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Getting a Fix on Tibial Osteotomy

What do you do if you need a new knee joint, but you're too young? Tibial osteotomy may be one option. The tibia is the shinbone in the lower leg. In a tibial osteotomy, a wedge of bone is taken out and the bone realigned. The goal is to change the areas of stress on the joint during weight bearing.

During the healing process the bone must be held in place. There are many ways to do this. Research has not been done to show which method is best. This study compares two commonly used devices: a plate with screws and a blade staple. The plate fits over the freshly cut bone and is screwed in place. The blade staple is pointed on both ends so it can be tapped in place to secure the bone.

Synthetic (manmade) bones were used to test both types of fixation devices. A machine put each bone to the test by stressing it over and over. Compression and tension loads similar to normal walking were applied. The plate and staple were subjected to more than 200,000 cycles of motion. This is equal to the number of walking steps taken by the average patient before healing is complete.

The researchers found the plate fixation lasted past 200,000 cycles. The blade staple did not. Only one of the nine blade staples lasted the full distance.

Holding the healing bone together after an osteotomy is important. The patient needs early knee motion without disturbing the new joint alignment. A secure fix at the osteotomy site will help healing. The authors advise using a plate and screws instead of a blade staple.

References: James M. Hartford, MD, et al. Biomechanical Superiority of Plate Fixation for Proximal Tibial Osteotomy. In Clinical Orthopaedics and Related Research. July 2003. Vol. 412. Pp. 125-130.

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