Princi Giorgio, Rossini Marco, Marzilli Fabio, Niccolo Riccardo Di, Conteduca Fabio, Ferretti Andrea
Department of Trauma and Orthopaedics, Sant'Andrea Hospital, Sapienza University of Rome, Italy.
J Orthop Case Rep. 2021 Oct;11(10):53-57. doi: 10.13107/jocr.2021.v11.i10.2466.
The open-wedge high tibial osteotomy (OWHTO) is a common technique for the treatment of medial compartmental osteoarthritis of the knee. There are many options to fill the osteotomy site gap. The autologous graft donor site morbidity can be avoided using heterologous bone grafts which represent a valid alternative.
This case report is about a 52-year-old male with knee osteoarthritis and varus deformity. Due to stiffness, swelling, and painful limitation during daily life activities, the patient underwent OWHTO. The osteotomy gap was filled with an equine cancellous bone wedge and nanohydroxyapatite (NHA) bone paste augmentation. After 3 years, the OWTHO was converted to total knee arthroplasty and a bone biopsy of the previous graft site was performed. The histological examination presented non-viable bone areas surrounded by viable bone without inflammatory cells, suggesting the presence of residual non-viable bone from the bone substitute graft.
The in vivo histology of the graft site after 3 years has shown that heterologous bone is a safe and valid choice as a scaffold for bone regeneration. Augmentation with NHA bone paste achieved good osteoinduction without an inflammatory reaction and good integration of the bone substitute insert.
开放性楔形高位胫骨截骨术（OWHTO）是治疗膝关节内侧间室骨关节炎的常用技术。填充截骨部位间隙有多种选择。使用异体骨移植可避免自体移植供区的并发症，异体骨移植是一种有效的替代方法。
本病例报告是关于一名52岁患有膝关节骨关节炎和内翻畸形的男性。由于日常生活活动中出现僵硬、肿胀和疼痛受限，该患者接受了OWHTO手术。截骨间隙用马松质骨楔和纳米羟基磷灰石（NHA）骨糊增强材料填充。3年后，OWHTO转换为全膝关节置换术，并对先前移植部位进行了骨活检。组织学检查显示，无活性骨区域被有活性的骨包围，且无炎症细胞，提示骨替代移植物存在残留的无活性骨。
3年后移植部位的体内组织学表明，异体骨作为骨再生支架是一种安全有效的选择。用NHA骨糊增强可实现良好的骨诱导，无炎症反应，且骨替代植入物融合良好。
