Koh Yong-Gon, Son Juhyun, Kwon Sae Kwang, Kim Hyo Jeong, Kang Kyoung-Tak
Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul 06698, Republic of Korea.
Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
Knee. 2018 Dec;25(6):977-987. doi: 10.1016/j.knee.2018.08.013. Epub 2018 Nov 13.
Medial opening-wedge high tibial osteotomy (HTO) has been used to treat osteoarthritis of the medial compartment of the knee. However, this makes the proximal tibia a highly unstable structure and causes the plate to be a potential source of mechanical failure. Consequently, proper design and material use of the fixation device are essential in HTO, especially for overweight or full-weight-bearing patients.
This study investigated the biomechanical effects of the TomoFix plate composed of conventional titanium (Ti) in comparison to plates composed of carbon short-fiber-reinforced (CSFR) polyetheretherketone (PEEK) and carbon long-fiber-reinforced (CLFR) PEEK, in medial opening-wedge HTO. A medial opening was simulated with various HTO plate models subjected to a 2500 N vertical load simulating the peak walking force using a validated knee-joint finite-element (FE) model. The stress on the plate and the bone, the contact stress on the menisci and articular cartilage, as well as wedge micromotion were measured.
The results of the FE analysis indicated that the Ti plate showed the best functional outcome in terms of micromotion. However, the CSFR PEEK plate showed a positive effect on relieving stress shielding. In addition, there was less contact stress on the meniscus and articular cartilage with the CSFR PEEK plate in comparison to CLFR PEEK and Ti plates.
These results can provide insights into the design of high-performing composite HTO plates to produce more desirable biomechanical effects.
内侧开口楔形高位胫骨截骨术（HTO）已被用于治疗膝关节内侧间室骨关节炎。然而，这使得胫骨近端成为高度不稳定的结构，并导致钢板成为机械失效的潜在来源。因此，在HTO中，固定装置的合理设计和材料使用至关重要，尤其是对于超重或需要完全负重的患者。
本研究调查了在内侧开口楔形HTO中，由传统钛（Ti）制成的TomoFix钢板与由碳短纤维增强（CSFR）聚醚醚酮（PEEK）和碳长纤维增强（CLFR）PEEK制成的钢板的生物力学效应。使用经过验证的膝关节有限元（FE）模型，对各种HTO钢板模型施加2500 N的垂直载荷以模拟步行峰值力，从而模拟内侧开口情况。测量钢板和骨骼上的应力、半月板和关节软骨上的接触应力以及楔形微动。
有限元分析结果表明，就微动而言，钛钢板显示出最佳的功能结果。然而，CSFR PEEK钢板在减轻应力遮挡方面显示出积极作用。此外，与CLFR PEEK钢板和钛钢板相比，CSFR PEEK钢板对半月板和关节软骨的接触应力更小。
这些结果可为高性能复合HTO钢板的设计提供见解，以产生更理想的生物力学效应。
