Titanium Versus Bioabsorbable Magnesium Headless Compression Screw Fixation for Tibial Tubercle Osteotomy

Purpose: This retrospective study aimed to compare the clinical and radiological outcomes of Fulkerson tibial tubercle osteotomy (TTO) fixed with either bioabsorbable magnesium (Mg) or titanium (Ti) headless compression screws, particularly focusing on the need for implant removal. Materials and Methods: 29 patients (19 Ti, 10 Mg screws) who underwent TTO between 2013 and 2023 were included. The primary outcome was implant removal; secondary outcomes included Kujala and Lysholm scores, complication rates, and radiographic union. Rehabilitation protocols were standardized, but early weight-bearing was delayed in the Mg group to mitigate potential implant degradation effects. Results: Both groups demonstrated significant improvements in Kujala and Lysholm Knee scores postoperatively, with no statistically significant differences between the groups. No cases of implant removal, fixation failure, nonunion, or significant range of motion loss were observed. Radiographically, persistent remnants of Mg screws were detected even after more than five years, raising concerns about incomplete bioabsorption. The Ti screws maintained mechanical stability without evidence of loss of fixation or the need for revision. Patient satisfaction and cosmetic outcomes were similar. Conclusion: The use of bioabsorbable Mg screws in TTO did not confer additional clinical or radiological benefits compared to headless Ti screws. Given the higher cost, the incomplete resorption observed at long-term follow-up, and the absence of an implant removal requirement in either group, the routine use of Mg screws cannot be recommended. Ti headless compression screws offer a cost-effective, reliable fixation method, achieving stable osteotomy healing without the need for secondary surgery.