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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 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 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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