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J Knee Surg 2020; 33(02): 158-166
DOI: 10.1055/s-0038-1676772
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Distribution of the Force in the Knee Joint during Daily Activities after Open Wedge High Tibial Osteotomy: A Rationale for the Proper Postoperative Management

Hansol Seo   *
1   Department of Mechanical Engineering, Sejong University, Seoul, The Republic of Korea
,
Dohyung Lim   *
1   Department of Mechanical Engineering, Sejong University, Seoul, The Republic of Korea
,
Young Woong Jang
2   Central Research and Development Center, Corentec Co. Ltd., Seoul, The Republic of Korea
,
Kwan-su Kang
3   Medical Device Development Center, OSONG Medical Innovation Foundation, Cheongju-si, The Republic of Korea
,
Myung Chul Lee
4   Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, The Republic of Korea
,
O-Sung Lee
5   Department of Orthopaedic Surgery, Mediplex Sejong Hospital, Incheon, The Republic of Korea
,
Byeong-Eun Im
6   Department of Orthopaedic Surgery, Seoul National University College of Medicine, Bundang Hospital, Seongnam, The Republic of Korea
,
Yong Seuk Lee
6   Department of Orthopaedic Surgery, Seoul National University College of Medicine, Bundang Hospital, Seongnam, The Republic of Korea
› Author Affiliations Funding This study was supported by Basic Science Research Program through the Ministry of Education of the Republic of Korea and National Research Foundation of Korea (NRF-2017R1D1A1A09000509).
Further Information

Publication History

08 July 2018

11 November 2018

Publication Date:
08 January 2019 (online)

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Abstract

The present study was conducted to evaluate the force distribution in knee joint during daily activities after open-wedge high tibial osteotomy (OWHTO). A three-dimensional proximal tibial finite element model (FEM) was created using Mimics software to evaluate computed tomography (CT) scans of the tibia after OWHTO. The anterior and posterior gaps were 7.0 and 12.1 mm, respectively, and the target opening angle was 12 degrees. The loading ratio of the medial and lateral tibial plateaus was 6:4. To evaluate force distribution in the knee joint during activities of daily living (ADLs) after OWHTO, peak von Mises stresses (PVMSs) were analyzed at the plate and posterolateral edge region of osteotomized tibia. ADLs associated with greater knee flexion (sitting 90 degrees, standing 90 degrees, bending 90 degrees, stepping up stairs 60 degrees, and stepping downstairs 30 and 60 degrees) yielded PVMSs ranging from 195.2 to 221.5 MPa at the posterolateral edge region. In particular, stepping downstairs with knee flexion to 60 degrees produced the highest PVMS (221.5 MPa), greater than the yield strength (100–200 MPa). The highest plate PVMS was greater than 300 MPa during ADLs associated with flexion angles of approximately 90 degrees. However, these values did not exceed the yield stress (760.0 MPa). Conclusively, higher force was generated during higher flexion associated with weight-bearing and stepping downstairs produced a high force (even at lower flexion) on the posterolateral area of the tibial plateau. Therefore, a caution should be exercised when engaging in knee flexion of approximately 90 degrees and stepping downstairs in the early postoperative period when patients follow a weight-bearing rehabilitation protocol. However, this study is based on modeling; further translational studies are needed prior to clinical application.

Keywords

knee - open-wedge high tibial osteotomy - activity of daily living - finite element analysis - peak von Mises stress

* Hansol Seo and Dohyung Lim contributed equally to this work.


