In vitro stability of open wedge high tibial osteotomy with synthetic bone graft

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 +/- 1.8 Mpa in Group A. On the other hand, this value in Group B was only 9.52 +/- 2.1 Mpa 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 +/- 280 N and in Group B 4270 +/- 420 N 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. (C) 2009 Elsevier B.V. All rights reserved.