Stress and stability comparison between different systems for high tibial osteotomies

BMC Musculoskeletal Disorders

Ching-Shiow Tseng²  Chun-Ming Chen²  Shang-Chih Lin³  Shi-Yuan Hua¹  Chu-An Luo² 

[1] Department of Orthopedic Surgery, Tri-Service General Hospital, Taipei, Taiwan;Department of Mechanical Engineering, National Central University, Taoyuan, Taiwan;Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, No. 43, Sec. 4, Keelung Road, Taipei, 106, Taiwan

关键词: Tibial plate;    Locking screw;    Finite-element analysis;    High tibial osteotomy;    Knee;   

Others  :  1133198
DOI  :  10.1186/1471-2474-14-110

 received in 2012-10-16, accepted in 2013-03-14,  发布年份 2013

【 摘 要 】

Background

High tibial osteotomy (HTO) with a medial opening wedge has been used to treat medial compartment osteoarthritis. However, this makes the proximal tibia a highly unstable structure and causes plate and screws to be the potentials sources for mechanical failure. Consequently, proper design and use of the fixation device are essential to the HTO especially for overweight or full weight-bearing patients.

Methods

Based on the CT-based images, a tibial finite-element model with medial opening was simulated and instrumented with one-leg and two-leg plate systems. The construct was subjected to physiological and surgical loads. Construct stresses and wedge micromotions were chosen as the comparison indices.

Results

The use of locking screws can stabilize the construct and decrease the implant and bone stresses. Comparatively, the two-leg design provides a wider load-sharing base to form a force-couple mechanism that effectively reduces construct stresses and wedge micromotions. However, the incision size, muscular stripping, and structural rigidity are the major concerns of using the two-leg systems. The one-leg plates behave as the fulcrum of the leverage system and make the wedge tip the zone of tension and thus have been reported to negatively affect the callus formation.

Conclusions

The choice of the HTO plates involved the trade-off between surgical convenience, construct stability, and stress-shielding effect. If the stability of the medial opening is the major concern, the two-leg system is suggested for the patients with heavy load demands and greater proximal tibial size. The one-leg system with locking screws can be used for the majority of the patients without heavy bodyweight and poor bone quality.

【 授权许可】

   
2013 Luo et al.; licensee BioMed Central Ltd.

【 图 表 】

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