 

  • References

  • 1 Amis AA. Biomechanics of high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2013; 21 (01) 197-205
    CrossrefPubMedGoogle Scholar
  • 2 Han SB, Bae JH, Lee SJ. , et al. Biomechanical properties of a new anatomical locking metal block plate for opening wedge high tibial osteotomy: uniplane osteotomy. Knee Surg Relat Res 2014; 26 (03) 155-161
    CrossrefPubMedGoogle Scholar
  • 3 Lee DC, Byun SJ. High tibial osteotomy. Knee Surg Relat Res 2012; 24 (02) 61-69
    CrossrefPubMedGoogle Scholar
  • 4 Lee SC, Jung KA, Yoon JY, Nam CH, Hwang SH, Park IS. Analysis of synovial fluid in culture-negative samples of suspicious periprosthetic infections. Orthopedics 2010; 33 (10) 725
    PubMedGoogle Scholar
  • 5 Dexel J, Fritzsche H, Beyer F, Harman MK, Lützner J. Open-wedge high tibial osteotomy: incidence of lateral cortex fractures and influence of fixation device on osteotomy healing. Knee Surg Sports Traumatol Arthrosc 2017; 25 (03) 832-837
    CrossrefPubMedGoogle Scholar
  • 6 Staubli AE, De Simoni C, Babst R, Lobenhoffer P. TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia--early results in 92 cases. Injury 2003; 34 (Suppl. 02) B55-B62
    CrossrefPubMedGoogle Scholar
  • 7 Agneskirchner JD, Freiling D, Hurschler C, Lobenhoffer P. Primary stability of four different implants for opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2006; 14 (03) 291-300
    CrossrefPubMedGoogle Scholar
  • 8 Deirmengian C, Kardos K, Kilmartin P, Cameron A, Schiller K, Parvizi J. Diagnosing periprosthetic joint infection: has the era of the biomarker arrived?. Clin Orthop Relat Res 2014; 472 (11) 3254-3262
    CrossrefPubMedGoogle Scholar
  • 9 Takeuchi R, Ishikawa H, Kumagai K. , et al. Fractures around the lateral cortical hinge after a medial opening-wedge high tibial osteotomy: a new classification of lateral hinge fracture. Arthroscopy 2012; 28 (01) 85-94
    CrossrefPubMedGoogle Scholar
  • 10 Lansdaal JR, Mouton T, Wascher DC. , et al. Early weight bearing versus delayed weight bearing in medial opening wedge high tibial osteotomy: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2017; 25 (12) 3670-3678
    CrossrefPubMedGoogle Scholar
  • 11 Lee OS, Ahn S, Lee YS. Effect and safety of early weight-bearing on the outcome after open-wedge high tibial osteotomy: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2017; 137 (07) 903-911
    CrossrefPubMedGoogle Scholar
  • 12 Schröter S, Ateschrang A, Löwe W, Nakayama H, Stöckle U, Ihle C. Early full weight-bearing versus 6-week partial weight-bearing after open wedge high tibial osteotomy leads to earlier improvement of the clinical results: a prospective, randomised evaluation. Knee Surg Sports Traumatol Arthrosc 2017; 25 (01) 325-332
    CrossrefPubMedGoogle Scholar
  • 13 Miller BS, Dorsey WO, Bryant CR, Austin JC. The effect of lateral cortex disruption and repair on the stability of the medial opening wedge high tibial osteotomy. Am J Sports Med 2005; 33 (10) 1552-1557
    CrossrefPubMedGoogle Scholar
  • 14 Miller BS, Downie B, McDonough EB, Wojtys EM. Complications after medial opening wedge high tibial osteotomy. Arthroscopy 2009; 25 (06) 639-646
    CrossrefPubMedGoogle Scholar
  • 15 Meidinger G, Imhoff AB, Paul J, Kirchhoff C, Sauerschnig M, Hinterwimmer S. May smokers and overweight patients be treated with a medial open-wedge HTO? Risk factors for non-union. Knee Surg Sports Traumatol Arthrosc 2011; 19 (03) 333-339
