Geometrical Planning of the Medial Opening Wedge High Tibial Osteotomy—An Experimental Approach

Abstract

This article presents an experimental approach to the geometrical planning of the medial opening wedge high tibial osteotomy surgery which, as it is known, is an efficient surgical strategy quite widely used in treating knee osteoarthritis. While most of the published papers focus on analyzing this surgery from a medical point of view, we suggest a postoperative experimental evaluation of the intervention from a biomechanical point of view. The geometrical planning and, more specifically, the determination of the point of intersection between the corrected mechanical axis and the medial-lateral articular line of the knee, is a problem quite often debated in literature. This paper aims to experimentally investigate the behavior of the tibia with an open wedge osteotomy fixed with a locking plate, TomoFix (DE Puy Synthes), taking into account two positions of the mechanical axis of the leg on the width of the tibial plateau, measured from medial to lateral at 50% and 62.5% (Fujisawa point), respectively. The variations of the force relative to the deformation, strains, and displacements resulting from the progressive loading of the tibial plateau are studied. The research results reveal that using the Fujisawa point is better for conducting the correction not only for medical reasons, but also from a mechanical point of view.

A Computer-Assisted Approach Regarding the Optimization of the Geometrical Planning of Medial Opening Wedge High Tibial Osteotomy

“…Analyzing all these results, it can be stated that the optimum point, taking into account the three response functions analyzed, is the Fujisawa Point, which has equivalent reasonable stresses of 113.7 MPa in the tibia bone, 152.85 MPa in the TomoFix plate under the condition of a total deformation of 0.452 mm, quite close to the resulting minimum value. This is a numerical confirmation of the experimental results in the article [44].…”

Research on the Influence of the Allogeneic Bone Graft in Postoperative Recovery After MOWHTO: A Retrospective Study

“…The results of countless biomechanical studies in the later period proved once again that Fujisawa point is an excellent positioning point for correcting mechanical axis, which can effectively improve the stability of the lower limbs and reduce the incidence of delayed union. 8 , 9 On the other hand, a recent application of locking compression plates and the locking screw provided sufficient support for the axial stress and torsional stability of the osteotomy site after MOWHTO, which can reduce friction between the plate and the bone tissue lateral to the osteotomy site and helps to maintain the blood supply required for the osteotomy to heal itself from the inside out. 10 , 11 In addition, MOWHTO can also reduce post-operative complications such as delayed union, lateral hinge fractures, and loss of correction.…”