Biomechanical comparison of two different locking plates for open wedge high tibial osteotomy

The purpose of this study was to compare the mechanical stability of a relatively thin locking plate (FlexitSystem implant) with a relatively firm locking plate (TomoFix implant), both used for opening wedge high tibial osteotomy.

Seven fresh frozen paired human cadaveric tibiae were used. The opening wedge high tibial osteotomies in the left tibiae were fixated with the FlexitSystem implant and in the right tibiae with the TomoFix implant. The tibiae were CT-scanned to determine the bone mineral density. Axial loading was applied in a cyclic fashion for 50,000 cycles. We compared throughout the loading history the relative motions between the proximal and distal tibia using roentgen stereophotogrammetry analysis at set intervals. Also the strength of the reconstructions was compared using a displacement-controlled compressive test until failure.

One pair (with the lowest bone mineral density) failed during the preparation of the osteotomy. The FlexitSystem implant displayed a similar stability compared to the TomoFix implant, with low translations (mean 2.16 ± 1.02 mm vs. 4.29 ± 5.66 mm) and rotations (mean 3.17 ± 2.04° vs. 4.30 ± 6.78°), which was not significant different. Although on average the FlexitSystem reconstructions were slightly stronger than the Tomofix reconstructions (mean 4867 ± 944 N vs. 4628 ± 1987 N), no significant (p = 0.71) differences between the two implants were found.

From a biomechanical point of view, the FlexitSystem implant is a suitable alternative to the TomoFix implant for a high tibial open wedge osteotomy.