Hinge location and apical drill holes in opening wedge high tibial osteotomy: A finite element analysis

Boström, Anna; Amin, Anish K.; Macpherson, Gavin; Pankaj, Pankaj; Scott, Chloe E H

doi:10.1002/jor.24704

Cited by 11 publications

(21 citation statements)

References 31 publications

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“…The maximum principal stress in heterogeneous and homogeneous models with cortical modulus of 16,700 MPa and different cancellous elastic moduli of 155, 500, 2130, and 5000 MPa at the 10 mm wedge opening (blue column represents heterogeneous bone model, green and yellow columns represent cortical and cancellous bone model, respectively, and purple column, used for Bostrom’s study). 8 …”

Section: Resultsmentioning

confidence: 99%

“…The cutting direction on the lateral side was osteotomized up to the tibiofibular joint, 33 and a hinge length of 10 mm was used. 1,8,33,34…”

Section: Methodsmentioning

confidence: 99%

“…A tie command bonded two mating surfaces together to prevent any relative motion between them. The elastic moduli used for homogeneous modeling HTO were presented in rows 1–5 of Table 1 7–11 . Based on the modulus incorporated in earlier studies, an elastic modulus of 16,700 MPa was used for the cortical bone in all four homogeneous model cases.…”

Section: Methodsmentioning

confidence: 99%

“…Based on the modulus incorporated in earlier studies, an elastic modulus of 16,700 MPa was used for the cortical bone in all four homogeneous model cases. The effects of cancellous elastic moduli of 5000, 7,11,37,38 2130, 9,10 500, 42,43 and 155 MPa 8 were investigated on the stress distribution and opening force amount.…”

Section: Methodsmentioning

confidence: 99%

“…These models applied the elastic modulus of 16,700 or 17,000 MPa for the cortical bone but utilized a range of different moduli of 155–5000 MPa for the cancellous bone. 7–11,18,19…”

Section: Introductionmentioning

confidence: 99%

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Homogeneous material models can overestimate stresses in high tibial osteotomy: A finite element analysis

Saghaei

Hashemi

2023

Proc Inst Mech Eng H

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Although widely used numerical models can assess the stability of lateral hinges in high tibial osteotomy (HTO) and may provide acceptable results in comparative studies, accurate stress prediction may not be possible due to simplified homogeneous models of the bone. The present study aimed to investigate the effect of a heterogeneous versus four homogeneous models on the results of stress and force. Each of the four homogenized FE models utilized the same elastic modulus of 16,700 MPa for the cortical while employing a single elastic modulus varying from 155 to 5000 MPa for the cancellous. In heterogeneous model, the modulus of each element was assigned using the bone density. It was found that stresses at the hinge in homogeneous models were higher than those in the heterogeneous model. The maximum principal stress (MPS) was 437 MPa for the heterogeneous model while that was 2179, 2351, 2581, and 2637 MPa for the homogeneous models with the elastic moduli of 155, 500, 2130, and 5000 MPa, respectively. Also, the opening force was 150 N for the heterogeneous model significantly lower than 649–1534 N range predicted for the homogeneous models. The use of a homogeneous model in the FE analysis of HTO overestimated the stresses and force. Thus, in addition to casting doubt on the use of a single modulus in the numerical analysis of HTO, Future HTO studies can use our results as a benchmark for comparison purposes and highlight the use of patient-specific bone density – elastic modulus relation in simulation.

