References of "Diffo Kaze, Arnaud 50001699"
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See detailGraft materials provide greater static strength to medial opening wedge high tibial osteotomy than when no graft is included
Belsey, James; Diffo Kaze, Arnaud UL; Jobson, Simon et al

in Journal of Experimental Orthopaedics (2019), 6(13),

Background The purpose of this study was to compare the stability of medial opening-wedge high tibial osteotomy (MOWHTO) with and without different graft materials. Good clinical and radiological outcomes ... [more ▼]

Background The purpose of this study was to compare the stability of medial opening-wedge high tibial osteotomy (MOWHTO) with and without different graft materials. Good clinical and radiological outcomes have been demonstrated when either using or not using graft materials during MOWHTO. Variations in the biomechanical properties of different graft types, regarding the stability they provide a MOWHTO, have not been previously investigated. Methods A 10 mm biplanar MOWHTO was performed on 15 artificial sawbone tibiae, which were fixed using the Activmotion 2 plate. Five bones had OSferion60 wedges (synthetic group), five had allograft bone wedges (allograft group), and five had no wedges (control group) inserted into the osteotomy gap. Static compression was applied axially to each specimen until failure of the osteotomy. Ultimate load, horizontal and vertical displacements were measured and used to calculate construct stiffness and valgus malrotation of the tibial head. Results The synthetic group failed at 6.3 kN, followed by the allograft group (6 kN), and the control group (4.5 kN). The most valgus malrotation of the tibial head was observed in the allograft group (2.6°). The synthetic group showed the highest stiffness at the medial side of the tibial head (9.54 kN·mm− 1), but the lowest stiffness at the lateral side (1.59 kN·mm-1). The allograft group showed high stiffness on the medial side of the tibial head (7.54 kN·mm− 1) as well as the highest stiffness on the lateral side (2.18 kN·mm− 1). Conclusions The use of graft materials in MOWHTO results in superior material properties compared to the use of no graft. The static strength of MOWHTO is highest when synthetic grafts are inserted into the osteotomy gap. Allograft wedges provide higher mechanical strength to a MOWHTO than when no graft used. In comparison to the synthetic grafts, allograft wedges result in the stiffness of the osteotomy being more similar at the medial and lateral cortices. [less ▲]

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See detailBiomechanical testing of osteotomy plates
Maas, Stefan UL; Diffo Kaze, Arnaud UL

Scientific Conference (2018, November 30)

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See detailStatic and fatigue strength of a novel anatomically contoured implant compared to five current open-wedge high tibial osteotomy plates
Diffo Kaze, Arnaud UL; Maas, Stefan UL; Belsey, James et al

in Journal of Experimental Orthopaedics (2017), 4(39),

Abstract Background The purpose of the present study was to compare the mechanical static and fatigue strength of the size 2 osteotomy plate “Activmotion” with the following five other common implants for ... [more ▼]

Abstract Background The purpose of the present study was to compare the mechanical static and fatigue strength of the size 2 osteotomy plate “Activmotion” with the following five other common implants for the treatment of medial knee joint osteoarthritis: the TomoFix small stature, the TomoFix standard, the Contour Lock, the iBalance and the second generation PEEKPower. Methods Six fourth-generation tibial bone composites underwent a medial open-wedge high tibial osteotomy (HTO), according to standard techniques, using size 2 Activmotion osteotomy plates. All bone-implant constructs were subjected to static compression load to failure and load-controlled cyclic fatigue failure testing, according to a previously defined testing protocol. The mechanical stability was investigated by considering different criteria and parameters: maximum forces, the maximum number of loading cycles, stiffness, the permanent plastic deformation of the specimens during the cyclic fatigue tests, and the maximum displacement range in the hysteresis loops of the cyclic loading responses. Results In each test, all bone-implant constructs with the size 2 Activmotion plate failed with a fracture of the lateral cortex, like with the other five previously tested implants. For the static compression tests the failure occurred in each tested implant above the physiological loading of slow walking (> 2400 N). The load at failure for the Activmotion group was the highest (8200 N). In terms of maximum load and number of cycles performed prior to failure, the size 2 Activmotion plate showed higher results than all the other tested implants except the ContourLock plate. The iBalance implant offered the highest stiffness (3.1 kN/mm) for static loading on the lateral side, while the size 2 Activmotion showed the highest stiffness (4.8 kN/mm) in cyclic loading. Conclusions Overall, regarding all of the analysed strength parameters, the size 2 Activmotion plate provided equivalent or higher mechanical stability compared to the previously tested implant. Implants with a metaphyseal slope adapted to the tibia anatomy, and positioned more anteriorly on the proximal medial side of the tibia, should provide good mechanical stability. [less ▲]

