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Published in: Archives of Orthopaedic and Trauma Surgery 10/2018

01-10-2018 | Orthopaedic Surgery

Stability of supramalleolar osteotomies using different implants in a sawbone model

Authors: Sarah Ettinger, Michael Schwarze, Daiwei Yao, Max Ettinger, Leif Claassen, Christina Stukenborg-Colsman, Hajo Thermann, Christian Plaass

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 10/2018

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Abstract

Background

With ankle arthritis often affecting young patients, joint-sparing treatments instead of total joint replacement should be considered. Only a few implants were specially developed for supramalleolar osteotomies (SMOT). This study was performed to analyse the stability of different implants and their appropriateness for SMOT.

Methods

Twenty-five bone models (Sawbone Europe, Malmö, Sweden) were used for biomechanical testing. SMOT were performed as a uniplanar osteotomy, leaving 5 mm of lateral bone intact with a standardized gap of 8 mm. Five different plates commonly used for SMOT were assessed. For axial stability, the constructs were tested during 100 cycles for each load (150N and 800N) at a rate of 0.5 Hz. For rotational stability, each construct was subject to 100 cycles of 5 Nm torque at a rate of 0.25 Hz, performing three runs with an axial preload of 0N, 150N, or 800N. Ultimate axial load was performed for one-half and ultimate rotational load was performed for the other half of the constructs. In addition, the stiffness of the different constructs after failure was tested.

Results

All constructs showed high stability and could be tested until maximum cyclic load. There was no significant difference between the five plates, neither for stiffness (axial or rotational) nor for failure load (axial or rotational). One plate indicated superiority in axial failure testing without any significant difference.

Conclusion

All implants could be tested until maximum load. The intact hinge apparently provides enough support to compensate for lower moment of inertia of some plates.

