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Joint Diseases and
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Original Article · Open access

Reduced lateral hinge stress and fracture risk in double-hinge medial open-wedge high tibial osteotomy: A finite element study

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Haluk Yaka

Department of Orthopedics and Traumatology, Necmettin Erbakan University Faculty of Medicine, Konya, Türkiye

ORCID: 0000-0001-7461-7298

Mustafa Özkaya

Department of Mechanical Engineering, KTO Karatay University, Konya, Türkiye

ORCID: 0000-0002-3916-1261

Alper Kırılmaz

Department of Orthopedics and Traumatology, Konya City Hospital, Konya, Türkiye

ORCID: 0000-0001-7277-9154

Turgut Emre Erdem

Department of Orthopedics and Traumatology, Pazarcık State Hospital, Kahramanmaraş, Türkiye

ORCID: 0000-0001-7144-2605

Mustafa Özer

Department of Orthopedics and Traumatology, Necmettin Erbakan University Faculty of Medicine, Konya, Türkiye

ORCID: 0000-0002-4199-836X

Faik Türkmen

Department of Orthopedics and Traumatology, Necmettin Erbakan University Faculty of Medicine, Konya, Türkiye

ORCID: 0000-0002-9293-645X

Abstract

Objectives: This study aims to describe the double-hinge medial open wedge high tibial osteotomy (DH-MOWHTO) with two lateral hinges and to investigate its feasibility and its utility in prevention of lateral hinge fractures (LHFs) using a finite element analysis (FEA) model.

Materials and methods: Three osteotomies were modeled. Model 1 (DH-MOWHTO) involved two monoplanar osteotomies from the same starting point, while Models 2 and 3 were standard monoplanar osteotomies using one osteotomy line from Model 1. They were compared in terms of maximum von-Mises stress value (MPa) in the hinges at 10° correction angle, gap distance at 10° correction angle (mm), force required to achieve a 10° correction angle (N), and total surface area (mm2 ) of osteotomy surfaces contacting the saw.

Results: In DH-MOWHTO, the maximum anterior hinge stress at 10º correction angle was reduced by 28.1 to 39.6% and the maximum posterior hinge stress was reduced by 19.2 to 60.1% compared to single monoplanar osteotomies. The average stress reduction in the hinges was 36%. The force required for a 10° correction was approximately 78 N, 114 N and 85 N for Models 1, 2 and 3, respectively. The model with two monoplanar osteotomies had approximately 1.8 and 2 times more osteotomy surface area than Models 2 and 3, respectively.

Conclusion: In this FEA study, two lateral hinges can be created in MOWHTO and lower hinge stresses can be obtained by applying lower forces with this osteotomy. In the light of these findings, DH-MOWHTO may be a novel osteotomy technique to avoid LHF.

Declarations

Author Contributions

Idea/concept: H.Y., M.Ö., F.T.; DESIGN: H.Y., M.Ö., M.Ö., F.T.; Control/supervision: M.Ö., F.T.; Data collection and/or processing, analysis and/or interpretation: A.K., T.E.E., M.Ö.; Literature review: H.Y., A.K., T.E.E., M.Ö.; Writing the article: H.Y., A.K., T.E.E.; Critical review: M.Ö., F.T.;

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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