Accuracy and initial stability of open- and closed-wedge high tibial osteotomy: a cadaveric RSA study

Gaasbeek, Robert D.A.; Welsing, Roy T. C.; Verdonschot, Nico; Rijnberg, W. J.; Loon, C. J. M. van; Kampen, A. van

doi:10.1007/s00167-004-0599-0

Cited by 31 publications

(24 citation statements)

References 16 publications

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“…We aimed to evaluate the intra-operative imaging in one type of surgery; the open wedge valgus HTO, and compared it with the were evaluated as not to bias the results by using different operating techniques and set-ups, and also because the postoperative loss of correction has been shown to differ between open and closed wedge osteotomies [15,16]. We aimed to evaluate the final radiographic outcome after placing the intra-operative mechanical axis on the lateral tibial eminence and to evaluate whether there is a loss of correction in the postoperative phase.…”

Section: Introductionmentioning

confidence: 99%

The value of the intra-operative clinical mechanical axis measurement in open-wedge valgus high tibial osteotomies

2012

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Section: Introductionmentioning

confidence: 99%

The value of the intra-operative clinical mechanical axis measurement in open-wedge valgus high tibial osteotomies

2012

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“…Osteotomies fixated with these plates offer superior initial stability compared to other medial fixation plates and equal stability compared to similar plates used for CW-HTO (Gaasbeek et al 2005, Agneskirchner et al 2006). With these implants, immediate full weight bearing appears to be possible (Takeuchi et al 2008, 2009).…”

Section: Introductionmentioning

confidence: 99%

Early full weight bearing is safe in open-wedge high tibial osteotomy

Brinkman¹,

Luites²,

Wymenga³

et al. 2010

Acta Orthopaedica

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Background and purpose In open-wedge, valgus osteotomy of the upper tibia, there are concerns regarding the initial stability and ability to retain the correction. Rehabilitation protocols vary depending on the osteotomy technique and the fixation method. Angle-stable implants offer superior initial stability. Early full weight bearing appears to be possible using these implants. In this prospective cohort study, we measured migration in open-wedge osteotomy in patients following an early full weight bearing protocol and compared the results to those from a historical cohort of open-wedge osteotomy patients who followed a standard protocol (full weight bearing after 6 weeks) using radiostereometry.Methods 14 open-wedge osteotomies fixated with the angle-stable Tomofix implant were performed; patients were allowed full weight bearing as soon as pain and wound healing permitted. Radiostereometry was used to measure motion across the osteotomy at regular intervals. Improvement in pain and functional outcome were assessed postoperatively. The results were compared to those from a group of 23 patients who had undergone the same operation but had used a standard rehabilitation protocol.Results There were no adverse effects because of the early full weight bearing protocol. There were no differences in motion at the osteotomy between groups as measured by radiostereometry. In both groups, pain and function improved substantially without any differences between groups. Patients in the early weight bearing group achieved the same result but in a shorter time.Interpretation Tomofix-plate-fixated open-wedge high tibial osteotomy allows early full weight bearing without loss of correction.

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“…Many HTO implants have been designed and traditionally, cadaver knee [5,6] and synthetic bone studies [7][8][9] have been used to investigate the primary stability of different plate designs. These studies have shown that longer plates with locking screws provide higher stability in both compression [5,7,9] and torsion [9] than shorter plates.…”

Section: Introductionmentioning

confidence: 99%

Assessing the Local Mechanical Environment in Medial Opening Wedge High Tibial Osteotomy Using Finite Element Analysis

Pauchard

Ivanov

McErlain

et al. 2015

Journal of Biomechanical Engineering

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High-tibial osteotomy (HTO) is a surgical technique aimed at shifting load away from one tibiofemoral compartment, in order the reduce pain and progression of osteoarthritis (OA). Various implants have been designed to stabilize the osteotomy and previous studies have been focused on determining primary stability (a global measure) that these designs provide. It has been shown that the local mechanical environment, characterized by bone strains and segment micromotion, is important in understanding healing and these data are not currently available. Finite element (FE) modeling was utilized to assess the local mechanical environment provided by three different fixation plate designs: short plate with spacer, long plate with spacer and long plate without spacer. Image-based FE models of the knee were constructed from healthy individuals (N = 5) with normal knee alignment. An HTO gap was virtually added without changing the knee alignment and HTO implants were inserted. Subsequently, the local mechanical environment, defined by bone compressive strain and wedge micromotion, was assessed. Furthermore, implant stresses were calculated. Values were computed under vertical compression in zero-degree knee extension with loads set at 1 and 2 times the subject-specific body weight (1 BW, 2 BW). All studied HTO implant designs provide an environment for successful healing at 1 BW and 2 BW loading. Implant von Mises stresses (99th percentile) were below 60 MPa in all experiments, below the material yield strength and significantly lower in long spacer plates. Volume fraction of high compressive strain ( > 3000 microstrain) was below 5% in all experiments and no significant difference between implants was detected. Maximum vertical micromotion between bone segments was below 200 μm in all experiments and significantly larger in the implant without a tooth. Differences between plate designs generally became apparent only at 2 BW loading. Results suggest that with compressive loading of 2 BW, long spacer plates experience the lowest implant stresses, and spacer plates (long or short) result in smaller wedge micromotion, potentially beneficial for healing. Values are sensitive to subject bone geometry, highlighting the need for subject-specific modeling. This study demonstrates the benefits of using image-based FE modeling and bone theory to fine-tune HTO implant design.

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Accuracy and initial stability of open- and closed-wedge high tibial osteotomy: a cadaveric RSA study

Cited by 31 publications

References 16 publications

The value of the intra-operative clinical mechanical axis measurement in open-wedge valgus high tibial osteotomies

The value of the intra-operative clinical mechanical axis measurement in open-wedge valgus high tibial osteotomies

Early full weight bearing is safe in open-wedge high tibial osteotomy

Assessing the Local Mechanical Environment in Medial Opening Wedge High Tibial Osteotomy Using Finite Element Analysis

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