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Intramedullary nailing in opening wedge high tibial osteotomy—in vitro test for validation of a method of fixation

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Abstract

Purpose

Opening wedge high tibial osteotomy (HTO) as a treatment in unicompartimental osteoarthritis of the knee can significantly relieve pain and prevent or at least delay an early joint replacement. The fixation of the osteotomy has undergone development and refinements during the last years. The angle-stable plate fixator is currently one of the most commonly used plates in HTOs. The angular stable fixation between screws and the plate offers a high primary stability to retain the correction with early weight-bearing protocols. This surgical technique is performed as a standard of care and generally well tolerated by the patients. Nevertheless, some studies observed that many patients complained about discomfort related to the implant.

Methods

Therefore, the stability of two different intramedullary nails, a short implant used in humeral fractures and a long device used in tibial fractures for stabilization in valgus HTOs, was investigated as an alternative fixation technique. The plate fixator was defined as reference standard. Nine synthetic tibia models were standardly osteotomized and stabilized by one of the fixation devices. Axial compression was realized using a special testing machine and two protocols were performed: a multi-step fatigue test and a load-to-failure test.

Results

Overall motion, medial, and lateral displacements were documented. Fractures always occurred at the lateral cortex. Axial cyclic loading up to 800 N was tolerated by all implants without failure. The tibia nail provided highest fatigue strength under the load-to-failure conditions.

Conclusions

The results suggest that intramedullary nailing might be used as an alternative concept in HTO.

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Abbreviations

HSS:

Hospital for special surgery

HTO:

High tibial osteotomy

IKDC:

International Knee Documentation Committee

NSAID:

Nonsteroidal anti-inflammatory drugs

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Acknowledgements

Dr. Graw is participant in the BIH-Charité Clinician Scientist Program funded by the Charité – Universitätsmedizin Berlin and the Berlin Institute of Health.

We thank Mrs. Monica Kosiol (Monash University of Melbourne) for language editing and proofreading of the manuscript.

Funding

This study received funding from the Gesellschaft für Prävention und Rehabilitation im Sport e.V.

Author information

Authors and Affiliations

  1. Department of Trauma and Orthopaedic Surgery, Kreisklinikum Siegen, Weidenauer Str. 76, 57076, Siegen, Germany

    Rene Burchard, Denise Katerla & Anke Pahlkötter

  2. Department of Health, University of Witten/Herdecke, Witten, Germany

    Rene Burchard

  3. School of Science and Technology, University of Siegen, Siegen, Germany

    Rene Burchard

  4. Department of Trauma Surgery, Landeskrankenhaus Bregenz, Carl-Pedenz-Strasse 2, 6900, Bregenz, Austria

    Denise Katerla

  5. Department of Mechanical Engineering, University of Siegen, Paul-Bonatz-Str. 9-11, 57076, Siegen, Germany

    Marina Hammer, Gerhard Dietrich, Arne Ohrndorf, Wolfgang Richter, Hans-Jürgen Christ & Claus-Peter Fritzen

  6. Department of Statistics and Econometrics, University of Siegen, Kohlbettstr. 15, 57072, Siegen, Germany

    Christian Soost

  7. Orthopädie Rhein-Nahe Partnergesellschaft, Eibinger Str. 9, 65385, Rüdesheim, Germany

    Markus Lengsfeld

  8. Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Platz 1, 13353, Berlin, Germany

    Jan Adriaan Graw

  9. Berlin Institute of Health (BIH), Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany

    Jan Adriaan Graw

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  1. Rene Burchard
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Contributions

DK, AP, ML, and RB conceived and designed the experiments. MH, GD, WR, AP, AO, HJC, and CPF performed the experiments. RB, JAG, and DK analyzed the data. CS performed the statistical analysis. RB, JAG, AP, ML, and DK wrote the paper. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Rene Burchard.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Burchard, R., Katerla, D., Hammer, M. et al. Intramedullary nailing in opening wedge high tibial osteotomy—in vitro test for validation of a method of fixation. International Orthopaedics (SICOT) 42, 1835–1843 (2018). https://doi.org/10.1007/s00264-018-3790-5

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