A pilot hole does not reduce the strains or risk of fracture to the lateral cortex during and following a medial opening wedge high tibial osteotomy in cadaveric specimens

Bujnowski, K; Getgood, Alan; Leitch, Kristyn M.; Farr, Jack; Dunning, Cynthia E.; Burkhart, Timothy A.

doi:10.1302/2046-3758.72.bjr-2017-0337.r1

Cited by 13 publications

(12 citation statements)

References 23 publications

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“…Their results confirm that, for tibial varus correction osteotomies < 5°, drilling a hole at the end of the osteotomy reduces stresses in the lateral hinge and increases the critical angle before failure of the hinge but only for corrections inferior to 5°. Indeed, for osteotomies superior to 9 mm of opening in cadaveric specimens, Bujnowski et al [4] recently demonstrated that a pilot hole showed no significant decrease in the strains experienced at the lateral cortex, nor did it reduce the risk of fracture of the lateral tibial hinge. According to Diffo Kaze et al [6], the ductility of the cortical bone is the decisive parameter for the critical angle of opening, defined as the angle from which the tibial hinge breaks.…”

Section: Discussionmentioning

confidence: 99%

Adding a protective K-wire during opening high tibial osteotomy increases lateral hinge resistance to fracture

Dessyn

Sharma

Donnez

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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Purpose It was hypothesized in this in-vitro study that positioning a K-wire intersecting the cutting plane at the theoretical lateral hinge location would limit the cut depth and help preserve the lateral hinge during the opening of the osteotomy. Objectives were (1) to compare the mechanical resistance of the hinge and the protective effect of leaving the K-wire during the opening procedure (2) to check if the K-wire would limit the depth of the osteotomy. Methods An ex-vivo mechanical study, testing 5 pairs of fresh-frozen tibias, was designed. CT-scan based Patientspecific cutting guides were obtained to define the cutting plane and the location of the K-wire at the hinge, using standardized 3D planning protocol. In each pair, OWHTO was performed either with or without the K-wire. To evaluate the hinge's resistance to fracture, the specimens were rigidly fixed at the proximal tibia and a direct load was applied on the free tibial diaphysis to open the osteotomy. The maximum load at breakage, maximum permissible displacement and maximal angulation of the osteotomy before hinge failure was measured. To assess the preservation of an unscathed hinge (protected by the K-wire), the distance from the end of the osteotomy cut to the lateral tibial cortical was measured in mm. Results The maximum load to hinge breakage in the K-wires PsCG knees compared to the control group (48.3 N vs 5.5 N, p = 0.004), the maximum permissible displacement (19.8 mm vs 7.5 mm, p = 0.005) and the maximal angulation of the osteotomy before hinge breakage (9.9° vs 2.9°, p = 0.002) were all statistically superior in the K-wires PsCG knees compared to the control group. A mean distance of 10 ± 1 mm between cut-bone (saw-print) and lateral hinge cortical bone was found post-performing the osteotomy and the hinge failing. ConclusionThe maximum load to breakage and the maximum permissible displacement were, respectively, 880% and 260% higher during the opening of the OWHTO in using K-wires compared to the non-K-wire control group. This confirms the mechanical advantage of using a K-wire for both stabilization and protecting the Hinge during OWHTO. This comparative cadaveric study shows an improvement of the lateral hinges resistance to failing during the opening of the osteotomy. This can be achieved by the placement of a K-wire intersecting the cutting plane at the theoretical location of the lateral hinge.

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Section: Discussionmentioning

confidence: 99%

Adding a protective K-wire during opening high tibial osteotomy increases lateral hinge resistance to fracture

Dessyn

Sharma

Donnez

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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“…In addition, the difference of having a drill hole or not at the end of a horizontal osteotomy was investigated, and the effect on reducing the risk of lateral cortex fracture was not significant, especially for older patients [64]. A cadaveric experiment produces similar conclusions that there was no significant difference in the strains on the lateral cortex during OWHTO between the pilot hole and no-hole conditions [65].…”

Section: Fixation Platementioning

confidence: 99%

High Tibial Osteotomy: Review of Techniques and Biomechanics

Liu

Chen

Gao

et al. 2019

Journal of Healthcare Engineering

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High tibial osteotomy becomes increasingly important in the treatment of cartilage damage or osteoarthritis of the medial compartment with concurrent varus deformity. HTO produces a postoperative valgus limb alignment with shifting the load-bearing axis of the lower limb laterally. However, maximizing procedural success and postoperative knee function still possess many difficulties. The key to improve the postoperative satisfaction and long-term survival is the understanding of the vital biomechanics of HTO in essence. This review article discussed the alignment principles, surgical technique, and fixation plate of HTO as well as the postoperative gait, musculoskeletal dynamics, and contact mechanics of the knee joint. We aimed to highlight the recent findings and progresses on the biomechanics of HTO. The biomechanical studies on HTO are still insufficient in the areas of gait analysis, joint kinematics, and joint contact mechanics. Combining musculoskeletal dynamics modelling and finite element analysis will help comprehensively understand in vivo patient-specific biomechanics after HTO.

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“…The osteotomy fixation plate experiences greater stresses and strains in the presence of fracture increasing the possibility of fatigue failure especially in delayed union 10. The effect of an apical drill hole in opening wedge HTO has been investigated previously in an experimental biomechanical model, though Bujnowski et al18 concluded no benefit in terms of cortical strain reduction or risk of lateral fracture in a cadaveric study of 14 paired specimens. Only one diameter of the drill hole was investigated and the cortical strain was measured at a single location using a single strain gauge.…”

mentioning

confidence: 99%

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

Boström

Amin

Macpherson

et al. 2020

Journal Orthopaedic Research

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At the time of medial opening wedge high tibial osteotomy (HTO) to realign the lower limb and offload medial compartment knee osteoarthritis, unwanted fractures can propagate from the osteotomy apex. The aim of this study was to use finite element (FE) analysis to determine the effect of hinge location and apical drill holes on cortical stresses and strains in HTO. A monoplanar medial opening wedge HTO was created above the tibial tuberosity in a composite tibia. Using the FE method, intact lateral hinges of different widths were considered (5, 7.5, and 10 mm). Additional apical drill holes (2, 4, and 6 mm diameters) were then incorporated into the 10 mm hinge model. The primary outcome measure was the maximum principal strain in the cortical bone surrounding the hinge axis. Secondary outcomes included the force required for osteotomy opening, minimum principal strain, and mean cortical bone stresses (maximum principal/minimum principal/von Mises). Larger intact hinges (10 mm) were associated with higher cortical bone maximum principal strain and stress, lower minimum principal strain/stress, and required greater force to open. Lateral cortex strain concentrations were present in all scenarios, but extended to the joint surface with the 10 mm hinge. Apical drill holes reduced the mean cortical bone maximum principal strain adjacent to the hinge axis: 2 mm hole 6% reduction; 4 mm 35% reduction; and 6 mm 55% reduction. Incorporating a 4‐mm apical drill hole centered 10 mm from the intact lateral cortex maintains a cortical bone hinge, minimizes cortical bone strains and reduces the force required to open the HTO; thus improving control.

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A pilot hole does not reduce the strains or risk of fracture to the lateral cortex during and following a medial opening wedge high tibial osteotomy in cadaveric specimens

Cited by 13 publications

References 23 publications

Adding a protective K-wire during opening high tibial osteotomy increases lateral hinge resistance to fracture

Adding a protective K-wire during opening high tibial osteotomy increases lateral hinge resistance to fracture

High Tibial Osteotomy: Review of Techniques and Biomechanics

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

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