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. 2019 Jul 16;14(1):219.
doi: 10.1186/s13018-019-1269-8.

Design optimization of high tibial osteotomy plates using finite element analysis for improved biomechanical effect

Yong-Gon Koh  1 , Jin-Ah Lee  2 , Hwa-Yong Lee  2 , Heoung-Jae Chun  2 , Hyo-Jeong Kim  3 , Kyoung-Tak Kang  4
Affiliations

Design optimization of high tibial osteotomy plates using finite element analysis for improved biomechanical effect

Yong-Gon Koh et al. J Orthop Surg Res. .

Abstract

Background: High tibial osteotomy (HTO) is a common treatment for moderate osteoarthritis of the medial compartment in the knee joint by the translation of the force center toward the lateral compartment. However, the stability of a short plate such as Puddu used in this procedure was not as effective as other long plates such as Tomofix. No previous studies have used a rigorous and systematic design optimization method to determine the optimal shape of short HTO plate. Therefore, the purpose of this study is to evaluate the improved biomechanical stability of a short HTO plate by using design optimization and finite element (FE) analysis.

Methods: A FE model of HTO was subjected to physiological and surgical loads in the tibia. Taguchi-style L27 orthogonal arrays were used to identify the most significant factors for optimizing the design parameters. The optimal design variables were calculated using the nondominated sorting genetic algorithm II. Plate and bone stresses and wedge micromotions in the initial and optimized designs were chosen as the comparison indices.

Results: Optimal designed HTO plate showed the decreased micromotions over the initial HTO plate with enhanced plate stability. In addition, increased bone stress and decreased plate stress supported the positive effect on stress shielding compared to initial HTO plate design. The results yielded a new short HTO design while demonstrating the feasibility of design optimization and potential improvements to biomechanical stability in HTO design. The newly developed short HTO plate throughout the optimization and computational simulation showed the improved biomechanical effect as good as the golden standard, TomoFix, does.

Conclusions: This study showed that plate design has a strong influence on the stability after HTO. This study demonstrated that the optimized short plates had low stress shielding effect and less micromotion because of its improvement in biomechanical performances. Our result showed that design optimization is an effective tool for HTO plate design. This information can aid future developments in HTO plate design and can be expanded to other implant designs.

Keywords: Design optimization; Finite element analysis; High tibial osteotomy.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Specifications of the opening wedge HTO used in this study. Three edges aa, bb, and cc along the medial opening were defined to evaluate the height changes in weight-bearing condition
Fig. 2
Fig. 2
Finite element models for a the Puddu plate and b the TomoFix plate
Fig. 3
Fig. 3
Loading boundary conditions used in this study. a Physiological and surgical load. b Loads on the four regions of the tibial plateau
Fig. 4
Fig. 4
Parameters in geometry of the initial HTO plate
Fig. 5
Fig. 5
Results of sensitivity analysis of the 12 geometric design variables for the HTO plate
Fig. 6
Fig. 6
Comparison of the average stresses on the bone, plate, and screw with respect to three difference HTO plates
Fig. 7
Fig. 7
Stress distribution of the bone in the Puddu plate and comparison of the stress distribution on the plate and bone with respect to three difference HTO plates
Fig. 8
Fig. 8
Comparison of the micromotion at edges aa, bb, and cc with respect to different design
See this image and copyright information in PMC

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