Personalized alignment correction targets based on osteoarthritis progression achieve sufficient lateral load transfer after open-wedge high tibial osteotomy: A patient-specific finite element analysis.

Authors

Yugo Morita, Shinichi Kuriyama, Yusuke Yamawaki, Sayako Sakai, Kohei Nishitani, Shinichiro Nakamura, Shuichi Matsuda

Published in

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association. Oct 09, 2026. Epub Oct 09, 2026.

Abstract

Open-wedge high tibial osteotomy (OWHTO) shifts medial loading laterally, but postoperative redistribution varies. Patient-specific finite element analysis (FEA) quantified load redistribution and associated factors.
Forty knees in 34 patients with medial compartment osteoarthritis were analyzed (Kellgren-Lawrence [KL] grades ≤2, 18; 3, 16; 4, 6). Surgical planning uniformly targeted a percentage mechanical axis (%MA) of 60.0%-62.5%. Patient-specific FEA models incorporating knee-specific geometry, alignment, joint morphology, and computed tomography (CT)-density-based bone properties were constructed from preoperative and 1-year post-implant-removal CT for pre- and postoperative standing simulations, respectively. Postoperative CT (1-2 weeks) measured opening width. FEA yielded contact forces and lateral-to-total ratios. Associations with postoperative %MA, opening width, and Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales were examined. Receiver operating characteristic (ROC) and KL-stratified regression analyses explored reference values for lateral-to-total ratio ≥50% (equal compartmental force sharing).
Radiographic %MA increased from 17.2% to 57.9%. FEA-derived medial contact force decreased from 415.4 to 320.9 N, lateral contact force increased from 157.1 to 268.6 N, and lateral-to-total ratio increased from 27.9% to 45.8% (all P < 0.001), without increasing peak lateral stress. Postoperative %MA correlated with lateral transfer; larger opening width, reflecting required correction rather than a causal effect, was associated with reduced transfer. Lateral contact force correlated with KOOS Symptoms and Activities of Daily Living. ROC analysis identified a postoperative %MA of 59.4% and an opening width of 9.5 mm as exploratory reference values. Estimated %MA for ratio ≥50% was 60.5%, 63.0%, and 68.8% for KL grades ≤2, 3, and 4, respectively.
OWHTO shifted tibiofemoral loading laterally without increasing peak lateral stress. A higher postoperative %MA was associated with greater lateral transfer. Opening width should be considered a marker of required correction rather than a causal determinant; alignment targets may warrant individualized consideration in advanced osteoarthritis.

PMID:
42850104
Bibliographic data and abstract were imported from PubMed on 09 Oct 2026.

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