Network meta-analysis of high tibial osteotomy combined with different bone defect filler materials for medial compartment knee osteoarthritis
Bibliographic record
Abstract
OBJECTIVE: This study aims to systematically review and analyze the clinical and radiographic outcomes of high tibial osteotomy (HTO) combined with various bone defect filler materials for the treatment of medial compartment knee osteoarthritis (MCKOA). In light of the increasing adoption of enhanced recovery after surgery (ERAS) principles, we further seek to refine treatment strategies for MCKOA by comparing the therapeutic effects of different filler materials. METHODS: We performed a comprehensive literature search of studies published from database inception to July 1, 2024, across PubMed, Medline, Embase, the Cochrane Library, Web of Science, and Scopus. Using a network meta-analysis framework, we systematically assessed clinical comparative studies involving two or more bone defect filler materials in patients undergoing medial open-wedge high tibial osteotomy. Evidence was synthesized through a Bayesian random-effects network meta-analysis. Methodological quality and risk of bias of included studies were evaluated using the Cochrane Risk of Bias Tool 2.0 and a modified Newcastle-Ottawa scale. RESULTS: After rigorous screening, 29 eligible trials were identified from 2755 references, including 10 randomized controlled trials (RCTs) and 19 non-randomized comparative trials (NCTs), involving a total of 1549 participants. These trials evaluated six intervention types: autografts, allografts, synthetic grafts, composite grafts, xenografts, and no grafts. Analyses based on outcomes such as clinical bone healing time, percentage of complete bone union, Lysholm knee score, infection, and delayed union, autogenous iliac bone grafting showed potential as a favorable option. However, considering correction of osteotomy defects and donor site morbidity, autogenous iliac bone grafting should be avoided. In contrast, synthetic grafts or allografts appeared more favorable when assessed using outcomes like WOMAC score, lateral cortical fracture, and donor site morbidity. CONCLUSION: Taking into account postoperative prognosis and complication profiles in HTO patients, autogenous iliac bone grafting may demonstrates superior efficacy in treating MCKOA, though its associated risks warrant careful consideration. Synthetic grafts and allografts offer a more balanced risk-benefit profile and represent recommended alternatives. LEVEL OF EVIDENCE: Level III, a meta-analysis of Level I RCTs and Level II-III non-randomized controlled trials.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.027 | 0.061 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.016 | 0.055 |
| Bibliometrics | 0.007 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".