Stress Effect in the Knee Joint Based on the Fibular Osteotomy Level and Varus Deformity: A Finite Element Analysis Study

Abstract

Proximal fibular osteotomy (PFO) was found to relieve pain and improve knee function in patients with medial compartment knee osteoarthritis (OA). Therapy redistributes the load applied from the inside to the outside and alleviates the load applied on the inside through fibula osteotomy. Therefore, the clinical effect of fibular osteotomy using the finite element (FE) method was evaluated to calculate the exact change in stress inside a knee joint with varus deformity. Using CT and MRI images of a patient’s lower extremities, 3D models of the bone, cartilage, meniscus, and ligaments were constructed. The varus angle, representing the inward angulation of the knee, was increased by applying a force ratio in the medial and lateral directions. The results showed that performing proximal fibular osteotomy led to a significant reduction in stress in the medial direction of the meniscus and cartilage. The stress reduction in the lateral direction was relatively minor. In conclusion, the study demonstrated that proximal fibular osteotomy effectively relieves stress and redistributes the load in the knee joints of patients with medial compartment knee osteoarthritis. The findings emphasize the importance of considering force distribution and the position of fibular osteotomy to achieve optimal clinical outcomes.

How effective is proximal fibular osteotomy in redistributing joint pressures? Insights from an HTO comparative in-silico study

“…This study is the first to compare these parameters in a preoperative original state model, a postoperative REHTO model, and a simulated PFO model. Compared to the few studies [19,20,54,55] that have utilized FEA to describe the effects of PFO on stress changes for KOA with varus deformity, this is the first to investigate the influence on CoP anatomical location after an in-silico PFO. Furthermore, such effects have never been compared to clinically intervened subjects using HTO as a treatment.…”

“…Ligaments were modeled to ensure proper contact conditions with the other structures, following the advice of one of the coauthors and based on the literature [47][48][49][50][51][52][53]. In addition, the proximal and distal anterior and posterior tibiofibular ligaments were constructed as 1D linear elements [54,55].…”

“…All bones were assumed to be 3D rigid bodies, homogeneous, isotropic, and linearly elastic [48,52]. In addition, ligaments were modeled as 1D linear elements [54,55] to represent their anisotropy [47,57].…”

How effective is proximal fibular osteotomy in redistributing joint pressures? Insights from an HTO comparative in-silico study

“…This study is the first to compare these parameters in a preoperative original state model, a postoperative HTO model, and a simulated PFO model. Compared to the few studies [ 22 , 23 , 56 , 57 ] that have utilized FEA to describe the effects of PFO on stress changes for KOA with varus deformity, this is the first to investigate the influence on CoP anatomical location after an in-silico PFO. Furthermore, such effects have never been compared to clinically intervened patients using HTO as a treatment.…”

“…All bones were assumed to be 3D rigid bodies, homogeneous, isotropic, and linearly elastic [ 50 , 54 ]. In addition, ligaments were modeled as 1D linear elements [ 56 , 57 ] to represent their anisotropy [ 49 , 59 ].…”