Although total knee replacement became a widespread procedure for the purpose of knee reconstruction, osteotomies around the knee were regularly performed. Total knee arthroplasty should be performed for advanced arthritis of the knee. With the advent of biplanar open wedge high tibial osteotomy (HTO) combined with locking plate fixation, HTO has been expanded and its surgical outcome has been improved in recent years. However, post-operative joint-line obliquity has been raised as a concern with this procedure, which may affect the outcome especially in the knees with severe varus deformity. Hence the purpose of this study is to analyze the compression and shear stresses in the knee cartilage with joint line obliquity after HTO. Using a three-dimensional computer aided design software, the digital knee model with soft tissues was developed. The geometrical bone data used in this study were derived from commercially available human bone digital anatomy media (3972 and 3976, Pacific Research Laboratories, Inc., WA, USA). The three-dimensional knee model was transferred to finite element model. Material properties of the soft tissues and bones were derived from previous studies. The loading condition was adjusted to the load during a single-leg stance of the gait cycle, which resulted in an axial compressive load of 1200 N. Two different conditions were subjected to the analysis: normal alignment and joint-line obliquity after HTO. For the normal alignment, a static force of 1200 N was applied along the mechanical axis. For the joint-line obliquity models, a single force of 1200 N was applied rotating force directions in the frontal plane from the normal direction by 2.5º, 5º, 7.5º, and 10º, respectively.Introduction
Methods
The Mangled Extremity Severity Score (MESS) may be used to decide whether to perform amputation in patients with injuries involving a limb. A score of 7 points or higher indicates the need for amputation. We have treated three patients with a MESS of 7 points or higher, in two of which the injured limb was salvaged. This scoring system was originally devised to assess injuries to the lower limb. However, a MESS of 7 points as a justification for amputation does not appear appropriate when assessing injuries to the major vessels in the upper limb.
