Abstract
High tibial osteotomy is a well established joint preserving procedure for the treatment of unicompartmental knee osteoarthritis. Of particular interest are the alterations in knee loading compartments during dynamic activities such as locomotion. Computer modelling can indirectly assess contact and muscle forces in the patient. This study aimed to develop a valid model representative of high tibial osteotomy to assess the medial joint contact force at the knee during gait.
Software for Interactive Musculoskeletal Modelling (version 2, SIMM Inc, USA) was used to develop a model to replicate the effects of high tibial osteotomy surgery on tibial alignment. The program was then used to perform a detailed analysis on gait data collected from two high tibial osteotomy patients preoperatively and 6 months post operatively. Inverse dynamics simulations were conducted to investigate knee joint contact force on the medial compartment of the two patients during the stance phase of their operated limbs.
Significant decreases (p<0.05) in the medial joint contact force were observed during both early and late stance for both patients. Force generated in muscles crossing the knee was found to be the major contributor to the joint contact force. Total muscle force was found to increase significantly (p<0.05) following surgery, however decreased loads were calculated for the medial compartment. The pattern and magnitude of joint reaction force was found to be consistent before and after surgery and replicated the results of previous studies. The HTO-specific model was valid and sensitive to changes in joint reaction force, medial joint contact force and muscle forces crossing the knee.
High tibial osteotomy reduced the medial joint contact force at the knee as a result of the coronal realignment of the limb. Osteoarthritis symptoms were relieved in terms of knee pain and function. Finally, a difference in compensatory strategies was observed between patients. This novel technique allows non-invasive assessment of the mechanical effect of procedures such as HTO. This should allow more accurate planning and assessment of such surgical procedures.
