Hospital, Aarhus University Hospital, Sdr. Skovvej 11, 9000, Aalborg, Denmark

    Thomas Lind-Hansen, Poul Torben Nielsen & Juozas Petruskevicius

  2. Department of Production, Aalborg University, Aalborg, Denmark

    Benny Endelt & Karl Brian Nielsen

  3. Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark

    Ivan Hvid & Martin Lind

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  1. Thomas Lind-Hansen
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  2. Poul Torben Nielsen
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Correspondence to Thomas Lind-Hansen.

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Lind-Hansen, T., Nielsen, P.T., Petruskevicius, J. et al. Calcium phosphate cement enhances primary stability of open-wedge high-tibial osteotomies. Knee Surg Sports Traumatol Arthrosc 17, 1425–1432 (2009). https://doi.org/10.1007/s00167-009-0862-5

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