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See detailA finite element model of the lower limb during stance phase of gait cycle including the muscle forces
Diffo Kaze, Arnaud UL; Maas, Stefan UL; Arnoux, Pierre-Jean et al

in BioMedical Engineering OnLine (2017), 16(138),

Abstract Background Results of finite element (FE) analyses can give insight into musculoskeletal diseases if physiological boundary conditions, which include the muscle forces during specific activities ... [more ▼]

Abstract Background Results of finite element (FE) analyses can give insight into musculoskeletal diseases if physiological boundary conditions, which include the muscle forces during specific activities of daily life, are considered in the finite element modelling. So far, many simplifications of the boundary conditions are currently made. This study presents an approach for FE modelling of the lower limb for which muscle forces were included. Method The stance phase of normal gait was simulated. Muscle forces were calculated using a musculoskeletal rigid body (RB) model of the human body, and were subsequently applied to a FE model of the lower limb. It was shown that the inertial forces are negligible during the stance phase of normal gait. The contact surfaces between the parts within the knee were modelled as bonded. Weak springs were attached to the distal tibia for numerical reasons. Results Hip joint reaction forces from the RB model and those from the FE model were similar in magnitude with relative differences less than 16%. The forces of the weak spring were negligible compared to the applied muscle forces. The maximal strain was 0.23% in the proximal region of the femoral diaphysis and 1.7% in the contact zone between the tibia and the fibula. Conclusions The presented approach based on FE modelling by including muscle forces from inverse dynamic analysis of musculoskeletal RB model can be used to perform analyses of the lower limb with very realistic boundary conditions. In the present form, this model can be used to better understand the loading, stresses and strains of bones in the knee area and hence to analyse osteotomy fixation devices. [less ▲]

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See detailMechanical strength assessment of a drilled hole in the contralateral cortex at the end of the open wedge for high tibial osteotomy.
Diffo Kaze, Arnaud UL; Maas, Stefan UL; Hoffmann, Alexander et al

in Journal of Experimental Orthopaedics (2017), 4(1),

BACKGROUND: This study aimed to investigate, by means of finite element analysis, the effect of a drill hole at the end of a horizontal osteotomy to reduce the risk of lateral cortex fracture while ... [more ▼]

