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Biomechanical evaluation of combined proximal tibial osteotomy for varus knee osteoarthritis implanted novel designed plate system: Finite element analysis

  • Gaiping Zhao
    Correspondence
    Corresponding author at: Gaiping Zhao. School of Health Science and Engineering, University of Shanghai for Science and Technology, 516 Jungong Road, Yangpu District, Shanghai 200093, China.
    Affiliations
    School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
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  • Dongyan Li
    Affiliations
    School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
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  • Weiping Ji
    Correspondence
    Corresponding author at: Weiping Ji. Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Xuhui District, Shanghai 200233, China.
    Affiliations
    Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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  • Congfeng Luo
    Affiliations
    Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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      Abstract

      Background

      Combined proximal tibial osteotomy (CPTO) is an innovative and effective procedure for correcting varus knee osteoarthritis (VKOA) with intra- and extra-articular deformity. Here, we designed a novel internal fixation plate system for CPTO and assessed the biomechanical strength of the bone-implant.

      Methods

      Our newly designed CPTO internal fixation plate system included a specialized plate shape, combination holes, locking screw holes, screw position, and size of fixation. The biomechanical performance of this plate system in CPTO treatment was compared via finite element analysis (FEA) to traditional Tomofix devices implanted in the opening-wedge high tibial osteotomy (OWHTO), tibial condylar valgus osteotomy (TCVO), and CPTO.

      Results

      The tibial wedge stiffness and displacement after CPTO implantation of the novel internal plate fixation increased by 9.6%, which was -65% higher than the CPTO with the Tomofix system. The average stress of the bone, plate, and screws in the CPTO implanted the novel designed plate system compared to the Tomofix system decreased by 12.7%, 1.9%, and 20.3 %, respectively. The device maximum stress and wedge stiffness after CPTO with the novel plate system versus traditional OWHTO and TCVO with the Tomofix system were 255.7 MPa, 204 MPa, 130.4 MPa, and 678.9 N/mm, 660.3 N/mm, 1626.0 N/mm, respectively.

      Conclusions

      The novel internal fixation plate system usage during CPTO exhibited similar bone-implant biomechanical strength, compared to OWHTO, but with enhanced construct stability.

