Biomechanical study of three-dimensional printed filler block design in open wedge high tibial osteotomy_Journal of Biomedical Engineering

Authors：

ZHANG Jing ¹ , ZHANG Jianing ¹ , GUO Lei ¹ , CHEN Shibin ¹ , JIN Zhongmin ² ,  CHEN Zhenxian ¹

1. School of Construction Machinery, Chang'an University, Xi'an 710064, P. R. China;
2. School of Mechanical Engineering, Southwest Jiaotong University, Chengdu 610031, P. R. China;

Corresponding author：

CHEN Zhenxian, Email: zhenxian_chen@yeah.net

Keywords：

Open wedge high tibial osteotomy; Filling block design; Biomechanics

DOI：

10.7507/1001-5515.202403056

Video：

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The use of a filling block can improve the initial stability of the fixation plate in the open wedge high tibial osteotomy (OWHTO), and promote bone healing. However, the biomechanical effects of filling block structures and materials on OWHTO remain unclear. OWHTO anatomical filling block model was designed and built. The finite element analysis method was adopted to study the influence of six filling block structure designs and four different materials on the stress of the fixed plate, tibia, screw, and filling block, and the micro-displacement at the wedge gap of the OWHTO fixation system. After the filling block was introduced in the OWHTO, the maximum von Mises stress of the fixation plate was reduced by more than 30%, the maximum von Mises stress of the tibia decreased by more than 15%, and the lateral hinge decreased by 81%. When the filling block was designed to be filled in the posterior position of the wedge gap, the maximum von Mises stress of the fixation system was 97.8 MPa, which was smaller than other filling methods. The minimum micro-displacement of osteotomy space was –2.9 μm, which was larger than that of other filling methods. Compared with titanium alloy and tantalum metal materials, porous hydroxyapatite material could obtain larger micro-displacement in the osteotomy cavity, which is conducive to stimulating bone healing. The results demonstrate that OWHTO with a filling block can better balance the stress distribution of the fixation system, and a better fixation effect can be obtained by using a filling block filled in the posterior position. Porous HA used as the material of the filling block can obtain a better bone healing effect.

Citation： ZHANG Jing, ZHANG Jianing, GUO Lei, CHEN Shibin, JIN Zhongmin, CHEN Zhenxian. Biomechanical study of three-dimensional printed filler block design in open wedge high tibial osteotomy. Journal of Biomedical Engineering, 2024, 41(4): 758-765. doi: 10.7507/1001-5515.202403056 Copy