BACKGROUND: This study aimed to investigate, by means of finite element analysis, the effect of a drill hole at the end of a horizontal osteotomy to reduce the risk of lateral cortex fracture while performing an opening wedge high tibial osteotomy (OWHTO). The question was whether drilling a hole relieves stress and increases the maximum correction angle without fracture of the lateral cortex depending on the ductility of the cortical bone. METHODS: Two different types of osteotomy cuts were considered; one with a drill hole (diameter 5 mm) and the other without the hole. The drill holes were located about 20 mm distally to the tibial plateau and 6 mm medially to the lateral cortex, such that the minimal thickness of the contralateral cortical bone was 5 mm. Based on finite element calculations, two approaches were used to compare the two types of osteotomy cuts considered: (1) Assessing the static strength using local stresses following the idea of the FKM-guideline, subsequently referred to as the "FKM approach" and (2) limiting the total strain during the opening of the osteotomy wedge, subsequently referred to as "strain approach". A critical opening angle leading to crack initiation in the opposite lateral cortex was determined for each approach and was defined as comparative parameter. The relation to bone aging was investigated by considering the material parameters of cortical bones from young and old subjects. RESULTS: The maximum equivalent (von-Mises) stress was smaller for the cases with a drill hole at the end of the osteotomy cut. The critical angle was approximately 1.5 times higher for the specimens with a drill hole compared to those without. This corresponds to an average increase of 50%. The calculated critical angle for all approaches is below 5°. The critical angle depends on the used approach, on patient's age and assumed ductility of the cortical bone. CONCLUSIONS: Drilling a hole at the end of the osteotomy reduces the stresses in the lateral cortex and increases the critical opening angle prior to cracking of the opposite cortex in specimen with small correction angles. But the difference from having a drill hole or not is not so significant, especially for older patients. The ductility of the cortical bone is the decisive parameter for the critical opening angle. [less ▲]

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See detailNumerical comparative study of five currently used implants for high tibial osteotomy: realistic loading including muscle forces versus simplified experimental loading
Diffo Kaze, Arnaud UL; Maas, Stefan UL; Kedziora, Slawomir UL et al

in Journal of Experimental Orthopaedics (2017), 5(28),

Background Many different fixation devices are used to maintain the correction angle after medial open wedge high tibial osteotomy (MOWHTO). Each device must provide at least sufficient mechanical ... [more ▼]

Background Many different fixation devices are used to maintain the correction angle after medial open wedge high tibial osteotomy (MOWHTO). Each device must provide at least sufficient mechanical stability to avoid loss of correction and unwanted fracture of the contralateral cortex until the bone heals. In the present study, the mechanical stability of following different implants was compared: the TomoFix small stature (sm), the TomoFix standard (std), the Contour Lock, the iBalance and the second generation PEEKPower. Simplified loading, usually consisting of a vertical load applied to the tibia plateau, is used for experimental testing of fixation devices and also in numerical studies. Therefore, this study additionally compared this simplified experimental loading with a more realistic loading that includes the muscle forces. Method Two types of finite element models, according to the considered loading, were created. The first type numerically simulated the static tests of MOWHTO implants performed in a previous experimental biomechanical study, by applying a vertical compressive load perpendicularly to the plateau of the osteotomized tibia. The second type included muscle forces in finite element models of the lower limb with osteotomized tibiae and simulated the stance phase of normal gait. Section forces in the models were determined and compared. Stresses in the implants and contralateral cortex, and micromovements of the osteotomy wedge, were calculated. Results For both loading types, the stresses in the implants were lower than the threshold values defined by the material strength. The stresses in the lateral cortex were smaller than the ultimate tensile strength of the cortical bone. The implants iBalance and Contour Lock allowed the smallest micromovements of the wedge, while the PEEKPower allowed the highest. There was a correlation between the micromovements of the wedge, obtained for the simplified loading of the tibia, and the more realistic loading of the lower limb at 15% of the gait cycle (Pearson’s value r = 0.982). Conclusions An axial compressive load applied perpendicularly to the tibia plateau, with a magnitude equal to the first peak value of the knee joint contact forces, corresponds quite well to a realistic loading of the tibia during the stance phase of normal gait (at 15% of the gait cycle and a knee flexion of about 22 degrees). However, this magnitude of the knee joint contact forces overloads the tibia compared to more realistic calculations, where the muscle forces are considered. The iBalance and Contour Lock implants provide higher rigidity to the bone-implant constructs compared to the TomoFix and the PEEKPower plates. [less ▲]

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See detailBiomechanik neuer Implantate für die HTO
Pape, Dietrich; Diffo Kaze, Arnaud UL; Hoffmann, Alexander et al

in Orthopade (Der) (2017), 46(7), 583-595

Biomechanical characteristics of 5 tibial osteotomy plates for the treatment of medial knee joint osteoarthritis were examined. Fourth-generation tibial bone composites underwent a medial open-wedge high ... [more ▼]