    CrossrefPubMedGoogle Scholar
  • 16 Yacobucci GN, Cocking MR. Union of medial opening-wedge high tibial osteotomy using a corticocancellous proximal tibial wedge allograft. Am J Sports Med 2008; 36 (04) 713-719
    CrossrefPubMedGoogle Scholar
  • 17 Agneskirchner JD, Hurschler C, Stukenborg-Colsman C, Imhoff AB, Lobenhoffer P. Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics: a biomechanical study in human cadaveric knees. Winner of the AGA-DonJoy Award 2004. Arch Orthop Trauma Surg 2004; 124 (09) 575-584
    CrossrefPubMedGoogle Scholar
  • 18 Stoffel K, Stachowiak G, Kuster M. Open wedge high tibial osteotomy: biomechanical investigation of the modified Arthrex Osteotomy Plate (Puddu Plate) and the TomoFix Plate. Clin Biomech (Bristol, Avon) 2004; 19 (09) 944-950
    CrossrefPubMedGoogle Scholar
  • 19 Spahn G, Wittig R. Primary stability of various implants in tibial opening wedge osteotomy: a biomechanical study. J Orthop Sci 2002; 7 (06) 683-687
    CrossrefPubMedGoogle Scholar
  • 20 Gaasbeek RD, Welsing RT, Verdonschot N, Rijnberg WJ, van Loon CJ, van Kampen A. Accuracy and initial stability of open- and closed-wedge high tibial osteotomy: a cadaveric RSA study. Knee Surg Sports Traumatol Arthrosc 2005; 13 (08) 689-694
    CrossrefPubMedGoogle Scholar
  • 21 Pauchard Y, Ivanov TG, McErlain DD. , et al. Assessing the local mechanical environment in medial opening wedge high tibial osteotomy using finite element analysis. J Biomech Eng 2015; 137 (03) 137
    PubMedGoogle Scholar
  • 22 Blecha LD, Zambelli PY, Ramaniraka NA, Bourban PE, Månson JA, Pioletti DP. How plate positioning impacts the biomechanics of the open wedge tibial osteotomy; a finite element analysis. Comput Methods Biomech Biomed Engin 2005; 8 (05) 307-313
    CrossrefPubMedGoogle Scholar
  • 23 Raja Izaham RM, Abdul Kadir MR, Abdul Rashid AH, Hossain MG, Kamarul T. Finite element analysis of Puddu and Tomofix plate fixation for open wedge high tibial osteotomy. Injury 2012; 43 (06) 898-902
    CrossrefPubMedGoogle Scholar
  • 24 Lustig S, Scholes CJ, Costa AJ, Coolican MJ, Parker DA. Different changes in slope between the medial and lateral tibial plateau after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2013; 21 (01) 32-38
    CrossrefPubMedGoogle Scholar
  • 25 Lee YS, Kang JY, Lee MC. , et al. Osteotomy configuration of the proximal wedge and analysis of the affecting factors in the medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2017; 25 (03) 793-799
    CrossrefPubMedGoogle Scholar
  • 26 Yoo OS, Lee YS, Lee MC, Elazab A, Choi DG, Jang YW. Evaluation of the screw position and angle using a post-contoured plate in the open wedge high tibial osteotomy according to the correction degree and surgical technique. Clin Biomech (Bristol, Avon) 2016; 35: 111-115
    CrossrefPubMedGoogle Scholar
  • 27 Yoo OS, Lee YS, Lee MC, Park JH, Kim JW, Sun DH. Morphologic analysis of the proximal tibia after open wedge high tibial osteotomy for proper plate fitting. BMC Musculoskelet Disord 2016; 17 (01) 423
    CrossrefPubMedGoogle Scholar
  • 28 Han SB, Lee DH, Shetty GM, Chae DJ, Song JG, Nha KWA. A “safe zone” in medial open-wedge high tibia osteotomy to prevent lateral cortex fracture. Knee Surg Sports Traumatol Arthrosc 2013; 21 (01) 90-95
    CrossrefPubMedGoogle Scholar
