Biomechanical evaluation of combined proximal tibial osteotomy for varus knee osteoarthritis implanted novel designed plate system: Finite element analysis

Abstract

BackgroundCombined proximal tibial osteotomy (CPTO) is an innovative and effective procedure for correcting varus knee osteoarthritis (VKOA) with intra- and extra-articular deformity. Here, we designed a novel internal fixation plate system for CPTO and assessed the biomechanical strength of the bone-implant. MethodsOur newly designed CPTO internal fixation plate system included a specialized plate shape, combination holes, locking screw holes, screw position, and size of fixation. The biomechanical performance of this plate system in CPTO treatment was compared via finite element analysis (FEA) to traditional Tomofix devices implanted in the opening-wedge high tibial osteotomy (OWHTO), tibial condylar valgus osteotomy (TCVO), and CPTO. ResultsThe tibial wedge stiffness and displacement after CPTO implantation of the novel internal plate fixation increased by 9.6%, which was -65% higher than the CPTO with the Tomofix system. The average stress of the bone, plate, and screws in the CPTO implanted the novel designed plate system compared to the Tomofix system decreased by 12.7%, 1.9%, and 20.3 %, respectively. The device maximum stress and wedge stiffness after CPTO with the novel plate system versus traditional OWHTO and TCVO with the Tomofix system were 255.7 MPa, 204 MPa, 130.4 MPa, and 678.9 N/mm, 660.3 N/mm, 1626.0 N/mm, respectively. ConclusionsThe novel internal fixation plate system usage during CPTO exhibited similar bone-implant biomechanical strength, compared to OWHTO, but with enhanced construct stability.