A preliminary modelling investigation into the safe correction zone for high tibial osteotomy

Martay, Jennifer L. B. and Palmer, Antony J. R. and Bangerter, Neil K. and Clare, Stuart and Monk, A. Paul and Brown, Cameron and Price, Andrew J. (2018) A preliminary modelling investigation into the safe correction zone for high tibial osteotomy. The Knee, 25 (2). pp. 286-295. ISSN 0968-0160

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Official URL: https://doi.org/10.1016/j.knee.2017.12.006

Abstract

Purpose: High tibial osteotomy (HTO) re-aligns the weight-bearing axis (WBA) of the lower limb. The surgery reduces medial load (reducing pain and slowing progression of cartilage damage) while avoiding overloading the lateral compartment. The optimal correction has not been established. This study investigated how different WBA re-alignments affected load distribu- tion in the knee, to consider the optimal post-surgery re-alignment. Methods: We collected motion analysis and 7T MRI data from 3 healthy sub- jects, and combined this data to create sets of subject-specific finite element models (total=45 models). Each set of models simulated a range of potential post-HTO knee re-alignments. We shifted the WBA from its native align- ment to between 40% and 80% medial-lateral tibial width (corresponding to 2.8◦-3.1◦ varus and 8.5◦-9.3◦ valgus), in 3% increments. We then compared stress/pressure distributions in the models. Results/Discussion: Correcting the WBA to 50% tibial width (0◦ varus- valgus) approximately halved medial compartment stresses, with minimal changes to lateral stress levels, but provided little margin for error in under- correction. Correcting the WBA to a more commonly-used 62%-65% tibial width (3.4◦-4.6◦ valgus) further reduced medial stresses but introduced the danger of damaging lateral compartment tissues. To balance optimal loading environment with that of the historical risk of under-correction, we propose a new target: WBA correction to 55% tibial width (1.7◦-1.9◦ valgus), which anatomically represented the apex of the lateral tibial spine. Conclusions: Finite element models can successfully simulate a variety of HTO re-alignments. Correcting the WBA to 55% tibial width (1.7◦-1.9◦ valgus) optimally distributes medial and lateral stresses/pressures.

Item Type: Journal Article
Keywords: osteoarthritis, high tibial osteotomy, weight-bearing axis, finite element modelling, knee alignment, knee re-alignment
Faculty: Faculty of Science & Technology
Depositing User: Dr Jennifer Martay
Date Deposited: 30 Jan 2018 14:40
Last Modified: 24 Apr 2019 10:33
URI: http://arro.anglia.ac.uk/id/eprint/702686

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