The effect of plate design, bridging span, and fracture healing on the performance of high tibial osteotomy plates – an experimental and finite element study.

Alisdair MacLeod, Gil Serrancoli, Benjamin J Fregly, Andrew Toms, Harinderjit Gill

Research output: Contribution to journalArticle

Abstract

Objectives
Opening wedge high tibial osteotomy (HTO) is an established surgical procedure for the treatment of early-stage knee arthritis. Other than infection, the majority of complications are related to mechanical factors – in particular, stimulation of healing at the osteotomy site. This study used finite element (FE) analysis to investigate the effect of plate design and bridging span on interfragmentary movement (IFM) and the influence of fracture healing on plate stress and potential failure.
Methods
A ten degree opening wedge HTO was created in a composite tibia. Imaging and strain gauge data were used to create and validate FE models. Models of an intact tibia and a tibia implanted with a custom HTO plate using two different bridging spans were validated against experimental data. Physiological muscle forces and different stages of callus healing simulating up to 6 weeks post-operatively were then incorporated. Predictions of plate stress and IFM for the custom plate were compared against predictions for an industry standard plate (Tomofix).
Results
For both plate types, long spans increased IFM but did not substantially alter peak plate stress. The custom plate increased axial and shear IFM values by up to 24% and 47%, respectively, compared to the Tomofix. In all cases, a callus stiffness of 528 MPa was required to reduce plate stress below the fatigue strength of titanium alloy.
Conclusions
We demonstrate that larger bridging spans in opening wedge HTO increase IFM without substantially increasing plate stress. The results indicate, however, that callus healing is required to prevent fatigue failure.

Original languageEnglish
JournalBone and Joint Research
Volume7
Issue number12
Early online date21 Dec 2018
DOIs
Publication statusPublished - Dec 2018

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Fracture Healing
Osteotomy
Bony Callus
Tibia
Fatigue
Finite Element Analysis
Titanium
Arthritis
Knee
Industry
Muscles
Infection

Cite this

The effect of plate design, bridging span, and fracture healing on the performance of high tibial osteotomy plates – an experimental and finite element study. / MacLeod, Alisdair; Serrancoli, Gil; Fregly, Benjamin J; Toms, Andrew; Gill, Harinderjit.

In: Bone and Joint Research, Vol. 7, No. 12, 12.2018.

Research output: Contribution to journalArticle

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title = "The effect of plate design, bridging span, and fracture healing on the performance of high tibial osteotomy plates – an experimental and finite element study.",
abstract = "ObjectivesOpening wedge high tibial osteotomy (HTO) is an established surgical procedure for the treatment of early-stage knee arthritis. Other than infection, the majority of complications are related to mechanical factors – in particular, stimulation of healing at the osteotomy site. This study used finite element (FE) analysis to investigate the effect of plate design and bridging span on interfragmentary movement (IFM) and the influence of fracture healing on plate stress and potential failure. MethodsA ten degree opening wedge HTO was created in a composite tibia. Imaging and strain gauge data were used to create and validate FE models. Models of an intact tibia and a tibia implanted with a custom HTO plate using two different bridging spans were validated against experimental data. Physiological muscle forces and different stages of callus healing simulating up to 6 weeks post-operatively were then incorporated. Predictions of plate stress and IFM for the custom plate were compared against predictions for an industry standard plate (Tomofix).ResultsFor both plate types, long spans increased IFM but did not substantially alter peak plate stress. The custom plate increased axial and shear IFM values by up to 24{\%} and 47{\%}, respectively, compared to the Tomofix. In all cases, a callus stiffness of 528 MPa was required to reduce plate stress below the fatigue strength of titanium alloy.ConclusionsWe demonstrate that larger bridging spans in opening wedge HTO increase IFM without substantially increasing plate stress. The results indicate, however, that callus healing is required to prevent fatigue failure.",
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AU - Toms, Andrew

AU - Gill, Harinderjit

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N2 - ObjectivesOpening wedge high tibial osteotomy (HTO) is an established surgical procedure for the treatment of early-stage knee arthritis. Other than infection, the majority of complications are related to mechanical factors – in particular, stimulation of healing at the osteotomy site. This study used finite element (FE) analysis to investigate the effect of plate design and bridging span on interfragmentary movement (IFM) and the influence of fracture healing on plate stress and potential failure. MethodsA ten degree opening wedge HTO was created in a composite tibia. Imaging and strain gauge data were used to create and validate FE models. Models of an intact tibia and a tibia implanted with a custom HTO plate using two different bridging spans were validated against experimental data. Physiological muscle forces and different stages of callus healing simulating up to 6 weeks post-operatively were then incorporated. Predictions of plate stress and IFM for the custom plate were compared against predictions for an industry standard plate (Tomofix).ResultsFor both plate types, long spans increased IFM but did not substantially alter peak plate stress. The custom plate increased axial and shear IFM values by up to 24% and 47%, respectively, compared to the Tomofix. In all cases, a callus stiffness of 528 MPa was required to reduce plate stress below the fatigue strength of titanium alloy.ConclusionsWe demonstrate that larger bridging spans in opening wedge HTO increase IFM without substantially increasing plate stress. The results indicate, however, that callus healing is required to prevent fatigue failure.

AB - ObjectivesOpening wedge high tibial osteotomy (HTO) is an established surgical procedure for the treatment of early-stage knee arthritis. Other than infection, the majority of complications are related to mechanical factors – in particular, stimulation of healing at the osteotomy site. This study used finite element (FE) analysis to investigate the effect of plate design and bridging span on interfragmentary movement (IFM) and the influence of fracture healing on plate stress and potential failure. MethodsA ten degree opening wedge HTO was created in a composite tibia. Imaging and strain gauge data were used to create and validate FE models. Models of an intact tibia and a tibia implanted with a custom HTO plate using two different bridging spans were validated against experimental data. Physiological muscle forces and different stages of callus healing simulating up to 6 weeks post-operatively were then incorporated. Predictions of plate stress and IFM for the custom plate were compared against predictions for an industry standard plate (Tomofix).ResultsFor both plate types, long spans increased IFM but did not substantially alter peak plate stress. The custom plate increased axial and shear IFM values by up to 24% and 47%, respectively, compared to the Tomofix. In all cases, a callus stiffness of 528 MPa was required to reduce plate stress below the fatigue strength of titanium alloy.ConclusionsWe demonstrate that larger bridging spans in opening wedge HTO increase IFM without substantially increasing plate stress. The results indicate, however, that callus healing is required to prevent fatigue failure.

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