Design optimization of high tibial osteotomy plates using finite element analysis for improved biomechanical effect

Koh, Yong‐Gon; Lee, Jin Ah; Lee, Hwa Yong; Chun, Hye‐Yeong; Kim, Hyo Jeong; Kang, Kyoung‐Tak

doi:10.1186/s13018-019-1269-8

Cited by 30 publications

(21 citation statements)

References 49 publications

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“…Third, we evaluated patients with OA after the removal of metal components. Finite element analysis has been used to demonstrate the stress shielding effect of the HTO plate on the bone around the plate 22 ; however, the mechanisms underlying this effect on the articular surface are unclear. Moreover, regardless of the stress shielding effect of the HTO plate, this study reveals that the distribution of subchondral bone density differs significantly before and 1.5 years after HTO.…”

Section: Discussionmentioning

confidence: 99%

Effect of High Tibial Osteotomy on the Distribution of Subchondral Bone Density Across the Proximal Tibial Articular Surface of the Knee With Medial Compartment Osteoarthritis

et al. 2021

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Background: The effect of high tibial osteotomy (HTO) on the stress distribution across the knee joint is not completely understood. Subchondral bone density is considered to reflect the pattern of stress distribution across a joint surface. Purpose: To assess the distribution of subchondral bone density across the proximal tibia in nonarthritic knees and in the knees of patients with osteoarthritis (OA) before and after HTO. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively collected radiological and computed tomography data from 16 patients without OA (control group) and 17 patients with OA. Data from the OA group were collected before and 1.5 years after HTO. Subchondral bone density of the proximal tibia was assessed with computed tomography–osteoabsorptiometry. The locations and percentages represented by high-density areas (HDAs) on the articular surface were quantitatively analyzed. Results: The ratio of the HDA of the medial compartment to the total HDA (medial ratio) was significantly higher in the preoperative OA group (mean, 80.1%) than in the control group (61.3%) ( P < .001). After HTO, the medial ratio decreased significantly to 75.1% ( P = .035 in comparison with preoperative values) and was significantly correlated with the hip-knee-ankle angle in both groups: control ( r = −0.551; P = .033) and OA ( r = −0.528; P = .043). The change in medial ratio after HTO was significantly correlated with the change in hip-knee-ankle angle ( r = 0.587; P = .035). In the medial compartment, the HDA in the most lateral region of 4 subregions increased after HTO, but that in 3 medial subregions decreased. Conclusion: In this exploratory study, HTO shifted the HDA of the medial compartment of the proximal tibial articular surface toward the lateral compartment. In contrast, the HDA of the most lateral region of the medial compartment increased after HTO. This change in subchondral bone density may result from the change in stress distribution.

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Section: Discussionmentioning

confidence: 99%

Effect of High Tibial Osteotomy on the Distribution of Subchondral Bone Density Across the Proximal Tibial Articular Surface of the Knee With Medial Compartment Osteoarthritis

et al. 2021

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“…In addition, the 3D models were simplified with the use of pins instead of screws. This modification has also been used in past OWHTO studies with FEA [ 25 ]. Third, the osteotomy was not biplanar but monoplanar.…”

Section: Discussionmentioning

confidence: 99%

Monocortical fixation for locking plate distal screws does not impair mechanical properties in open-wedge high tibial osteotomy

Itou

Kuwashima

Itoh

et al. 2021

BMC Musculoskelet Disord

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Background The neurovascular bundle containing the deep peroneal nerve has a potential risk of injury during open-wedge high tibial osteotomy (OWHTO), particularly due to drilling for bicortical fixation at distal screw holes. Therefore, monocortical fixation is recommended for distal fixation of a long locking plate as long as good stability is ensured. The purpose of this study was to analyse the biomechanical properties of monocortical fixation of distal locking screws for OWHTO. Methods Three-dimensional models of bone and fixation materials simulating OWHTO were created using computed tomographic data of patients and material data of a T-shaped long locking plate and screws. Three of the four distal screws of the locking plate were chosen for a bicortical fixation or monocortical fixation procedure. In addition, loss of correction was assessed by measuring the medial proximal tibial angle (MPTA) in patients who underwent OWHTO with two bicortical and two monocortical distal fixation screws at 1 month and 1 year after surgery. Results No significant differences in stress were observed in either the normal or osteoporotic bone model between the monocortical and bicortical fixation models, including in the area of the lateral hinge at the osteotomy site. Furthermore, there were no significant differences in MPTA between the early post-operative period and 1-year follow-up. Conclusions The monocortical fixation method for three distal screws of the locking plate did not worsen the mechanical properties of fixation for OWHTO using a long locking plate with four proximal and four distal screws. In actual surgery, the number of distal bicortical screws should be reduced based on the patient’s condition, taking into account the risk of lateral hinge fracture and unexpected surgical complications. Using at least two bicortical screws would be practical considering the various factors related to reduced fixing ability.