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2.	Demeo P J, Johnson E M, Chiang P P, et al. Midterm follow-up of opening-wedge high tibial osteotomy. Am J Sports Med, 2010, 38(20): 77-84.
3.	Park C H, Bae D K, Kim K I, et al. Serial changes in the joint space width and joint line convergence angle after closed-wedge high tibial osteotomy. Am J Sports Med, 2017, 45(32): 54-61.
4.	Cheng X, Liu F, Xiong F, et al. Radiographic changes and clinical outcomes after open and closed wedge high tibial osteotomy: a systematic review and meta-analysis. J Orthop Surg Res, 2019, 14(1): 179.
5.	Rupp M C, Lindner F, Winkler P W, et al. Clinical effect of isolated lateral closing wedge distal femoral osteotomy compared to medial opening wedge high tibial osteotomy for the correction of varus malalignment: a propensity score-matched analysis. Am J Sports Med, 2023, 51(2): 437-445.
6.	Takeuchi R, Bito H, Akamatsu Y, et al. In vitro stability of open wedge high tibial osteotomy with synthetic bone graft. Knee, 2010, 17(3): 217-220.
7.	Pauchard Y, Ivanov T G, McErlain D D, et al. Assessing the local mechanical environment in medial opening wedge high tibial osteotomy using finite element analysis. J Biomech Eng, 2015, 137(3): 1-7.
8.	Kaze A D, Maas S, Belsey J, et al. Static and fatigue strength of a novel anatomically contoured implant compared to five current open-wedge high tibial osteotomy plates. J Exp Orthop, 2017, 4(1): 39.
9.	Koh Y G, Lee J A, Lee H Y, et al. Design optimization of high tibial osteotomy plates using finite element analysis for improved biomechanical effect. J Orthop Surg Res., 2019, 14(1): 219.
10.	Pape D, Kohn D, Giffen V, et al. Differences in fixation stability between spacer plate and plate fixator following high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc, 2013, 21(1): 82-89.
11.	Jeong H W, Shim S J, Park S Y, et al. Analysis of the determinant factor of the medial joint space width after medial opening wedge high tibial osteotomy. Arch Orthop Trauma Surg, 2023, 143(8): 4879-4888.
12.	Golovakhа M L, Orljanski W, Benedetto K-P, et al. Comparison of theoretical fixation stability of three devices employed in medial opening wedge high tibial osteotomy: a finite element analysis. BMC Musculoskelet Disord, 2014, 15: 230.
13.	Jang Y W, Lim D, Seo H, et al. Role of an anatomically contoured plate and metal block for balanced stability between the implant and lateral hinge in open-wedge high-tibial osteotomy. Arch Orthop Trauma Surg, 2018, 138(7): 911-920.
14.	Ha J K, Yeom C H, Jang H S, et al. Biomechanical analysis of a novel wedge locking plate in a porcine tibial model. Clin Orthop Surg, 2016, 8(4): 373-378.
15.	Belsey J, Diffo Kaze A, Jobson S, et al. Graft materials provide greater static strength to medial opening wedge high tibial osteotomy than when no graft is included. J Exp Orthop, 2019, 6(1): 13.
16.	Costantino P D, Friedman C D. Synthetic bone graft substitutes. Otolaryngol Clin North Am, 1994, 27(5): 1037-1074.
17.	Jeon J W, Jang S, Ro D H, et al. Faster bone union progression and less sclerosis at the osteotomy margin after medial opening-wedge high tibial osteotomy using highly porous beta-tricalcium phosphate granules versus allogeneic bone chips: A matched case-control study. Knee, 2021, 29: 33-41.
18.	Lee S S, So S Y, Jung E Y, et al. The efficacy of porous hydroxyapatite chips as gap filling in open-wedge high tibial osteotomy in terms of clinical, radiological, and histological criteria. Knee, 2020, 27(2): 436-443.
19.	Peng L, Bai J, Zeng X, et al. Comparison of isotropic and orthotropic material property assignments on femoral finite element models under two loading conditions. Med Eng Phys, 2006, 28(3): 227-233.
20.	Sopher R S, Amis A A, Calder J D, et al. Total ankle replacement design and positioning affect implant-bone micromotion and bone strains. Med Eng Phys, 2017, 42: 80-90.
21.	Luo C A, Hua S Y, Lin S C, et al. Stress and stability comparison between different systems for high tibial osteotomies. BMC Musculoskelet Disord, 2013, 14: 110.
22.	Luo D, Rong Q, Chen Q, et al. Finite-element design and optimization of a three-dimensional tetrahedral porous titanium scaffold for the reconstruction of mandibular defects. Med Eng Phys, 2017, 47: 176.
23.	Chen Y N, Chang C W, Li C T, et al. Biomechanical investigation of the type and configuration of screws used in high tibial osteotomy with titanium locking plate and screw fixation. J Orthop Surg Res, 2019, 14(1): 35.
24.	Raja Izaham R M, Abdul Kadir M R, Abdul Rashid A H, et al. Finite element analysis of Puddu and Tomofix plate fixation for open wedge high tibial osteotomy. Injury, 2012, 43(6): 898-902.
25.	Koh Y G, Son J, Kwon S K, et al. Biomechanical evaluation of opening-wedge high tibial osteotomy with composite materials using finite-element analysis. Knee, 2018, 25(6): 977-987.
26.	Han Q, Wang C, Chen H, et al. Porous tantalum and titanium in orthopedics: A review. ACS Biomater Sci Eng, 2019, 5(11): 5798-5824.
27.	Tanaka T. Opening wedge high tibial osteotomy using a puddu plate and β-Tricalcium phosphate blocks. Tech Orthop, 2013, 28(2): 74831354.
28.	Pan C S, Wang X, Ding L Z, et al. The best position of bone grafts in the medial open-wedge high tibial osteotomy: A finite element analysis. Comput Methods Programs Biomed, 2023, 228: 107253.