      Keywords

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      References

        • Park H-J
        • Kim SS
        • Lee S-Y
        • Park N-H
        • Park J-Y
        • Choi Y-J
        • et al.
        A practical MRI grading system for osteoarthritis of the knee: Association with Kellgren-Lawrence radiographic scores.
        Eur J Radiol. 2013; 82: 112-117
        • Zhang H
        • Fan Y
        • Wang R
        • Feng W
        • Chen J
        • Deng P
        • et al.
        Research trends and hotspots of high tibial osteotomy in two decades (from 2001 to 2020): a bibliometric analysis.
        J Orthopaed Surg Res. 2020; : 15
        • Teramoto T.
        Controversy of high tibial osteotomy.
        J Limb Lengthening Reconstruct. 2015; 1
        • Takeuchi R
        • Ishikawa H
        • Aratake M
        • Bito H
        • Saito I
        • Kumagai K
        • et al.
        Medial Opening Wedge High Tibial Osteotomy With Early Full Weight Bearing.
        Arthroscopy. 2009; 25: 46-53
        • Dowd GSE
        • Somayaji HS
        • Uthukuri M.
        High tibial osteotomy for medial compartment osteoarthritis.
        Knee. 2006; 13: 87-92
        • Amis AA.
        Biomechanics of high tibial osteotomy.
        Knee Surg Sports Traumatol Arthrosc. 2013; 21: 197-205
        • Koseki H
        • Yonekura A
        • Horiuchi H
        • Noguchi C
        • Higuchi T
        • Osaki M.
        L-shaped tibial condylar valgus osteotomy for advanced medial knee osteoarthritis: A case report.
        Biomed Res. 2017; 28: 4878-4882
        • Ji W
        • Luo C
        • Zhan Y
        • Xie X
        • He Q
        • Zhang B.
        A residual intra-articular varus after medial opening wedge high tibial osteotomy (HTO) for varus osteoarthritis of the knee.
        Arch Orthop Trauma Surg. 2019; 139: 743-750
        • Chiba K
        • Yonekura A
        • Miyamoto T
        • Osaki M
        • Chiba G.
        Tibial condylar valgus osteotomy (TCVO) for osteoarthritis of the knee: 5-year clinical and radiological results.
        Arch Orthop Trauma Surg. 2017; 137: 303-310
        • Gray HA
        • Zavatsky AB
        • Taddei F
        • Cristofolini L
        • Gill HS.
        Experimental validation of a finite element model of a composite tibia.
        Proc Instit Mech Eng Part H. 2007; 221: 315-324
        • Cheng C-T
        • Luo C-A
        • Chen Y-C.
        Biomechanical effects of screw orientation and plate profile on tibial condylar valgus osteotomy-Finite-element analysis.
        Comput Meth Biomech Biomed Eng. 2020; 23: 906-913
        • Izaham RMAR
        • Kadir MRA
        • Rashid AHA
        • Hossain MG
        • Kamarul T.
        Finite element analysis of Puddu and Tomofix plate fixation for open wedge high tibial osteotomy.
        Injury. 2012; 43: 898-902
        • Koh Y-G
        • Lee J-A
        • Lee H-Y
        • Chun H-J
        • Kim H-J
        • Kang K-T.
        Design optimization of high tibial osteotomy plates using finite element analysis for improved biomechanical effect.
        J Orthopaed Surg Res. 2019; : 14
        • Kimsal J
        • Mercer D
        • Schenck R
        • DeCoster T
        • Bozorgnia S
        • Fitzpatrick J
        • et al.
        Finite element analysis of plate-screw systems used in medial opening wedge proximal tibial osteotomies.
        Int J Biomed Eng Technol. 2015; 19: 154-168
        • Luo C-A
        • Hwa S-Y
        • Lin S-C
        • Chen C-M
        • Tseng C-S.
        Placement-induced effects on high tibial osteotomized construct - biomechanical tests and finite-element analyses.
        Bmc Musculoskel Disorders. 2015; : 16
        • Ji W
        • Luo C
        • Zhan S
        • Zhan Y
        • Xie X
        • Zhang B.
        Combined proximal tibial osteotomy for varus osteoarthritis of the knee: Biomechanical tests and finite-element analyses.
        Knee. 2020; 27: 863-870
        • Staubli AE
        • De Simoni C
        • Babst R
        • Lobenhoffer P.
        TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia–early results in 92 cases.
        Injury. 2003; 34 (Suppl): B55-B62
        • Jung WH
        • Chun CW
        • Lee JH
        • Ha JH
        • Kim JH
        • Jeong JH.
        Comparative Study of Medial Opening-Wedge High Tibial Osteotomy Using 2 Different Implants.
        Arthroscopy. 2013; 29: 1063-1071
        • Luo C-A
        • Hua S-Y
        • Lin S-C
        • Chen C-M
        • Tseng C-S.
        Stress and stability comparison between different systems for high tibial osteotomies.
        Bmc Musculoskel Disorders. 2013; : 14
        • Kang K-T
        • Koh Y-G
        • Lee J-A
        • Lee JJ
        • Kwon SK.
        Biomechanical effect of a lateral hinge fracture for a medial opening wedge high tibial osteotomy: finite element study.
        J Orthopaed Surg Res. 2020; : 15
        • Taylor WR
        • Heller MO
        • Bergmann G
        • Duda GN.
        Tibio-femoral loading during human gait and stair climbing.
        J Orthop Res. 2004; 22: 625-632
        • Stoffel K
        • Stachowiak G
        • Kuster M.
        Open wedge high tibial osteotomy: Biomechanical investigation of the modified Arthrex Steotomy Plate (Puddu Plate) and the TomoFix Plate.
        Clin Biomech. 2004; 19: 944-950
        • Itou J
        • Itoh M
        • Maruki C
        • Tajimi T
        • So T
        • Kuwashima U
        • et al.
        Deep peroneal nerve has a potential risk of injury during open-wedge high tibial osteotomy.
        Knee Surg Sports Traumatol Arthrosc. 2020; 28: 1372-1379
        • Mehboob A
        • Chang S-H.
        Effect of initial micro-movement of a fracture gap fastened by composite prosthesis on bone healing.
        Compos Struct. 2019; : 226
        • Schueller M
        • Weninger P
        • Tschegg E
        • Jamek M
        • Redl H
        • Stanzl-Tschegg S.
        Micromotion at the Fracture Site After Tibial Nailing With Four Unreamed Small-Diameter Nails-A Biomechanical Study Using a Distal Tibia Fracture Model.
        J Trauma-Injury Infect Crit Care. 2009; 66: 1391-1397
        • Kazimoglu C
        • Akdogan Y
        • Sener M
        • Kurtulmus A
        • Karapinar H
        • Uzun B.
        Which is the best fixation method for lateral cortex disruption in the medial open wedge high tibial osteotomy? A biomechanical study.
        Knee. 2008; 15: 305-308