A preliminary modeling investigation into the safe correction zone for high tibial osteotomy
<h4>Background</h4> <p>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...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Journal article |
| Language: | English |
| Published: |
Elsevier
2018
|
| _version_ | 1797092989462380544 |
|---|---|
| author | Martay, J Palmer, A Bangerter, N Clare, S Monk, A Brown, C Price, A |
| author_facet | Martay, J Palmer, A Bangerter, N Clare, S Monk, A Brown, C Price, A |
| author_sort | Martay, J |
| collection | OXFORD |
| description | <h4>Background</h4> <p>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 distribution in the knee, to consider the optimal post-surgery re-alignment.</p> <h4>Methods</h4> <p>We collected motion analysis and seven Tesla MRI data from three healthy subjects, 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 alignment to between 40% and 80% medial–lateral tibial width (corresponding to 2.8°–3.1° varus and 8.5°–9.3° valgus), in three percent increments. We then compared stress/pressure distributions in the models.</p> <h4>Results</h4> <p>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 undercorrection. 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.</p> <h4>Conclusions</h4> <p>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.</p> |
| first_indexed | 2024-03-07T03:53:54Z |
| format | Journal article |
| id | oxford-uuid:c23334d1-e14a-4d1e-9ba9-14d10b43143d |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T03:53:54Z |
| publishDate | 2018 |
| publisher | Elsevier |
| record_format | dspace |
| spelling | oxford-uuid:c23334d1-e14a-4d1e-9ba9-14d10b43143d2022-03-27T06:07:16ZA preliminary modeling investigation into the safe correction zone for high tibial osteotomyJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:c23334d1-e14a-4d1e-9ba9-14d10b43143dEnglishSymplectic Elements at OxfordElsevier2018Martay, JPalmer, ABangerter, NClare, SMonk, ABrown, CPrice, A <h4>Background</h4> <p>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 distribution in the knee, to consider the optimal post-surgery re-alignment.</p> <h4>Methods</h4> <p>We collected motion analysis and seven Tesla MRI data from three healthy subjects, 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 alignment to between 40% and 80% medial–lateral tibial width (corresponding to 2.8°–3.1° varus and 8.5°–9.3° valgus), in three percent increments. We then compared stress/pressure distributions in the models.</p> <h4>Results</h4> <p>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 undercorrection. 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.</p> <h4>Conclusions</h4> <p>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.</p> |
| spellingShingle | Martay, J Palmer, A Bangerter, N Clare, S Monk, A Brown, C Price, A A preliminary modeling investigation into the safe correction zone for high tibial osteotomy |
| title | A preliminary modeling investigation into the safe correction zone for high tibial osteotomy |
| title_full | A preliminary modeling investigation into the safe correction zone for high tibial osteotomy |
| title_fullStr | A preliminary modeling investigation into the safe correction zone for high tibial osteotomy |
| title_full_unstemmed | A preliminary modeling investigation into the safe correction zone for high tibial osteotomy |
| title_short | A preliminary modeling investigation into the safe correction zone for high tibial osteotomy |
| title_sort | preliminary modeling investigation into the safe correction zone for high tibial osteotomy |
| work_keys_str_mv | AT martayj apreliminarymodelinginvestigationintothesafecorrectionzoneforhightibialosteotomy AT palmera apreliminarymodelinginvestigationintothesafecorrectionzoneforhightibialosteotomy AT bangertern apreliminarymodelinginvestigationintothesafecorrectionzoneforhightibialosteotomy AT clares apreliminarymodelinginvestigationintothesafecorrectionzoneforhightibialosteotomy AT monka apreliminarymodelinginvestigationintothesafecorrectionzoneforhightibialosteotomy AT brownc apreliminarymodelinginvestigationintothesafecorrectionzoneforhightibialosteotomy AT pricea apreliminarymodelinginvestigationintothesafecorrectionzoneforhightibialosteotomy AT martayj preliminarymodelinginvestigationintothesafecorrectionzoneforhightibialosteotomy AT palmera preliminarymodelinginvestigationintothesafecorrectionzoneforhightibialosteotomy AT bangertern preliminarymodelinginvestigationintothesafecorrectionzoneforhightibialosteotomy AT clares preliminarymodelinginvestigationintothesafecorrectionzoneforhightibialosteotomy AT monka preliminarymodelinginvestigationintothesafecorrectionzoneforhightibialosteotomy AT brownc preliminarymodelinginvestigationintothesafecorrectionzoneforhightibialosteotomy AT pricea preliminarymodelinginvestigationintothesafecorrectionzoneforhightibialosteotomy |