1. Luites J W H, Brinkman J M, Wymenga A B, et al. Fixation stability of opening- versus closing-wedge high tibial osteotomy: a randomised clinical trial using radiostereometry. Bone Joint Surg Br, 2009, 91(11): 1459-1465.
2. Demeo P J, Johnson E M, Chiang P P, et al. Midterm follow-up of opening-wedge high tibial osteotomy. Am J Sports Med, 2010, 38(20): 77-84.
3. Park C H, Bae D K, Kim K I, et al. Serial changes in the joint space width and joint line convergence angle after closed-wedge high tibial osteotomy. Am J Sports Med, 2017, 45(32): 54-61.
4. Cheng X, Liu F, Xiong F, et al. Radiographic changes and clinical outcomes after open and closed wedge high tibial osteotomy: a systematic review and meta-analysis. J Orthop Surg Res, 2019, 14(1): 179.
5. Rupp M C, Lindner F, Winkler P W, et al. Clinical effect of isolated lateral closing wedge distal femoral osteotomy compared to medial opening wedge high tibial osteotomy for the correction of varus malalignment: a propensity score-matched analysis. Am J Sports Med, 2023, 51(2): 437-445.
6. Takeuchi R, Bito H, Akamatsu Y, et al. In vitro stability of open wedge high tibial osteotomy with synthetic bone graft. Knee, 2010, 17(3): 217-220.
7. Pauchard Y, Ivanov T G, McErlain D D, et al. Assessing the local mechanical environment in medial opening wedge high tibial osteotomy using finite element analysis. J Biomech Eng, 2015, 137(3): 1-7.
8. Kaze A D, Maas S, Belsey J, et al. Static and fatigue strength of a novel anatomically contoured implant compared to five current open-wedge high tibial osteotomy plates. J Exp Orthop, 2017, 4(1): 39.
9. Koh Y G, Lee J A, Lee H Y, et al. Design optimization of high tibial osteotomy plates using finite element analysis for improved biomechanical effect. J Orthop Surg Res., 2019, 14(1): 219.
10. Pape D, Kohn D, Giffen V, et al. Differences in fixation stability between spacer plate and plate fixator following high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc, 2013, 21(1): 82-89.
11. Jeong H W, Shim S J, Park S Y, et al. Analysis of the determinant factor of the medial joint space width after medial opening wedge high tibial osteotomy. Arch Orthop Trauma Surg, 2023, 143(8): 4879-4888.
12. Golovakhа M L, Orljanski W, Benedetto K-P, et al. Comparison of theoretical fixation stability of three devices employed in medial opening wedge high tibial osteotomy: a finite element analysis. BMC Musculoskelet Disord, 2014, 15: 230.
13. Jang Y W, Lim D, Seo H, et al. Role of an anatomically contoured plate and metal block for balanced stability between the implant and lateral hinge in open-wedge high-tibial osteotomy. Arch Orthop Trauma Surg, 2018, 138(7): 911-920.
14. Ha J K, Yeom C H, Jang H S, et al. Biomechanical analysis of a novel wedge locking plate in a porcine tibial model. Clin Orthop Surg, 2016, 8(4): 373-378.
15. Belsey J, Diffo Kaze A, Jobson S, et al. Graft materials provide greater static strength to medial opening wedge high tibial osteotomy than when no graft is included. J Exp Orthop, 2019, 6(1): 13.
16. Costantino P D, Friedman C D. Synthetic bone graft substitutes. Otolaryngol Clin North Am, 1994, 27(5): 1037-1074.
17. Jeon J W, Jang S, Ro D H, et al. Faster bone union progression and less sclerosis at the osteotomy margin after medial opening-wedge high tibial osteotomy using highly porous beta-tricalcium phosphate granules versus allogeneic bone chips: A matched case-control study. Knee, 2021, 29: 33-41.
18. Lee S S, So S Y, Jung E Y, et al. The efficacy of porous hydroxyapatite chips as gap filling in open-wedge high tibial osteotomy in terms of clinical, radiological, and histological criteria. Knee, 2020, 27(2): 436-443.
19. Peng L, Bai J, Zeng X, et al. Comparison of isotropic and orthotropic material property assignments on femoral finite element models under two loading conditions. Med Eng Phys, 2006, 28(3): 227-233.
20. Sopher R S, Amis A A, Calder J D, et al. Total ankle replacement design and positioning affect implant-bone micromotion and bone strains. Med Eng Phys, 2017, 42: 80-90.
21. Luo C A, Hua S Y, Lin S C, et al. Stress and stability comparison between different systems for high tibial osteotomies. BMC Musculoskelet Disord, 2013, 14: 110.
22. Luo D, Rong Q, Chen Q, et al. Finite-element design and optimization of a three-dimensional tetrahedral porous titanium scaffold for the reconstruction of mandibular defects. Med Eng Phys, 2017, 47: 176.
23. Chen Y N, Chang C W, Li C T, et al. Biomechanical investigation of the type and configuration of screws used in high tibial osteotomy with titanium locking plate and screw fixation. J Orthop Surg Res, 2019, 14(1): 35.
24. Raja Izaham R M, Abdul Kadir M R, Abdul Rashid A H, et al. Finite element analysis of Puddu and Tomofix plate fixation for open wedge high tibial osteotomy. Injury, 2012, 43(6): 898-902.
25. Koh Y G, Son J, Kwon S K, et al. Biomechanical evaluation of opening-wedge high tibial osteotomy with composite materials using finite-element analysis. Knee, 2018, 25(6): 977-987.
26. Han Q, Wang C, Chen H, et al. Porous tantalum and titanium in orthopedics: A review. ACS Biomater Sci Eng, 2019, 5(11): 5798-5824.
27. Tanaka T. Opening wedge high tibial osteotomy using a puddu plate and β-Tricalcium phosphate blocks. Tech Orthop, 2013, 28(2): 74831354.
28. Pan C S, Wang X, Ding L Z, et al. The best position of bone grafts in the medial open-wedge high tibial osteotomy: A finite element analysis. Comput Methods Programs Biomed, 2023, 228: 107253.

Journal of Biomedical Engineering

Biomechanical study of three-dimensional printed filler block design in open wedge high tibial osteotomy

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