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Background <p>Medial open-wedge high tibial osteotomy (OWHTO) is widely performed to correct varus malalignment associated with medial compartment osteoarthritis of the knee. Despite its popularity, this technique is frequently accompanied by undesirable complications, such as lateral hinge fractures, an increase in posterior tibial slope (PTS), and a reduction in patellar height. As an alternative, the open-wedge distal tuberosity osteotomy (OWDTO) has been introduced to preserve the patellar position. However, limited biomechanical information exists regarding its influence on hinge fracture stability and PTS changes.</p> Purpose <p>The present study aimed to compare the biomechanical consequences of OWHTO and OWDTO under cyclic loading conditions, with a particular emphasis on the incidence of hinge fractures, displacement across the osteotomy site, and alterations in PTS.</p> Methods <p>Forty-eight fresh porcine tibiae were allocated into three groups: OWHTO (<i>n</i> = 16), OWDTO with anterior–posterior (AP) cortical screw fixation (<i>n</i> = 16), and OWDTO with AP locking screw fixation (<i>n</i> = 16). All specimens were stabilized using a medial locking plate and subjected to cyclic loading up to 2000 cycles at 800&#xa0;N. Measurements included anterior and posterior gap variations, displacement along the mechanical axis, and PTS changes. Occurrence of lateral hinge fracture was also recorded. Statistical comparisons were performed using ANOVA with Tukey post hoc testing for continuous outcomes and Fisher’s exact test for categorical data.</p> Results <p>There were no significant group differences in axial displacement or in anterior/posterior gap variation or PTS change. However, OWDTO fixed with AP locking screws demonstrated a significantly higher incidence of lateral hinge fractures compared with OWHTO and OWDTO fixed with cortical screws (<i>p</i> &lt; 0.05).</p> Conclusion <p>This study demonstrates that hinge fracture susceptibility during OWDTO is dependent on the fixation strategy. While overall construct displacement under axial cyclic loading did not differ among groups, OWDTO with locking screw fixation showed a higher incidence of hinge fracture. These findings highlight the importance of fixation choice when performing OWDTO.</p>

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Comparative biomechanical analysis of hinge fracture risk between medial open-wedge high tibial osteotomy and distal tuberosity osteotomy: a porcine tibia study

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  • 发表日期：

    2026年3月6日

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  • Hibiki Kakiage,
  • Yoshiya Nibe,
  • Tsuneari Takahashi,
  • Katsushi Takeshita,
  • Hirotaka Chikuda

摘要

Background

Medial open-wedge high tibial osteotomy (OWHTO) is widely performed to correct varus malalignment associated with medial compartment osteoarthritis of the knee. Despite its popularity, this technique is frequently accompanied by undesirable complications, such as lateral hinge fractures, an increase in posterior tibial slope (PTS), and a reduction in patellar height. As an alternative, the open-wedge distal tuberosity osteotomy (OWDTO) has been introduced to preserve the patellar position. However, limited biomechanical information exists regarding its influence on hinge fracture stability and PTS changes.

Purpose

The present study aimed to compare the biomechanical consequences of OWHTO and OWDTO under cyclic loading conditions, with a particular emphasis on the incidence of hinge fractures, displacement across the osteotomy site, and alterations in PTS.

Methods

Forty-eight fresh porcine tibiae were allocated into three groups: OWHTO (n = 16), OWDTO with anterior–posterior (AP) cortical screw fixation (n = 16), and OWDTO with AP locking screw fixation (n = 16). All specimens were stabilized using a medial locking plate and subjected to cyclic loading up to 2000 cycles at 800 N. Measurements included anterior and posterior gap variations, displacement along the mechanical axis, and PTS changes. Occurrence of lateral hinge fracture was also recorded. Statistical comparisons were performed using ANOVA with Tukey post hoc testing for continuous outcomes and Fisher’s exact test for categorical data.

Results

There were no significant group differences in axial displacement or in anterior/posterior gap variation or PTS change. However, OWDTO fixed with AP locking screws demonstrated a significantly higher incidence of lateral hinge fractures compared with OWHTO and OWDTO fixed with cortical screws (p < 0.05).

Conclusion

This study demonstrates that hinge fracture susceptibility during OWDTO is dependent on the fixation strategy. While overall construct displacement under axial cyclic loading did not differ among groups, OWDTO with locking screw fixation showed a higher incidence of hinge fracture. These findings highlight the importance of fixation choice when performing OWDTO.