Biomechanical characteristics of 5 tibial osteotomy plates for the treatment of medial knee joint osteoarthritis were examined. Fourth-generation tibial bone composites underwent a medial open-wedge high tibial osteotomy, using TomoFix™ standard, PEEKPower®, ContourLock®, TomoFix™ small stature plates, and iBalance® implants. Static compression load to failure and load-controlled cyclic fatigue failure tests were performed. All plates had sufficient stability up to 2400 N in the static compression load to failure tests. Screw breakage in the iBalance® group and opposite cortex fractures in all constructs occurred at lower loading conditions. The highest fatigue strength in terms of maximal load and number of cycles performed prior to failure was observed for the ContourLock® group followed by the iBalance® implants, the TomoFix™ standard and small stature plates. PEEKPower® had the lowest fatigue strength. All plates showed sufficient stability under static loading. Compared to the TomoFix™ and the PEEKPower® plates, the ContourLock® plate and iBalance® implant showed a higher mechanical fatigue strength during cyclic fatigue testing, suggesting that both mechanical static and fatigue strength increase with a wider proximal T‑shaped plate design together with diverging proximal screws. Mechanical strength of the bone–implant constructs decreases with a narrow T‑shaped proximal end design and converging proximal screws (TomoFix™) or a short vertical plate design (PEEKPower®). Published results indicate high fusion rates and good clinical results with the TomoFix™ plate, which is contrary to our findings. A certain amount of interfragmentary motion rather than high mechanical strength and stiffness seem to be important for bone healing which is outside the scope of this paper. [less ▲]

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See detailEtude biomécanique comparative de cinq différents systèmes de fixation utilisés dans les cas d'ostéotomies tibiales valgisantes: Essais expérimentaux et simulations numériques incluant les forces musculaires
Diffo Kaze, Arnaud UL

Doctoral thesis (2016)

This research project was carried out in partnership with the Orthopaedic and Traumatology service of the “clinique d’Eich” of the Centre Hospitalier de Luxembourg. The main objective consisted in a ... [more ▼]

This research project was carried out in partnership with the Orthopaedic and Traumatology service of the “clinique d’Eich” of the Centre Hospitalier de Luxembourg. The main objective consisted in a comparative biomechanical study of the stability of five different currently used implants for open-wedge high tibial osteotomy (HTO). The following implants were tested in the comparative biomechanical study: Contour Lock HTO, PEEKPower HTO, iBalance HTO, TomoFix standard and TomoFix small stature. The implants were chosen freely from the market and there has not been any funding or link to any of the manufacturers. The comparison was first made experimentally using static compression loading to failure and dynamic loading to failure tests, then computationally using simulations by mean of the finite element method. Muscle forces were predicted using musculoskeletal modeling and applied to the finite element models of the lower limb that simulated the stance phase of the gait cycle. The finite element models created included all the bones of the lower limb, except those of the foot, as well as the menisci, the articular cartilage layers of the knee and the patellar tendon which was modelled by springs. The comparative study using numerical simulations was done considering two separate loadings: (1) application of a compressive load on the tibial plateau and (2) consideration of muscle forces. The comparison of the two types of loading (1) and (2) showed that loading (1) used during the mechanical tests is compatible with a realistic loading of the tibia with the leg at 15 % of the gait cycle during slow walking. Observations from numerical simulations considering loading (2) emphasized the necessity to take into account the muscle forces in the testing protocols and implant design process. The results of the numerical simulations considering loading (1) were in line with the findings of the experimental study. All the implants tested showed sufficient stability during static loading. All the specimens failed due to fracture of the opposite cortical bone. In regards to the results of this study, the implant iBalance offered the best mechanical stability to the operated tibia, and the PEEKPower plate the worst. Simplifications were made to reduce the complexity of the different physical and numerical models; hence the transposition of the obtained results to clinical settings should be done with precaution. There is no conflict of interest in relation to this work. [less ▲]