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Section: Resultsmentioning

confidence: 99%

“…The cutting direction on the lateral side was osteotomized up to the tibiofibular joint, 33 and a hinge length of 10 mm was used. 1,8,33,34…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…These models applied the elastic modulus of 16,700 or 17,000 MPa for the cortical bone but utilized a range of different moduli of 155–5000 MPa for the cancellous bone. 7–11,18,19…”

Section: Introductionmentioning

confidence: 99%

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Homogeneous material models can overestimate stresses in high tibial osteotomy: A finite element analysis

Saghaei

Hashemi

2023

Proc Inst Mech Eng H

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Setting hinge position distal to the proximal margin of the distal lateral femur reduces the maximum principal strains of the hinge area and risk of hinge fractures

Tanaka,

Matsushita,

Nakatsuji

et al. 2024

J. exp. orthop.

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PurposeThe optimal hinge position to prevent hinge fractures in medial closing wedge distal femoral osteotomy (MCWDFO) based on the biomechanical background has not yet been well examined. This study aimed to examine the appropriate hinge position in MCWDFO using finite element (FE) analysis to prevent hinge fractures.MethodsComputer‐aided design (CAD) models were created using composite replicate femurs. FE models of the MCWDFO with a 5° wedge were created with three different hinge positions: (A) 5 mm proximal to the proximal margin of the lateral epicondylar region, (B) proximal margin level and (C) 5 mm distal to the proximal margin level. The maximum and minimum principal strains in the cortical bone were calculated for each model. To validate the FE analysis, biomechanical tests were performed using composite replicate femurs with the same hinge position models as those in the FE analysis.ResultsIn the FE analysis, the maximum principal strains were in the order of Models A > B > C. The highest value of maximum principal strain was observed in the area proximal to the hinge. In the biomechanical test, hinge fractures occurred in the area proximal to the hinge in Models A and B, whereas the gap closed completely without hinge fractures in Model C. Fractures occurred in an area similar to where the highest maximal principal strain was observed in the FE analysis.ConclusionDistal to the proximal margin of the lateral epicondylar region is an appropriate hinge position in MCWDFO to prevent hinge fractures.Level of EvidenceLevel V.

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Finite element analysis confirms the optimal apex position in medial opening wedge high tibial osteotomy to avoid lateral hinge fracture

Osmani,

Gupta,

Earl

et al. 2024

J. exp. orthop.

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PurposeLateral hinge fracture is a significant complication of medial opening wedge high tibial osteotomy. While fracture risk is closely associated with the osteotomy apex position, the optimum position remains variable within the literature. Our hypothesis is that stresses at the osteotomy apex predicted by finite element analysis can be used to identify an apex position which minimises intra and postoperative fracture risks.MethodsA finite element model was studied to investigate the effect of varying the hinge position on fracture risk and severity for a given bone geometry; variables analysed included stress, strain and micromotion levels. Nine further knee models were studied to assess the variability between patients' bone properties and examine the effect of apex location on strains.ResultsLateral hinge width and height significantly influence intra‐operative stress, strain, and fracture risk, while hinge width predominately determines postoperative stability. Wider hinges improve postoperative stability, but increase the likelihood of intra‐articular fractures. Aiming the apex at the fibular head height minimises strain. The osteotomy apex should be located such that the hinge width is equal to 13% of the medial‐lateral width to minimise apex stress and fracture risk while preserving sufficient bone at the hinge for stability. The height of the apex from the tibial plateau should maintain a minimum value of 16% of the medial‐lateral width to avoid intra‐articular fracture, with the apex below the fibula head if necessary. The size of the tibia does not alter the optimal location, making our findings applicable across all tibia sizes.ConclusionsOur study has investigated and verified a proposed optimal apex position, based upon fracture risk prediction and micromotion at the osteotomy apex. This is clinically useful due to the potential use of the apex point on preoperative 2D radiographs when planning surgery.Level of EvidenceNot applicable.

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Hinge location and apical drill holes in opening wedge high tibial osteotomy: A finite element analysis

Cited by 11 publications

References 31 publications

Homogeneous material models can overestimate stresses in high tibial osteotomy: A finite element analysis

Homogeneous material models can overestimate stresses in high tibial osteotomy: A finite element analysis

Setting hinge position distal to the proximal margin of the distal lateral femur reduces the maximum principal strains of the hinge area and risk of hinge fractures

Finite element analysis confirms the optimal apex position in medial opening wedge high tibial osteotomy to avoid lateral hinge fracture

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