Advantages of creation of holes and removal of air in artificial bone for early bone formation when used artificial bone as a gap filler in open wedge high tibial osteotomy

  • Yasuaki TohmaEmail author
  • Ryohei Takeuchi
  • Yasuhito Tanaka
Original Article • KNEE - OSTEOTOMY


Recently, many facilities perform open wedge high tibial osteotomy (OWHTO) using artificial bone as a gap filler. However, there are many cases in which artificial bone is used without a clear purpose. We recommend a surgical technique to promote early synostosis between artificial bone and recipient bone due to mechanical support especially in the early stage after OWHTO. At our hospital, beta-tricalcium phosphate (β-TCP) with 60% porosity is used in OWHTO. Initially, a wedge-shaped block-type β-TCP, as large as possible, was inserted into the gap. However, from the standpoint of initial mechanical support, we changed the artificial bone size and created intentional holes. Furthermore, we removed air bubbles from β-TCP. We evaluated the synostosis on the basis of clinical results and diagnostic imaging. As a result of creating holes and removing air from the artificial bone, a trend toward faster synostosis was noted, especially at the early stage. No adverse events such as tibial plateau fracture, lateral cortical fracture, plate and screw failure and correction loss due to reducing the size of the artificial bone occurred, but placement of the artificial bone in contact with cortical bone and surface contact installation with the recipient bone tissue was important. When using artificial bone in OWHTO, holes formation and removal of air from the artificial bone are recommended for faster synostosis between artificial bone and recipient bone in the early stage after surgery. Artificial bone should be used, with attention to its positioning and shape, for efficient mechanical support.


Open wedge osteotomy Artificial bone Beta-tricalcium phosphate Bone formation Hole formation Air removal 



This work was supported in part by a Grant-in-Aid for Scientific Research (C) from the Ministry of Education, Culture, Sports, Science and Technology, JSPS KAKENHI Grant Number JP17K10980.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Institutional Review Board director of National Hospital Organization Nara Medical Centre. The patient provided permission to publish this clinical case, and the identity of the patient has been protected.

Informed consent

Informed consent was obtained from all the patients to present their medical data.


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryNara City HospitalNaraJapan
  2. 2.Department of Orthopaedic SurgeryNara Medical UniversityKashihara, NaraJapan
  3. 3.Department of Joint Surgery CenterYokosuka City HospitalYokosukaJapan

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