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See detailBiomechanical properties of five different currently used implants for open-wedge high tibial osteotomy
Diffo Kaze, Arnaud UL; Maas, Stefan UL; Waldmann, Danièle UL et al

in Journal of Experimental Orthopaedics (2015), 2(14),

Background: As several new tibial osteotomy plates recently appeared on the market, the aim of the present study was to compare mechanical static and fatigue strength of three newly designed plates with ... [more ▼]

Background: As several new tibial osteotomy plates recently appeared on the market, the aim of the present study was to compare mechanical static and fatigue strength of three newly designed plates with gold standard plates for the treatment of medial knee joint osteoarthritis. Methods: Sixteen fourth-generation tibial bone composites underwent a medial open-wedge high tibial osteotomyn(HTO) according to standard techniques, using five TomoFix standard plates, five PEEKPower plates and six iBalance implants. Static compression load to failure and load-controlled cyclic fatigue failure tests were performed. Forces, horizontal and vertical displacements were measured; rotational permanent plastic deformations, maximal displacement ranges in the hysteresis loops of the cyclic loading responses and dynamic stiffness were determined. Results: Static compression load to failure tests revealed that all plates showed sufficient stability up to 2400 N without any signs of opposite cortex fracture, which occurred above this load in all constructs at different load levels. During the fatigue failure tests, screw breakage in the iBalance group and opposite cortex fractures in all constructs occurred only under physiological loading conditions (<2400 N). The highest fatigue strength in terms of maximal load and number of cycles performed prior to failure was observed for the ContourLock group followed by the iBalance implants, the TomoFix standard (std) and small stature (sm) plates. The PEEKPower group showed the lowest fatigue strength. Conclusions: All plates showed sufficient stability under static loading. Compared to the TomoFix and the PEEKPower plates, the ContourLock plate and iBalance implant showed a higher mechanical fatigue strength during cyclic fatigue testing. These data suggest that both mechanical static and fatigue strength increase with a wider proximal T-shaped plate design together with diverging proximal screws as used in the ContourLock plate or a closed-wedge construction as in the iBalance design. Mechanical strength of the bone-implant constructs decreases with a narrow T-shaped proximal end design and converging proximal screws (TomoFix) or a short vertical plate design (PEEKPower Plate). Whenever high mechanical strength is required, a ContourLock or iBalance plate should be selected. [less ▲]

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See detailStatic and dynamic differences in fixation stability between a spacer plate and a small stature plate fixator used for high tibial osteotomies – A biomechanical bone composite study
Maas, Stefan UL; Diffo Kaze, Arnaud UL; Dueck, Klaus et al

in ISRN Orthopedics (2013), 2013

Background: The objective of the present study was to comparemechanical strength and stability of the newly designed spacer plate with the gold standard plate for the treatment of medial knee joint ... [more ▼]

Background: The objective of the present study was to comparemechanical strength and stability of the newly designed spacer plate with the gold standard plate for the treatment of medial knee joint osteoarthritis. Materials and Methods: Ten fourth-generation tibial bone composites underwent a medial open-wedge high tibial osteotomy (HTO) according to standard techniques, using five TomoFix plates and five Contour Lock plates. Static compression load to failure and load-controlled cyclical fatigue failure tests were performed. Forces and horizontal displacements were measured; plastic deformations and dynamic stiffness were determined. Results and Discussion: In all samples, rotation of the tibial head and fracture of the opposite cortex were observed. Behaviors of the specimens under static loading were comparable between groups. Cyclic testing revealed lateral significant higher stiffness untilfailure for the Contour Lock compared to the TomoFix plate. No visible implant failure was observed in any group. Conclusion: Considering the static analysis, both plates offered sufficient stability under physiologic loads of up to 3000N. The Contour Lock plate-fixated specimens showed a higher stability during the cyclic testing, supposedly due to the wider distance between the fixation screws. [less ▲]

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