ORIGINAL RESEARCH article
Front. Bioeng. Biotechnol.
Sec. Biomechanics
Fixation Stability and Stress Redistribution Following Metal Block Use in Opening-Wedge High Tibial Osteotomy: A Finite Element Analysis
Provisionally accepted
- 1Department of Orthopedic Surgery, Inje University Ilsan Paik Hospital, Goyang-si, Republic of Korea
- 2Department of Orthopedic Surgery, Suncheon Joonggng Hospital, Sunchon, Republic of Korea
- 3Skyve R&D LAB, Seoul, Republic of Korea
- 4Department of Mechanical Engineering, Yonsei University, Seodaemun-gu, Republic of Korea
- 5Department of Orthopedic Surgery, Korea University Ansan Hospital, Ansan-si, Republic of Korea
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Introduction Medial opening wedge high tibial osteotomy (OWHTO) is a widely performed procedure for correcting varus malalignment and alleviating medial compartment osteoarthritis. Metal block augmentation has been proposed to enhance construct stability by reducing micromotion and stress at the osteotomy site. However, its biomechanical effects under lateral hinge fractures (LHF) and across different osteotomy techniques (uniplanar vs biplanar osteotomy) remain poorly understood. Methods A finite element model of the proximal tibia was constructed using the computed tomography data of a 62-year-old woman. Simulations were conducted under uniplanar and biplanar osteotomy configurations, with and without a 12 mm metal block augmentation. The LHF was modeled for three Takeuchi fracture types, in addition to the intact condition. Each model was evaluated under axial loading to quantify micromotion, peak stress at the D-hole, mean stress at the lateral hinge, and stress distribution in the locking plate and the proximal tibia. Results Metal block augmentation significantly improved the fixation stability across all OWHTO configurations. In the uniplanar models, the micromotion was reduced by over 90% in both the non-fracture and Type I LHF conditions, whereas the reduction ranged from 84%–91% in the biplanar models. The peak stress around the D-hole decreased by 14%–21% in constructs with a metal block compared to those without. However, the mean plate stress increased
Keywords: Opening wedge high tibial osteotomy (OWHTO), metal block augmentation, Lateral hinge fracture, Biomechanical stability, Finite Element Analysis
Received: 10 Sep 2025; Accepted: 28 Nov 2025.
Copyright: © 2025 Nha, Kim, Song, Kang and Park. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Kyoung Tak Kang
Hyung Jun Park
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