Is structural hydroxyapatite tricalcium-phosphate graft or tricortical iliac crest autograft better for calcaneal lengthening osteotomy in childhood? interim results from a randomised, controlled non-inferiority study

Bone Joint J. 2016 Nov;98-B(11):1554-1562. doi: 10.1302/0301-620X.98B11.BJJ-2016-0095.R1.


Aims: To compare the structural durability of hydroxyapatite-tricalcium phosphate (HATCP) to autologous iliac crest bone graft in calcaneal lengthening osteotomy (CLO) for pes planovalgus in childhood.

Patients and methods: We present the interim results of ten patients (HATCP, n = 6 and autograft, n = 5) with a mean age of 11.5 years (8.2 to 14.2) from a randomised controlled non-inferiority trial with six months follow-up. The primary outcome was the stability of the osteotomy as measured by radiostereometric analysis. A non-inferiority margin of ≤ 2 mm osteotomy compression was set.

Results: At six months the data showed that the osteotomy had been compressed by a mean 1.97 mm (99.8% confidence interval -1.65 to 5.60) more in the HATCP group than in the autograft group. Migration of the CLO grafted with HATCP stabilised at six months rather than at six weeks with autograft.

Conclusion: This is the first randomised trial to compare the efficacy of HATCP graft with autograft in terms of stability of CLO in children. Because of problems with the HATCP the trial was stopped. We do not recommend HATCP graft in its current structure for use in unfixed CLOs. Cite this article: Bone Joint J 2016;98-B:1554-62.

Keywords: Autograft; Calcaneal lengthening; Planovalgus; Radiostereomteric analysis; Tricalciumphosphate hydroxyapatite; randomised controlled trial.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Bone Lengthening / adverse effects
  • Bone Lengthening / methods
  • Bone Substitutes / adverse effects
  • Bone Substitutes / therapeutic use*
  • Bone Transplantation / methods
  • Calcaneus / surgery
  • Child
  • Child, Preschool
  • Female
  • Flatfoot / diagnostic imaging
  • Flatfoot / surgery*
  • Humans
  • Hydroxyapatites / adverse effects
  • Hydroxyapatites / therapeutic use*
  • Ilium / transplantation*
  • Male
  • Osteotomy / adverse effects
  • Osteotomy / methods*
  • Pain, Postoperative
  • Radiostereometric Analysis / methods
  • Treatment Outcome


  • Bone Substitutes
  • Hydroxyapatites
  • hydroxyapatite-beta tricalcium phosphate