Placement-induced effects on high tibial osteotomized construct - biomechanical tests and finite-element analyses

Luo, Chuan; Hwa, Su‐Yang; Lin, Shang-Chih; Chen, Chun‐Ming; Tseng, Ching-Shiow

doi:10.1186/s12891-015-0630-2

Cited by 29 publications

(24 citation statements)

References 33 publications

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“…Accordingly, it can be deduced that the configuration (Figure 9) with a higher value of the reaction force (F) is more stable, and the one with a lower pressure (pmax) ensures reduced damage of the bone and, consequently, a higher stability of the implant. To obtain highly reliable numerical models, we set up the FEM models following a largely validated protocol [19,37,39]. Table 3 summarizes the main results obtained for each configuration analysed.…”

Section: Resultsmentioning

confidence: 99%

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Influence of the Screw Positioning on the Stability of Locking Plate for Proximal Tibial Fractures: A Numerical Approach

et al. 2020

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Tibial fractures are common injuries in people. The proper treatment of these fractures is important in order to recover complete mobility. The aim of this work was to investigate if screw positioning in plates for proximal tibial fractures can affect the stability of the system, and if it can consequently influence the patient healing time. In fact, a more stable construct could allow the reduction of the non-weight-bearing period and consequently speed up the healing process. For that purpose, virtual models of fractured bone/plate assemblies were created, and numerical simulations were performed to evaluate the reaction forces and the maximum value of the contact pressure at the screw/bone interface. A Schatzker type I tibial fracture was considered, and four different screw configurations were investigated. The obtained results demonstrated that, for this specific case study, screw orientation affected the pressure distribution at the screw/bone interface. The proposed approach could be used effectively to investigate different fracture types in order to give orthopaedists useful guidelines for the treatment of proximal tibial fractures.

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Section: Resultsmentioning

confidence: 99%

“…To obtain highly reliable numerical models, we set up the FEM models following a largely validated protocol [19,37,39]. Table 3 summarizes the main results obtained for each configuration analysed.…”

Section: Resultsmentioning

confidence: 99%

Influence of the Screw Positioning on the Stability of Locking Plate for Proximal Tibial Fractures: A Numerical Approach

et al. 2020

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“…14,32 Schröter et al 14 reported a screw failure rate of 6% using short spacer plates, and Nelissen et al 32 reported plate breakage in 6.1% of cases and broken screws in 7.5%. Further, Luo et al 33 demonstrated that wedge micro-motion of the anteriorly placed plate was larger than that of the medially placed plate. They also mentioned the potential risk of deterioration of wedge stiffness.…”

Section: Discussionmentioning

confidence: 99%

Radiographic Evaluation of Medial Opening-Wedge High Tibial Osteotomy Using a New Internal Fixator with a Wedge-Shaped Spacer Block

et al. 2020

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We developed a new internal fixator: a rigid T-shaped plate with locking screws and wedge-shaped spacer block for high tibial osteotomy. The purpose of the present study was to evaluate the radiographic outcome of opening-wedge high tibial osteotomy (OWHTO) using this new internal fixator. Sixty OWHTOs were performed in patients with medial compartment osteoarthritis and varus deformity (28 males and 23 females). Patients' mean age was 60.4 years. Preoperative and postoperative radiographs were obtained. The paired t-test was used to evaluate the differences over time with respect to radiographic variables. Union of the osteotomy gap was obtained in all patients, and no implant breakage was found. On anterior–posterior radiographs, a significant difference was observed (p < 0.01) between the preoperative and postoperative mean values of femorotibial angles (179.6 ± 3.2 vs. 170.6 ± 2.5 degrees), weight-bearing line ratios (23.8 ± 13.5 vs. 60.5 ± 11.5%), anatomical medial proximal tibial angles (84.8 ± 2.5 vs. 91.0 ± 2.6 degrees), and joint line coverage angles (3.6 ± 2.0 vs. 2.4 ± 1.7 degrees). On lateral radiographs, posterior tibial slopes were 11.5 ± 3.9 degrees preoperatively and 12.2 ± 4.0 degrees postoperatively (p < 0.01), and Insall–Salvati ratios were 1.04 ± 0.12 preoperatively and 1.06 ± 0.13 postoperatively (p = 0.24). Performing OWHTO using a new internal fixator with a wedge-shaped spacer achieves adequate correction of lower limb alignment without implant-related complications. This is a Level IV, case series study.

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“…Luo et al reported micromovements of the wedge, 420 μm opening versus 926 μm closing, with a TomoFix plate (Luo et al 2015 ). However, trabecular bone was considered in their model and the axial load that was applied on the tibia plateau was asymmetrical with a distribution of 40% on the lateral side.…”

Section: Discussionmentioning

confidence: 99%

Numerical comparative study of five currently used implants for high tibial osteotomy: realistic loading including muscle forces versus simplified experimental loading

et al. 2018

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BackgroundMany different fixation devices are used to maintain the correction angle after medial open wedge high tibial osteotomy (MOWHTO). Each device must provide at least sufficient mechanical stability to avoid loss of correction and unwanted fracture of the contralateral cortex until the bone heals. In the present study, the mechanical stability of following different implants was compared: the TomoFix small stature (sm), the TomoFix standard (std), the Contour Lock, the iBalance and the second generation PEEKPower. Simplified loading, usually consisting of a vertical load applied to the tibia plateau, is used for experimental testing of fixation devices and also in numerical studies. Therefore, this study additionally compared this simplified experimental loading with a more realistic loading that includes the muscle forces.MethodTwo types of finite element models, according to the considered loading, were created. The first type numerically simulated the static tests of MOWHTO implants performed in a previous experimental biomechanical study, by applying a vertical compressive load perpendicularly to the plateau of the osteotomized tibia. The second type included muscle forces in finite element models of the lower limb with osteotomized tibiae and simulated the stance phase of normal gait. Section forces in the models were determined and compared. Stresses in the implants and contralateral cortex, and micromovements of the osteotomy wedge, were calculated.ResultsFor both loading types, the stresses in the implants were lower than the threshold values defined by the material strength. The stresses in the lateral cortex were smaller than the ultimate tensile strength of the cortical bone. The implants iBalance and Contour Lock allowed the smallest micromovements of the wedge, while the PEEKPower allowed the highest. There was a correlation between the micromovements of the wedge, obtained for the simplified loading of the tibia, and the more realistic loading of the lower limb at 15% of the gait cycle (Pearson’s value r = 0.982).ConclusionsAn axial compressive load applied perpendicularly to the tibia plateau, with a magnitude equal to the first peak value of the knee joint contact forces, corresponds quite well to a realistic loading of the tibia during the stance phase of normal gait (at 15% of the gait cycle and a knee flexion of about 22 degrees). However, this magnitude of the knee joint contact forces overloads the tibia compared to more realistic calculations, where the muscle forces are considered. The iBalance and Contour Lock implants provide higher rigidity to the bone-implant constructs compared to the TomoFix and the PEEKPower plates.

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Placement-induced effects on high tibial osteotomized construct - biomechanical tests and finite-element analyses

Cited by 29 publications

References 33 publications

Influence of the Screw Positioning on the Stability of Locking Plate for Proximal Tibial Fractures: A Numerical Approach

Influence of the Screw Positioning on the Stability of Locking Plate for Proximal Tibial Fractures: A Numerical Approach

Radiographic Evaluation of Medial Opening-Wedge High Tibial Osteotomy Using a New Internal Fixator with a Wedge-Shaped Spacer Block

Numerical comparative study of five currently used implants for high tibial osteotomy: realistic loading including muscle forces versus simplified experimental loading

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