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“…The elastic modulus of bone voxels were ranged from 5000 to 17,000 MPa, for cancellous and cortical bone, respectively, according to their HU numbers, with a constant Poisson’s ratio of 0.33. 16,22,23 The plate and screws were assumed to be made from Ti-6Al-4V alloy with modulus of elastic and Poisson’s ratio of 110,000 MPa and 0.37, respectively. 23,25…”

Section: Methodsmentioning

confidence: 99%

“…Similarly, for modeling the engagement of the bone and screw shafts, surface-to-surface contact conditions with a friction coefficient of 0.4 were considered. 16,25 Finally, for locking screws, the interface between screw heads and plate was bonded using tie contact condition, assuming a perfect lock between the screw heads and the threaded holes of the plate. 23…”

Section: Methodsmentioning

confidence: 99%

“…The advantages and shortcomings of the plate adapting techniques, raises the question that “what level of geometrical fit with the underlying bone is appropriate for a HTO locking plate fixation?” The previous studies on the biomechanics of the HTO fixation have often neglected this question and focused on the effects of different plate designs, for example, Puddu (Arthrex Ltd, Naples, FL, USA), 16–18 Tomofix (Arthrex Ltd, Naples, FL, USA), 16–28 Limmed, 29 Activemotion (Newclip Technics, Haute-Goulaine, France), 26 iBalance (Arthrex, Munich, Germany), 24,26 Contour Lock (Arthrex, Munich, Germany), 24,26 PEEKPower (Arthrex, Munich, Germany), 20,24,26 and LCfit (Corentec, Cheonan-si, South Korea), 23 as well as the screw types 19,22,25,30 and configurations, 27 on the fixation stability. In fact, we found only a single study 31 addressing the influence of plate contouring on the biomechanical performance of the HTO fixation.…”

Section: Introductionmentioning

confidence: 99%

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Effects of plate contouring quality on the biomechanical performance of high tibial osteotomy fixation: A parametric finite element study

Hayatbakhsh

Farahmand

2022

Proc Inst Mech Eng H

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Locking plates have threaded holes, in which threaded-head screws are affixed. Hence, they do not need to be in intimate contact with underlying bone to provide fixation. There are, however, reports that a large distance between the plate and the bone might cause clinical complications such as delayed union or nonunion, screw pull out, and screw and plate breakage. Considering the diversity in the capabilities and costs of different plate customization techniques, the purpose of this study was to investigate the effect of the plate contouring quality on the biomechanical performance of high tibial osteotomy (HTO) fixation. A finite element model of proximal tibia was developed in Abaqus, using the QCT data of a cadaver. The model was then subjected to open-wedge HTO (correction angle 12°) with TomoFix plate fixation. The sagittal curvature of the plate was changed parametrically to provide certain levels of geometrical fit, and the biomechanical performance parameters of fixation were assessed. Results indicated 5%, 9% and 38% increase in the stiffness of the construct, and the von Mises stress in the plate and locking screw just above the osteotomy site, respectively, when the level of fit of plate changed from 0% (initial non-contoured initial shape) to 100% (fully adapted shape). The same change decreased the pressure at the lateral hinge of the osteotomy by 61%, and the mean of the tensile stress on the screw shaft by 12%. It was concluded that the level of fit has conflicting effects on the biomechanical parameters of the HTO fixation system, that is, the structural stiffness, the pressure at the lateral hinge, the stresses in the plate and screws, and the pull out resistance of the screws. In particular, for HTO patients with high quality bone, the optimal level of fit should provide a tradeoff between these parameters.

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Design optimization of high tibial osteotomy plates using finite element analysis for improved biomechanical effect

Cited by 30 publications

References 49 publications

Effect of High Tibial Osteotomy on the Distribution of Subchondral Bone Density Across the Proximal Tibial Articular Surface of the Knee With Medial Compartment Osteoarthritis

Effect of High Tibial Osteotomy on the Distribution of Subchondral Bone Density Across the Proximal Tibial Articular Surface of the Knee With Medial Compartment Osteoarthritis

Monocortical fixation for locking plate distal screws does not impair mechanical properties in open-wedge high tibial osteotomy

Effects of plate contouring quality on the biomechanical performance of high tibial osteotomy fixation: A parametric finite element study

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