  • 29 Kim H, Nha KW, Lee SJ. A biomechanical analysis on the sensitivity of bone graft and osteotomy orientation in relation to post-operative stability in open wedge high tibial osteotomy. Journal of Biomechanical Science and Engineering 2012; 7 (04) 358-368
    CrossrefPubMedGoogle Scholar
  • 30 Lim Fat D, Kennedy J, Galvin R, O'Brien F, Mc Grath F, Mullett H. The Hounsfield value for cortical bone geometry in the proximal humerus--an in vitro study. Skeletal Radiol 2012; 41 (05) 557-568
    CrossrefPubMedGoogle Scholar
  • 31 Jensen NC, Hvid I, Krøner K. Strength pattern of cancellous bone at the ankle joint. Eng Med 1988; 17 (02) 71-76
    CrossrefPubMedGoogle Scholar
  • 32 Hoffler CE, Moore KE, Kozloff K, Zysset PK, Goldstein SA. Age, gender, and bone lamellae elastic moduli. J Orthop Res 2000; 18 (03) 432-437
    CrossrefPubMedGoogle Scholar
  • 33 Reilly DT, Burstein AH. The elastic and ultimate properties of compact bone tissue. J Biomech 1975; 8 (06) 393-405
    CrossrefPubMedGoogle Scholar
  • 34 Taylor WR, Heller MO, Bergmann G, Duda GN. Tibio-femoral loading during human gait and stair climbing. J Orthop Res 2004; 22 (03) 625-632
    CrossrefPubMedGoogle Scholar
  • 35 Luo CA, Hwa SY, Lin SC, Chen CM, Tseng CS. Placement-induced effects on high tibial osteotomized construct - biomechanical tests and finite-element analyses. BMC Musculoskelet Disord 2015; 16: 235
    CrossrefPubMedGoogle Scholar
  • 36 Kutzner I, Heinlein B, Graichen F. , et al. Loading of the knee joint during activities of daily living measured in vivo in five subjects. J Biomech 2010; 43 (11) 2164-2173
    CrossrefPubMedGoogle Scholar
  • 37 Pinskerova V, Johal P, Nakagawa S. , et al. Does the femur roll-back with flexion?. J Bone Joint Surg Br 2004; 86 (06) 925-931
    PubMedGoogle Scholar
  • 38 Ramaniraka NA, Rakotomanana LR, Leyvraz P-F. The fixation of the cemented femoral component. Effects of stem stiffness, cement thickness and roughness of the cement-bone surface. J Bone Joint Surg Br 2000; 82 (02) 297-303
    PubMedGoogle Scholar
  • 39 Havaldar R, Pilli SC, Putti BB. Insights into the effects of tensile and compressive loadings on human femur bone. Adv Biomed Res 2014; 3: 101
    CrossrefPubMedGoogle Scholar
  • 40 Edson CJ, Fanelli GC, Beck JD. Postoperative rehabilitation of the posterior cruciate ligament. Sports Med Arthrosc Rev 2010; 18 (04) 275-279
    CrossrefPubMedGoogle Scholar
  • 41 Edson CJ, Fanelli GC, Beck JD. Rehabilitation after multiple-ligament reconstruction of the knee. Sports Med Arthrosc Rev 2011; 19 (02) 162-166
    CrossrefPubMedGoogle Scholar
  • 42 Katonis P, Papoutsidakis A, Aligizakis A, Tzanakakis G, Kontakis GM, Papagelopoulos PJ. Mechanoreceptors of the posterior cruciate ligament. J Int Med Res 2008; 36 (03) 387-393
    PubMedGoogle Scholar
  • 43 Brinkman JM, Luites JW, Wymenga AB, van Heerwaarden RJ. Early full weight bearing is safe in open-wedge high tibial osteotomy. Acta Orthop 2010; 81 (02) 193-198
    CrossrefPubMedGoogle Scholar
  • 44 Hernigou P, Flouzat Lachaniette C, Delambre J. , et al. Full weight bearing and dynamisation with Limmed locked plate fixation accelerates bone regeneration in the volume of opening wedge high tibial osteotomy. Int Orthop 2015; 39 (07) 1295-1300
    CrossrefPubMedGoogle Scholar
  • 45 Hernigou P, Queinnec S, Picard L. , et al. Safety of a novel high tibial osteotomy locked plate fixation for immediate full weight-bearing: a case-control study. Int Orthop 2013; 37 (12) 2377-2384
    CrossrefPubMedGoogle Scholar