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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March 2015
Research-Article
Assessing the Local Mechanical Environment in Medial Opening Wedge High Tibial Osteotomy Using Finite Element Analysis
Yves Pauchard,
Yves Pauchard
Robarts Research Institute,
Western University
,London, ON N6A 5K8
, Canada
Institute of Applied Information Technology,
School of Engineering,
e-mail: pauc@zhaw.ch
School of Engineering,
Zurich University of Applied Sciences
,Steinberggasse 13, Postfach
,Winterthur CH-8401, Switzerland
e-mail: pauc@zhaw.ch
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Todor G. Ivanov,
Todor G. Ivanov
Robarts Research Institute,
Western University
,London, ON N6A 5K8
, Canada
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David D. McErlain,
David D. McErlain
Department of Radiology,
Faculty of Medicine,
Faculty of Medicine,
University of Calgary
,Calgary, AB T2N 2T9
, Canada
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Jaques S. Milner,
Jaques S. Milner
Robarts Research Institute,
Western University
,London, ON N6A 5K8
, Canada
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J. Robert Giffin,
J. Robert Giffin
Schulich School of Medicine and Dentistry,
Western University
,London, ON N6A 5C1
, Canada
Wolf Orthopaedic Biomechanics Laboratory,
Fowler Kennedy Sport Medicine Clinic,
Faculty of Health Sciences,
Fowler Kennedy Sport Medicine Clinic,
Faculty of Health Sciences,
Western University
,London, ON N6A 3K7
, Canada
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Trevor B. Birmingham,
Trevor B. Birmingham
Wolf Orthopaedic Biomechanics Laboratory,
Fowler Kennedy Sport Medicine Clinic,
Faculty of Health Sciences,
Fowler Kennedy Sport Medicine Clinic,
Faculty of Health Sciences,
Western University
,London, ON N6A 3K7
, Canada
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David W. Holdsworth
David W. Holdsworth
1
Schulich School of Medicine and Dentistry,
Western University
,London, ON N6A 3K7
, Canada
Wolf Orthopaedic Biomechanics Laboratory,
Fowler Kennedy Sport Medicine Clinic,
Faculty of Health Sciences,
Fowler Kennedy Sport Medicine Clinic,
Faculty of Health Sciences,
Western University
,London, ON N6A 3K7
, Canada
Imaging Research Laboratories
Robarts Research Institute,
e-mail: dholdsworth@robarts.ca
Robarts Research Institute,
Western University
,P.O. Box 5015, 100 Perth Drive
,London, ON N6A 5K8
, Canada
e-mail: dholdsworth@robarts.ca
1Corresponding author.
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Yves Pauchard
Robarts Research Institute,
Western University
,London, ON N6A 5K8
, Canada
Institute of Applied Information Technology,
School of Engineering,
e-mail: pauc@zhaw.ch
School of Engineering,
Zurich University of Applied Sciences
,Steinberggasse 13, Postfach
,Winterthur CH-8401, Switzerland
e-mail: pauc@zhaw.ch
Todor G. Ivanov
Robarts Research Institute,
Western University
,London, ON N6A 5K8
, Canada
David D. McErlain
Department of Radiology,
Faculty of Medicine,
Faculty of Medicine,
University of Calgary
,Calgary, AB T2N 2T9
, Canada
Jaques S. Milner
Robarts Research Institute,
Western University
,London, ON N6A 5K8
, Canada
J. Robert Giffin
Schulich School of Medicine and Dentistry,
Western University
,London, ON N6A 5C1
, Canada
Wolf Orthopaedic Biomechanics Laboratory,
Fowler Kennedy Sport Medicine Clinic,
Faculty of Health Sciences,
Fowler Kennedy Sport Medicine Clinic,
Faculty of Health Sciences,
Western University
,London, ON N6A 3K7
, Canada
Trevor B. Birmingham
Wolf Orthopaedic Biomechanics Laboratory,
Fowler Kennedy Sport Medicine Clinic,
Faculty of Health Sciences,
Fowler Kennedy Sport Medicine Clinic,
Faculty of Health Sciences,
Western University
,London, ON N6A 3K7
, Canada
David W. Holdsworth
Schulich School of Medicine and Dentistry,
Western University
,London, ON N6A 3K7
, Canada
Wolf Orthopaedic Biomechanics Laboratory,
Fowler Kennedy Sport Medicine Clinic,
Faculty of Health Sciences,
Fowler Kennedy Sport Medicine Clinic,
Faculty of Health Sciences,
Western University
,London, ON N6A 3K7
, Canada
Imaging Research Laboratories
Robarts Research Institute,
e-mail: dholdsworth@robarts.ca
Robarts Research Institute,
Western University
,P.O. Box 5015, 100 Perth Drive
,London, ON N6A 5K8
, Canada
e-mail: dholdsworth@robarts.ca
1Corresponding author.
Manuscript received January 21, 2014; final manuscript received October 21, 2014; published online January 29, 2015. Assoc. Editor: Guy M. Genin.
J Biomech Eng. Mar 2015, 137(3): 031005 (7 pages)
Published Online: March 1, 2015
Article history
Received:
January 21, 2014
Revision Received:
October 21, 2014
Online:
January 29, 2015
Citation
Pauchard, Y., Ivanov, T. G., McErlain, D. D., Milner, J. S., Giffin, J. R., Birmingham, T. B., and Holdsworth, D. W. (March 1, 2015). "Assessing the Local Mechanical Environment in Medial Opening Wedge High Tibial Osteotomy Using Finite Element Analysis." ASME. J Biomech Eng. March 2015; 137(3): 031005. https://doi.org/10.1115/1.4028966
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