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The Journal of Bone and Joint Surgery (American). 2004;86:2399-2405
© 2004 The Journal of Bone and Joint Surgery, Inc.

Low-Intensity Pulsed Ultrasound Accelerates Maturation of Callus in Patients Treated with Opening-Wedge High Tibial Osteotomy by Hemicallotasis

Noriyuki Tsumaki, MD1, Masaaki Kakiuchi, MD2, Jiro Sasaki3, Takahiro Ochi, MD1 and Hideki Yoshikawa, MD1

1 Department of Orthopaedics, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan. E-mail address for N. Tsumaki: tsumaki-n{at}umin.ac.jp
2 Department of Orthopaedic Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka 543-0035, Japan
3 Department of Radiology, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka 543-0035, Japan

Investigation performed at the Department of Orthopaedics, Osaka University Graduate School of Medicine, and the Department of Orthopaedic Surgery and Radiology, Osaka Police Hospital, Osaka, Japan

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

In support of their research or preparation of this manuscript, one or more of the authors received Scientific Research Grant 15390458 from the Ministry of Education, Science and Culture of Japan; Health and Labor Sciences Research Grants of Japan; and Grant 0126 from the Japan Orthopaedic and Traumatology Foundation, Incorporated. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Opening-wedge high tibial osteotomy by hemicallotasis for osteoarthritis in the medial compartment of the knee requires external fixation for a long time, until callus maturation is complete. The aim of this study was to determine if low-intensity pulsed ultrasound would accelerate callus maturation when applied after distraction to limbs treated with opening-wedge high tibial osteotomy by hemicallotasis.

Methods: Twenty-one patients with symmetric grades of osteoarthritis and similar degrees of varus deformity in the two knees underwent bilateral one-stage opening-wedge high tibial osteotomy by hemicallotasis. After completion of distraction, the bone mineral density of the distraction callus was measured. Then, one randomly selected limb was subjected to ultrasound treatment for twenty minutes daily until removal of the external fixator. The contralateral limb was left untreated to serve as the control. After four weeks of treatment, bone mineral density was measured again.

Results: During the four-week treatment period, the mean increase in callus bone mineral density was significantly greater in the ultrasound-treated tibiae (0.20 ± 0.12 g/cm2) than in the control tibiae (0.13 ± 0.10 g/cm2) (p = 0.02, unpaired t test). In eighteen patients the increase in the bone mineral density was greater in the ultrasound-treated limb than in the control limb, whereas in three patients the increase was greater in the control limb.

Conclusions: We found that low-intensity pulsed ultrasound applied during the consolidation phase of distraction osteogenesis accelerates callus maturation after opening-wedge high tibial osteotomy by hemicallotasis in elderly patients.

Level of Evidence: Therapeutic study, Level I-1a (randomized controlled trial [significant difference]). See Instructions to Authors for a complete description of levels of evidence.


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