title: In vitro stability of open wedge high tibial osteotomy with synthetic bone graft.
abstract: It has been predicted that significant stress will be applied to the plate and lateral cortical hinge of an osteotomy site when early full weight bearing is commenced after an open wedge high tibial osteotomy. We hypothesized that the stress concentration on the plate or at the lateral cortical hinge would be reduced by inserting bone substitutes into the osteotomy gap. Two different types of tibia model were investigated: Group A, fixation with TomoFix with the osteotomy site left as an open space; and Group B, two beta-TCP wedges are inserted into osteotomy site and fixed with TomoFix. Stress at five points was measured using strain gauges. Specimens were mounted onto a testing machine with an FTA (femoro-tibial angle) of 170 degrees . Cyclic load tests and an ultimate load test were then performed. The mean stress on the plate was measured at 15.5+/-1.8Mpa in Group A. On the other hand, this value in Group B was only 9.52+/-2.1Mpa and this was a significant difference (P<0.01). The mean stress on the lateral hinge in Groups A and B was 3.31+/-0.5 and 2.49+/-0.2, respectively which was also a significant difference (P<0.05). The mean maximum breaking load in Group A was 2500+/-280N and in Group B 4270+/-420N which was a significant difference (P<0.01). Hence, for OWHTO procedures, the use of beta-TCP wedges and TomoFix is thus likely to improve the initial axial and possibly rotational stability at the osteotomy site in comparison with methods that leave the osteotomy gap open.
authors.affiliation: Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Kanazawa-ku, Yokohama, Japan. take0822@hotmail.com
authors.forename: Ryohei
authors.initials: R
authors.lastname: Takeuchi
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Bito
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Akamatsu
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Shiraishi
authors.forename: Shin
authors.initials: S
authors.lastname: Morishita
authors.forename: Tomihisa
authors.initials: T
authors.lastname: Koshino
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Saito
mesh_terms: D001696:Biomechanical Phenomena; D018786:Bone Substitutes / Q000627:therapeutic use*; D002130:Calcium Phosphates / Q000627:therapeutic use*; D006801:Humans; D007593:Joint Instability; D007719:Knee Joint / Q000502:physiology*; D008422:Materials Testing; D008953:Models, Anatomic; D010027:Osteotomy / Q000295:instrumentation / Q000379:methods*; D013977:Tibia / Q000601:surgery*; D016474:Weight-Bearing
chemical_list: D018786:Bone Substitutes; D002130:Calcium Phosphates; C485817:beta-tricalcium phosphate