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Role of an anatomically contoured plate and metal block for balanced stability between the implant and lateral hinge in open-wedge high-tibial osteotomy

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Open-wedge high tibial osteotomy (OWHTO) is a well-established surgical option for medial compartment osteoarthritis of the varus knee. The initial strength of the fixation plate is critical for successful correction maintenance and healing of the osteotomy site. This study was conducted to verify if a newly designed anatomical plate (LCfit) improves the stability of both the medial implant and lateral hinge area, as well as to evaluate how the metal block contributes to both medial and lateral stability.

Materials and methods

A finite element (FE) tibial model was combined with TomoFix plate, a LCfit plate with and without a metal block. Data analysis was conducted to evaluate the balanced stability, which refers to the enforced lateral stability resulting from redistribution of overall stress. We assessed the balanced stability of the medial implant and lateral hinge area in three cases using the same Sawbones and loads using the tibia FE model.

Results

The LCfit plate reduced stress by 23.1% at the lateral hinge compared to the TomoFix plate (TomoFix vs. LCfit: 34.2 ± 23.3 MPa vs. 26.3 ± 17.5 MPa). The LCfit plate with a metal block reduced stress by 40.1% at the medial plate (210.1 ± 64.2 MPa vs. 125.8 ± 65.7 MPa) and by 31.2% (26.3 ± 17.5 MPa vs. 18.1 ± 12.1 MPa) at the lateral hinge area compared to the reduction using the LCfit plate without a metal block.

Conclusion

The newly designed fixation system for OWHTO balanced the overall stress distribution and reduced stress at the lateral hinge area compared to that using a conventional fixation system. The addition of the metal block showed additional benefits for balanced stability between the medial implant and lateral hinge area. However, this conclusion could only be drawn using the FE model in this study. Therefore, further clinical studies are necessary to reveal the clinical effect of reduced lateral stress on the occurrence of the lateral hinge fracture and the biologic effect of the metal block on the healing of the medial cortex.

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Funding

Yong Seuk Lee this work was supported by a grant from the SNUBH Research Fund (09-2017-003) and Basic Science Research Program through the Ministry of Education of the Republic of Korea and National Research Foundation of Korea (NRF-2017R1D1A1A09000509). DoHyung Lim this work was supported by National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP) (NRF-2017M3A9E9073544).

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Authors and Affiliations

  1. Central R&D Center, Corentec Co., Ltd., Seoul, South Korea

    Young Woong Jang

  2. Department of Mechanical Engineering, Sejong University, Seoul, South Korea

    DoHyung Lim & Hansol Seo

  3. Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea

    Myung Chul Lee

  4. Department of Orthopaedic Surgery, Mediplex Sejong Hospital, Incheon, South Korea

    O-Sung Lee

  5. Department of Orthopaedic Surgery, Seoul National University College of Medicine, Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea

    Yong Seuk Lee

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  1. Young Woong Jang
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Correspondence to Yong Seuk Lee.

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Yong Seuk Lee and Myung Chul Lee receive royalty from Corentec.

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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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Young Woong Jang and DoHyung Lim contributed equally to this work.

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Jang, Y.W., Lim, D., Seo, H. et al. Role of an anatomically contoured plate and metal block for balanced stability between the implant and lateral hinge in open-wedge high-tibial osteotomy. Arch Orthop Trauma Surg 138, 911–920 (2018). https://doi.org/10.1007/s00402-018-2918-9

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