Level of evidence

Not applicable.
Literature
1.
go back to reference Agneskirchner JD, Freiling D, Hurschler C, Lobenhoffer P (2006) Primary stability of four different implants for opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 14(3):291–300CrossRefPubMed Agneskirchner JD, Freiling D, Hurschler C, Lobenhoffer P (2006) Primary stability of four different implants for opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 14(3):291–300CrossRefPubMed
2.
go back to reference Brinkman JM, Hurschler C, Agneskirchner JD, Freiling D, van Heerwaarden RJ (2011) Axial and torsional stability of supracondylar femur osteotomies: biomechanical comparison of the stability of five different plate and osteotomy configurations. Knee Surg Sports Traumatol Arthrosc 19(4):579–587CrossRefPubMed Brinkman JM, Hurschler C, Agneskirchner JD, Freiling D, van Heerwaarden RJ (2011) Axial and torsional stability of supracondylar femur osteotomies: biomechanical comparison of the stability of five different plate and osteotomy configurations. Knee Surg Sports Traumatol Arthrosc 19(4):579–587CrossRefPubMed
3.
go back to reference Brinkman JM, Hurschler C, Staubli AE, van Heerwaarden RJ (2011) Axial and torsional stability of an improved single-plane and a new bi-plane osteotomy technique for supracondylar femur osteotomies. Knee Surg Sports Traumatol Arthrosc 19(7):1090–1098CrossRefPubMed Brinkman JM, Hurschler C, Staubli AE, van Heerwaarden RJ (2011) Axial and torsional stability of an improved single-plane and a new bi-plane osteotomy technique for supracondylar femur osteotomies. Knee Surg Sports Traumatol Arthrosc 19(7):1090–1098CrossRefPubMed
4.
go back to reference Buda R, Castagnini F, Cavallo M, Ramponi L, Vannini F, Giannini S (2016) “One-step” bone marrow-derived cells transplantation and joint debridement for osteochondral lesions of the talus in ankle osteoarthritis: clinical and radiological outcomes at 36 months. Arch Orthop Trauma Surg 136(1):107–116CrossRefPubMed Buda R, Castagnini F, Cavallo M, Ramponi L, Vannini F, Giannini S (2016) “One-step” bone marrow-derived cells transplantation and joint debridement for osteochondral lesions of the talus in ankle osteoarthritis: clinical and radiological outcomes at 36 months. Arch Orthop Trauma Surg 136(1):107–116CrossRefPubMed
5.
go back to reference Coventry MB, Ilstrup DM, Wallrichs SL (1993) Proximal tibial osteotomy. A critical long-term study of eighty-seven cases. J Bone Joint Surg Am 75(2):196–201CrossRefPubMed Coventry MB, Ilstrup DM, Wallrichs SL (1993) Proximal tibial osteotomy. A critical long-term study of eighty-seven cases. J Bone Joint Surg Am 75(2):196–201CrossRefPubMed
6.
go back to reference Cristofolini L, Viceconti M (2000) Mechanical validation of whole bone composite tibia models. J Biomech 33(3):279–288CrossRefPubMed Cristofolini L, Viceconti M (2000) Mechanical validation of whole bone composite tibia models. J Biomech 33(3):279–288CrossRefPubMed
7.
go back to reference Heiner AD, Brown TD (2001) Structural properties of a new design of composite replicate femurs and tibias. J Biomech 34(6):773–781CrossRefPubMed Heiner AD, Brown TD (2001) Structural properties of a new design of composite replicate femurs and tibias. J Biomech 34(6):773–781CrossRefPubMed
8.
go back to reference Korner D, Gueorguiev B, Niemeyer P et al (2017) Parameters influencing complaints and joint function in patients with osteochondral lesions of the ankle-an investigation based on data from the German Cartilage Registry (KnorpelRegister DGOU). Arch Orthop Trauma Surg 137(3):367–373CrossRefPubMed Korner D, Gueorguiev B, Niemeyer P et al (2017) Parameters influencing complaints and joint function in patients with osteochondral lesions of the ankle-an investigation based on data from the German Cartilage Registry (KnorpelRegister DGOU). Arch Orthop Trauma Surg 137(3):367–373CrossRefPubMed
9.
go back to reference Korovessis P, Katsoudas G, Salonikides P, Stamatakis M, Baikousis A (1999) Medium- and long-term results of high tibial osteotomy for varus gonarthrosis in an agricultural population. Orthopedics 22(8):729–736PubMed Korovessis P, Katsoudas G, Salonikides P, Stamatakis M, Baikousis A (1999) Medium- and long-term results of high tibial osteotomy for varus gonarthrosis in an agricultural population. Orthopedics 22(8):729–736PubMed
10.
go back to reference Krahenbuhl N, Zwicky L, Bolliger L, Schadelin S, Hintermann B, Knupp M (2017) Mid- to long-term results of supramalleolar osteotomy. Foot Ankle Int 38(2):124–132CrossRefPubMed Krahenbuhl N, Zwicky L, Bolliger L, Schadelin S, Hintermann B, Knupp M (2017) Mid- to long-term results of supramalleolar osteotomy. Foot Ankle Int 38(2):124–132CrossRefPubMed
11.
go back to reference Lee OS, Ahn S, Lee YS (2017) Effect and safety of early weight-bearing on the outcome after open-wedge high tibial osteotomy: a systematic review and meta-analysis. Arch Orthop Trauma Surg 137(7):903–911CrossRefPubMed Lee OS, Ahn S, Lee YS (2017) Effect and safety of early weight-bearing on the outcome after open-wedge high tibial osteotomy: a systematic review and meta-analysis. Arch Orthop Trauma Surg 137(7):903–911CrossRefPubMed
12.
go back to reference Miller BS, Dorsey WO, Bryant CR, Austin JC (2005) The effect of lateral cortex disruption and repair on the stability of the medial opening wedge high tibial osteotomy. Am J Sports Med 33(10):1552–1557CrossRefPubMed Miller BS, Dorsey WO, Bryant CR, Austin JC (2005) The effect of lateral cortex disruption and repair on the stability of the medial opening wedge high tibial osteotomy. Am J Sports Med 33(10):1552–1557CrossRefPubMed
13.
go back to reference Nha KW, Lee SH, Rhyu IJ et al (2016) Safe zone for medial open-wedge supramalleolar osteotomy of the ankle: a cadaveric study. Foot Ankle Int 37(1):102–108CrossRefPubMed Nha KW, Lee SH, Rhyu IJ et al (2016) Safe zone for medial open-wedge supramalleolar osteotomy of the ankle: a cadaveric study. Foot Ankle Int 37(1):102–108CrossRefPubMed
14.
go back to reference Pagenstert GI, Hintermann B, Barg A, Leumann A, Valderrabano V (2007) Realignment surgery as alternative treatment of varus and valgus ankle osteoarthritis. Clin Orthop Relat Res 462:156–168CrossRefPubMed Pagenstert GI, Hintermann B, Barg A, Leumann A, Valderrabano V (2007) Realignment surgery as alternative treatment of varus and valgus ankle osteoarthritis. Clin Orthop Relat Res 462:156–168CrossRefPubMed
15.
go back to reference Pape D, Lorbach O, Schmitz C et al. (2010) Effect of a biplanar osteotomy on primary stability following high tibial osteotomy: a biomechanical cadaver study. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 18(2):204–211CrossRef Pape D, Lorbach O, Schmitz C et al. (2010) Effect of a biplanar osteotomy on primary stability following high tibial osteotomy: a biomechanical cadaver study. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 18(2):204–211CrossRef
16.
go back to reference Schmid T, Zurbriggen S, Zderic I, Gueorguiev B, Weber M, Krause FG (2013) Ankle joint pressure changes in a pes cavovarus model: supramalleolar valgus osteotomy versus lateralizing calcaneal osteotomy. Foot Ankle Int 34(9):1190–1197CrossRefPubMed Schmid T, Zurbriggen S, Zderic I, Gueorguiev B, Weber M, Krause FG (2013) Ankle joint pressure changes in a pes cavovarus model: supramalleolar valgus osteotomy versus lateralizing calcaneal osteotomy. Foot Ankle Int 34(9):1190–1197CrossRefPubMed
17.
go back to reference Spahn G, Muckley T, Kahl E, Hofmann GO (2006) Biomechanical investigation of different internal fixations in medial opening-wedge high tibial osteotomy. Clin Biomech (Bristol Avon) 21(3):272–278CrossRef Spahn G, Muckley T, Kahl E, Hofmann GO (2006) Biomechanical investigation of different internal fixations in medial opening-wedge high tibial osteotomy. Clin Biomech (Bristol Avon) 21(3):272–278CrossRef
18.
go back to reference Stamatis ED, Cooper PS, Myerson MS (2003) Supramalleolar osteotomy for the treatment of distal tibial angular deformities and arthritis of the ankle joint. Foot Ankle Int 24(10):754–764CrossRefPubMed Stamatis ED, Cooper PS, Myerson MS (2003) Supramalleolar osteotomy for the treatment of distal tibial angular deformities and arthritis of the ankle joint. Foot Ankle Int 24(10):754–764CrossRefPubMed
19.
go back to reference Takakura Y, Takaoka T, Tanaka Y, Yajima H, Tamai S (1998) Results of opening-wedge osteotomy for the treatment of a post-traumatic varus deformity of the ankle. J Bone Joint Surg Am 80(2):213–218CrossRefPubMed Takakura Y, Takaoka T, Tanaka Y, Yajima H, Tamai S (1998) Results of opening-wedge osteotomy for the treatment of a post-traumatic varus deformity of the ankle. J Bone Joint Surg Am 80(2):213–218CrossRefPubMed
20.
go back to reference Valderrabano V, Horisberger M, Russell I, Dougall H, Hintermann B (2009) Etiology of ankle osteoarthritis. Clin Orthop Relat Res 467(7):1800–1806CrossRefPubMed Valderrabano V, Horisberger M, Russell I, Dougall H, Hintermann B (2009) Etiology of ankle osteoarthritis. Clin Orthop Relat Res 467(7):1800–1806CrossRefPubMed
Metadata
Title
Stability of supramalleolar osteotomies using different implants in a sawbone model
Authors
Sarah Ettinger
Michael Schwarze
Daiwei Yao
Max Ettinger
Leif Claassen
Christina Stukenborg-Colsman
Hajo Thermann
Christian Plaass
Publication date
01-10-2018
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 10/2018
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-018-2981-2

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